helen bevan chief transformation...

@HelenBevan NFKH

Helen Bevan

Chief Transformation Officer @HelenBevan

@HelenBevan NFKH

Everyone has gifts and strengths What superpower do you have?

@helenbevan @HelenBevan

Peter Fuda’s Transformational Change Agent framework

Skills and methods for creating change

Ability to make sense of, and reshape perceptions of ‘reality’

Personal characteristics and qualities

Peter Fuda’s Transformational Change Agent framework: my perspective

“Doing” • Where most change agents

in health and care put most of their effort and emphasis

• What others typically judge us on

• What we often perceive we need to do to add value

• What most change and improvement courses focus on

Peter Fuda’s Transformational Change Agent framework: my perspective

“Seeing ” and “Being” • We can only do effective

“doing” if we build on strong foundations of “seeing and being”

• Change begins with me • Hopeful futures, creative

opportunities and potential • Multiple lenses for change • See myself in the context of

my higher purpose

@helenbevan #NHSChangeDay #SHCRchat Source : Lois Kelly www.rebelsatwork.com

You can’t be a rebel on your own

@helenbevan @HelenBevan Source of image: outskirtsbattledome.wikispaces.com

The easiest way to thrive as an outlier

...is to avoid being one

Seth Goodin

Leading change in a new era

Dominant approach Emerging direction

Power in community “Power used to come largely through and from big institutions.

Today power can and does come from connected individuals in community.

When community invests in an idea, it co-owns its success.

Source of image: orton.org

Instead of trying to achieve scale all by ourselves, we have a new way to have scale. Scale can be in, with and through community.”

Nilofer Merchant

@helenbevan

“When we talk of social change, we talk of movements, a word that suggest vast

groups of people walking together, leaving behind one way and travelling towards

another”

Rebecca Solnit

Learning from social movement leaders

http://www.slideshare.net/NHSIQ/the-power-of-one-the-power-of-many?qid=97bb3464-07c2-4883-9531-c3d436a66aa1&v=qf1&b=&from_search=2

Six characteristics of people or groups within effective social movements

1. They share a sense of PURPOSE: There is purposefulness about

collaborations, discussions, actions, decisions and a sense of forward momentum

2. They are UNITED: They have learned to manage their differences well enough

that they can unite to accomplish their purpose. Differences are openly debated, discussed, and resolved.

3. They share UNDERSTANDING: There is a widely shared understanding of what's going on, what the challenges are and why what is being done has to be done

4. People PARTICIPATE: Lots of people and organisations in the system are active - not just in discussions and meetings, but getting the work done.

5. They take INITIATIVE: Rather than reacting to whatever happens in their

environment, they are proactive, and act upon their environment.

6. They ACT: People do the work they must do to

make the things happen that need to happen

Source: adapted from Wellstone Action

Calls to Action

Leadership is….

…the art of mobilising others to want to struggle for shared

aspirations Jim Kouzes

Source of image: environmentvictoria.org.au

Framing … is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action.

Snow D A and Benford R D (1992)

What’s the financial incentive?

Who is performance managing?

What’s the project plan?

Source: @RobertVarnam

The reality “What the leader cares about (and typically bases at

least 80% of his or her message to others on) does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into the change

programme” Scott Keller and Carolyn Aiken (2009)

The Inconvenient Truth about Change Management

Source of image: swedenbourg-openlearning.org.uk

Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........

Sensemaking is not done via marketing...or slogans but by emotional connection with employees

Ron Weil

1. People speak intellectually but engage emotionally

2. Facts are hard to remember and easy to challenge

3. If we only talk about our success people won’t believe us

4. People don’t want more communication; they want meaningful communication

Source: Peter Fuda http://www.peterfuda.com/2014/10/30/traditional-comms-fail-engage/

Four gaps between how we

communicate change

how people engage with that communication

@helenbevan #IQTGOLD @HelenBevan

“I have some Key

Performance

Indicators

for you”

“I have a

dream”

Source: @RobertVarnam

@helenbevan

If we want people to take action, we have to connect with their emotions through values

action

values

emotion

Source: Marshall Ganz

But not all emotions are equal.........

inertia urgency

anger apathy

solidarity isolation

you can make a difference

Self-doubt

hope fear

Action motivators Action inhibitors

@helenbevan #SHCR @School4Radicals

‘‘Leaders must wake people out of inertia. They must get people excited about something they’ve never seen before, something that does not yet

exist”

Rosa Beth Moss Kanter

Source of image: www.linkedin.com/company/activate-brand-agency

Effective framing: what do we need to do?

