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Lessons from large scale change:

research and practice Helen Bevan

Delivery team NHS Improving Quality @helenbevan @NHSIQ

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Some of the themes I’m hearing today

• Moving beyond “best practice” • AHSN as source of energy, aspiration, ambition

• From hierarchy to network • AHSNs as super-connector

• From “play safe” to risk taking • AHSN as catalyst for innovation

• From incremental to transformational • AHSN as accelerator of large scale change

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Christine’s questions

We have years of experience in “spreading good practice” in the NHS but much of it hasn’t worked • How is it going to be

different this time? • What are AHSNs going to

do to make it different? Christine Camacho

Greater Manchester AHSN

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In line with direction of thinking about large scale change

From

industrial era (doing) to

social era (connecting)

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Emerging themes in large scale change Current 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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What are the implications for the way we organise?

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“If people give to a cause, they expect a relationship, not a transaction”

Nilofer Merchant

“You can’t impose anything on anyone and expect them

to be committed to it” Edgar Schein, Professor Emeritus

MIT Sloan School

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Compliance

States a minimum performance standard that everyone must achieve

Uses hierarchy, systems and standard procedures for co-ordination and control

Threat of penalties/ sanctions/ shame creates momentum for delivery

What is our approach to change? Commitment

States a collective goal that everyone can aspire to

Based on shared goals, values and sense of purpose for co-ordination and control

Commitment to a common purpose creates energy for delivery

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A 3-word concept

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[Shared] purpose goes way deeper than vision and mission; it goes right into your gut

and taps some part of your primal self. I believe that if you can bring people with similar primal-purposes together and get them all marching in the same direction,

amazing things can be achieved. Seth Carguilo

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Leaders as “signal generators”

“As a leader, think of yourself as a “signal generator” whose words and actions are constantly being scrutinised and interpreted, especially by those below you [in the hierarchy]”

“Signal generators reduce uncertainty and ambiguity

about what is important and how to act” Charles O’Reilly, Leaders in Difficult Times, 2009

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Avoiding “de facto” purpose • What leaders pay attention to matters to staff, and consequently

staff pay attention to that too • Shared purpose can easily be displaced by a “de facto” purpose: hitting a target reducing costs reducing length of stay eliminating waste completing activities within a timescale complying with an inspection regime

• If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce

Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector

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Being a great change agent is about knowing, doing, living and being improvement

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The new economy is a passion economy, where the function of organisations is no longer to

direct work, but to focus purpose Greg Satell

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Conversation

What do we need to do to be the role models for what we espouse? What one commitment/pledge do I make leaving today?