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What’s happening?Discussions with AquA

20th August 2013

Helen BevanDelivery teamNHS Improving Quality@helenbevan@NHSIQ

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“There’s no denying it—we’re knee-deep in an era of radical change that may well transform

the way our world works”Gina Amaro Rudan

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You can’t cross a chasm

in two small stepsDavid Lloyd George

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The aim of the NHS Horizons team is to bring the future forward to the by making some “great leaps” rather than small

incremental steps:• Skipping a generation of thinking about how to create large scale improvement

in healthcare • Connecting with the clinicians in training and young leaders (“the Net

Generation”) that will take responsibility for delivering transformational change in the NHS over the next three decades and helping them to be powerful agents for change

• Creating and spreading knowledge, skills and ideas using Net Generation principles: • “connecting” rather than “doing” improvement• building massive networks of engagement through social media• utilising informal as well as formal networks on a large scale, • building a vibrant grassroots movement that delivers change across the whole

system • Acting as the “futures department” for NHS Improving Quality• Curating knowledge about transformational change to create more relevance

and effectiveness• Being a source of inspiration, ideas and hope that helps people to move more

confidently towards a different future

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The Horizons team is identifying, creating and spreading actionable knowledge for large scale

change

Knowledge that is “actionable” is that which creates specific value for an organisation

because it can be implemented in ways that lead to tangible improvements for patients and the

public (Pearson 2004)

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Discussion question: emerging trends in large scale change

When you think about our ideas for large scale change, spread, scale and roll out, what’s different now compared to five years ago?

What are some of the emerging directions?

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Fromindustrial era (doing)

to social era (connecting)

Direction of thinking about large scale change

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Emerging themes in large scale changeCurrent focus Emerging direction

Organisation Community

Power through hierarchy Power through connection

Mission and vision Shared purpose

Making sense through rational argument

Making sense through emotional connection

Leadership-driven (top down) innovation

Viral (grass-roots driven) creativity

Engaged patients Passionate users

Clinical networks Mass communities

Tried and tested, based on experience

“Net Generation” principles

Transactions Relationships

John Kotter: “Accelerate!”• Many change agents, not just the usual few • A “want-to” - not just a “have-to” - mind-set• The spirit of volunteerism - the desire to work with others for a

shared purpose – creates the energy to power the network• Head and heart, not just head• People won’t want to do a day job in the hierarchy and a night

job in the network if we appeal only to logic with numbers, contracts and business cases

• Much more leadership, not just more management• The network AND the organisation

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The Network Secrets of Great Change Agents

Place in the network

• Change agents who are central in the informal network are significantly more likely to deliver change, regardless of their position in the formal hierarchy

bridge networks

versus cohesive networks

• Change agents who bridge disconnected groups and individuals are more effective at enabling large scale change

• Change agents with cohesive networks are better at delivering minor incremental changes

Links with resisters

• Being close to “fence-sitters,” who are ambivalent about a change, is always beneficial

• Close relationships with resisters are a double edged sword: such ties help push through minor initiatives but hinder major change attempts.

Julie Battilana and Tiziana Casciaro

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Implications for improvement leaders

From “doing”

improvement to “connecting”

for improvement at

scale

Rethinking: • who’s in the improvement

community• How we lead change• Metrics of success

New roles• Curators

• Relationship leaders• Storytellers • Co-creators

New mechanisms

for connecting:• Social media• Web seminars• Tweet chats

New methods for

enabling integration• open innovation• hacks/hackathons• crowdsourcing• Ideas channels

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Organisations with transformational goals are increasingly using “hackathon” type processes

Example: Hacking HR to Build an Adaptability Advantage Chartered Institute for Personnel and Development

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