1. Tell a story

Source of image: woccdoc.org

http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-crafting-visual-stories-with-data?sf3881865=1

1. Tell a story

2. Make it personal

1. Tell a story

2. Make it personal

3. Be authentic

1. Tell a story

2. Make it personal

3. Be authentic

4. Create a sense of “us” (and be clear who the “us” is)

1. Tell a story

2. Make it personal

3. Be authentic

4. Create a sense of “us” (and be clear who the “us” is)

5. Build in a call for urgent action

Vivid details

Talk to the person next to you

• Tell your story about why the change you are involved in now is so important to you

• Relate it to a personal experience

You have:

• 2 minutes to prepare your story

• 3 minutes each to tell your story

What is a

Randomized Coffee Trial!

Outcomes of randomised coffee trials

How do we create a sense of “us” to build momentum for

change?

Source of image: www.tannerfriedman.com

Moving beyond us and them to us and us

Source of image: www.delta7.com

@helenbevan

The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro

1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy

2. If you want to create small scale change, work through a cohesive network

If you want to create big change, create

bridge networks between disconnected groups

strong ties (cohesive) v.

weak ties (disconnected)

Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml

@helenbevan

When we spread change through strong ties:

• we interact with “people like us”, with the same life experiences, beliefs and values

• Change is “peer to peer”; GP to GP, social worker to social worker, nurse to nurse, community leader to community leader

• Influence is spread through people who are strongly connected to each other, like and trust each other

@helenbevan

When we spread change through strong ties:

• we interact with “people like us”, with the same life experiences, beliefs and values

• Change is “peer to peer”; GP to GP, social worker to social worker, nurse to nurse, community leader to community leader

• Influence is spread through people who are strongly connected to each other, like and trust each other

IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied

@helenbevan

The pros and cons of strong ties

Pros Cons

When we seek to spread change through weak ties • we build bridges between groups and individuals who were previously different and separate

• we create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action

• We can mobilise all the resources in our organisation, system or community to help achieve our goals

Why we need to build weak ties AS WELL AS strong ties

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

More on weak ties: https://www.youtube.com/watch?v=w7AzRVxhEXA#t=45

• In situations of uncertainty, we have a tendency to revert to our strong tie relationships

yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity

• In situations of uncertainty, we have a tendency to revert to our strong tie relationships

yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity

• The most breakthrough innovations and most radical change will come when we tap into our weak ties

Sources of weak ties

Three components of a great narrative

• Diagnostic – what is the problem that we are addressing? What is the extent of the problem? What is the specific source or sources?

• Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan?

• Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of our audience?

Source: Benford and Snow Source of image: www.ecommercedefense.com

Four keys to collaboration

• Lean into your discomfort

• Listen as an ally

• State your intent

• Share your “street corner” Source: Judith Katz and Fred Miller

Four keys to collaboration

• Lean into your discomfort

• Listen as an ally

• State your intent

• Share your “street corner” Source: Judith Katz and Fred Miller

@helenbevan @HelenBevan 57

http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite

Source of image: http://switchandshift.com/transactional-or-transformational-which-leadership-style-is-best

“You don’t need an engine when you have

wind in your sails”

Questions for reflection

1. What learning and inspiration can you take from social movement leaders to help you in your role as an agent of change in health and care?

2. How will you attract the attention of the people you want to call to action?

3. Who are the people who are currently disconnected that you want to unite in order to achieve your goal for change? How can you build a sense of “us” with them?

What happens to large scale change efforts in reality?

In order of frequency:

1. the effort effectively “runs out of energy” and simply fades away

2. the change hits a plateau at some level and no longer attracts new supporters

3. the change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way

Source: Leading Large Scale Change:

a practical guide (2011), NHS Institute

Research shows that more than almost any other factor affecting an

organisation, organisational energy can lead to either a wellspring of corporate

vitality or the destruction of its very core

Source: Bruch and Vogel

Bruch and Vogel research

Organisations with HIGH productive energy scored higher on:

• overall performance - 14% higher

• productivity – 17%

• efficiency – 14%

• customer satisfaction – 6%

• customer loyalty – 12%

the capacity and drive of a team, organisation or system to act and make the

difference necessary to

achieve its goals

Psychological

Physical

Spiritual

Social Intellectual

Energy for change is:

Five energies for change Energy Definition

Social energy of personal engagement, relationships and connections between people. It’s where people feel a sense of “us and us” rather than “us and them”

Spiritual energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It gives people the confidence to move towards a different future that is more compelling than the status quo

Psychological energy of courage, resilience and feeling safe to do things differently. It involves feeling supported to make a change and trust in leadership and direction

Physical energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen

Intellectual energy of analysis, planning and thinking. It involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/ evidence

High and low ends of each energy domain

Low High

Social isolated solidarity

Spiritual uncommitted higher purpose

Psychological risky safe

Physical fatigue vitality

Intellectual Illogical reason

Some questions

• Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)

• Nearer to CEO, higher or lower energy scores?

@helenbevan

• Are particular energy domains more dominant than others for our team at the moment?

• Is this the optimal energy profile to help us achieve our improvement goals?

Energy for change profile

5 Social

Spiritual

Psychological Physical

Intellectual

5 Social

Spiritual

Intellectual

Team 1: what’s your assessment of

their energy for change?

5 Social

Spiritual

Intellectual

Team 2: what’s your assessment of

their energy for change?

Ten key principles of large scale change 1. Movement towards a new vision that is better and fundamentally

different from the status quo

2. Identification and communication of key themes that people can relate to and that will make a big difference

3. Multiples of things (‘lots of lots’)

4. Framing the issues in ways that engage and mobilise the imagination, energy and will of a large number of diverse stakeholders in order to create a shift in the balance of power and distribute the leadership

5. Mutually reinforcing change across multiple processes/subsystems

http://www.slideshare.net/NHSIQ/leading-large-scale-change-part-1

6. Continually refreshing the story and attracting new, active supporters

7. Emergent planning and design, based on monitoring progress and adapting as you go

8. Many people contribute to the leadership of change, beyond organisational boundaries

9. Transforming mindsets, leading to inherently sustainable change

10. Maintaining and refreshing the leaders’

energy over the long haul

Ten key principles of large scale change

http://www.slideshare.net/NHSIQ/leading-large-scale-change-part-1

There has never been a time in the history of healthcare when this advice has been

more pertinent

“Leadership is not about making clever decisions and doing bigger deals. It is

about helping release the positive energy that exists naturally within people”

Henry Mintzberg

Employee resistance is the most common reason executives cite for the

failure of big organizational-change

efforts Scott Keller and Colin Price

(2011), Beyond Performance: How Great Organizations Build Ultimate

Competitive Advantage Source of image: Businessconjunctions.com

“ Thousands of patients have died needlessly because of a

damaging reluctance amongst doctors and the

public to accept changes in the NHS, according to the country’s top emergency

doctor

Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........

Sensemaking is not done via marketing...or slogans but by emotional connection with employees

Ron Weil

@helenbevan

Resistant behaviour is a good indicator of missing relevance

Harald Schirmer http://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-role-of-hr-driving-social-adoption-and-change-in-the-enterprise

Source of image: driverlayer.com

‘ ‘

@helenbevan

Cultural change is a million

subversive acts of resistance

Brene Brown

Source of image: zazzle.com

‘ ‘

“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

• smoking cessation

• exercise adoption

• alcohol and drug use

• weight control

• fruit and vegetable intake

• domestic violence

• HIV prevention

• use of sunscreens to prevent skin cancer

• medication compliance

• mammography screening

The model is mostly used around health-related behaviours

• smoking cessation

• exercise adoption

• alcohol and drug use

• weight control

• fruit and vegetable intake

• domestic violence

• HIV prevention

• use of sunscreens to prevent skin cancer

• medication compliance

• mammography screening

It works for organisational and service change too!

The model is mostly used around health-related behaviours

“Stages of change” Smoking

I am not aware my smoking is a

problem – I have no intention to quit

I know my smoking is a problem – I

want to stop but no plans yet

I am making plans & changing things

I do in preparation.

I have stopped smoking!

I am continuing to not smoke.

I sometimes miss it – but I am still not

smoking

I am continuing to not smoke.

I sometimes miss it – but I am still not

smoking

“Stages of change” Transtheoretical model of behaviour change

• Which stage do most change activities in health and care focus on?

• Which stage are most people actually at?

Some questions

The reality of our change situation

• Our tools are often not effective at the stage of change that most people we work with are at

• It’s hard to engage people in change

• It’s hard to get people to make the changes we want them to make

• People get irritated, defensive, irrational

• We feel powerless in our ability to lead or facilitate the change

90% of the tools available for health and care change agents are designed for the “action” stage

@helenbevan

• Designed for Stage 4 – ACTION!

• Mandated it through targets

• Despite compelling case for change – people resisted it – no values connection

• People did the task and missed the point

Example – WHO Surgical Safety Checklist

IN A NUTSHELL

• Evidence from observational studies that the use of surgical safety checklists results in striking improvements in outcomes

• Led to rapid adoption of such checklists worldwide

• Researchers studied effect of mandatory adoption of checklists in Ontario, Canada

• Use of checklists not associated with significant reductions in operative mortality or complications

• Lower our ambitions for improvement • Focus our energies on those who are

already in the “action” stage • Put negative labels on those who are

not yet at the action stage such as “blocker” or “resister” or “laggard”

• Blame “the management” for not enforcing change

So what do we TEND to do when people resist?

The single biggest problem in communication is the illusion that it has taken

George Bernard Shaw

‘ ‘

• Listen and understand • appreciate the starting point

• elaborate interests

• Roll with resistance (Singh)

• Don’t argue against it • Encourage elaboration of resistance

• What makes it so hard? • What would help?

• Build meaning and conviction in the change

So what SHOULD we do?

• The focus should be on creating awareness for me of the need to change

• Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation

• I am not thinking about changing my behaviours, actions or work processes

• The problem or issue is outside my frame of awareness or my perceived need

Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model:

• What stage of change are some of the key people that you need to influence for your change initiative at?

• What actions can you take to help them move to the next stage?

Thinking about your own situation

If your horse dies, get off it

Cherokee proverb

Source of image: fenwickgallery.co.uk

‘ ‘

@helenbevan @HelenBevan Source: Helen Bevan

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

Leaders who focus on meaning also

get compliance, without focusing on it

@JeremyScrivens

We know that ...

• Shared purpose is a common thread in successful change programmes*

• Organisations and change initiatives with strong shared purpose consistently outperform those without it.**

*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)

**Management Agenda 2013 Boury et al (Roffey Park Institute)

@helenbevan #NHSChangeDay #SHCRchat

A 3-word concept

[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

The power of shared purpose:

Perhaps the single most important influence on program response by individual units—either in promoting or resisting change—was the extent of consensus and

coalition among the senior medical and nursing staff on individual Intensive Care Units….

[Consultant says] ‘I think it’s been successful because it’s a unifying program, it’s one of the few things that we’ve done that hasn’t been just a doctor thing, or just a nurse thing, it’s involved the doctors and the nurses together.’

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/

As leaders, we are “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

Source of image: vintage-radio.com

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

@helenbevan @HelenBevan @SimonJGuilfoyle Police Inspector and systems thinker

Police

@SimonJGuilfoyle Police Inspector and systems thinker

Education

Healthcare

....the last era of management was about how much performance we could extract from people

.....the next is all about how much humanity we can inspire

Dov Seidman

helen bevan chief transformation...

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