Leading change into the future

@helenbevan #2017congress
Leading change into the future
Themes and trends in the wider world of
change and implications for healthcare leaders

The Horizons team:
Change agents and change agency
• A small, diverse team of people within
the English National Health Service
• We tune into the latest change thinking
and practice in healthcare and other
industries around the world –
translating this learning into practical
approaches to change
• The team has emerged through years of supporting
change in the NHS and the wider health and care system

3
The greatest
danger today is NOT
micro-managing:
it is MACRO-LEADING
Henry Mintzberg

Change is changing

Kinthi Sturtevant, IBM
13th annual Change Management
Conference
We rarely see two, three or
four year change projects
any more. Now it’s 30-60-90
day change projects

We still organise health and care like the
Tabulating Machine Co. of 1917
Source of image: @corp_rebels

Source: Innovisor

Three time points of collaboration among
cancer clinicians and researchers
from Braithwaite and colleagues 2017

Power is shifting
Power is one’s
ability to achieve
goals
Bertrand Russell

Jeremy Heimens, Henry Timms
This is New Power
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship

To make change happen,
connect with the 3%
Just 3% of people in
the organisation or
system typically
drive conversations
with 90% of the
other people
Source: research by Innovisor

WHO will make the change happen?
List A
• The Delivery Board
• The programme sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Clinical Leads
• The Directors of
participating organisations
• The Change Facilitators
Source: adapted by Helen Bevan
from Leandro Herrera

List A
• The Programme
Management Office
streams
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who spread
behaviours, role model at a scale,
set mountains on fire and multiply
anything they get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
onesSource: adapted by Helen Bevan

List A
• The Programme
Management Office
streams
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who spread
behaviours, role model at a scale,
set mountains on fire and multiply
anything they get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
ones
Source: adapted by Helen Bevan

What’s the evidence?
The failure of large scale
transformational change projects is
rarely due to the content or
structure of the plans that are put
into action
To make transformational change
happen we need to connect networks
of people who ‘want’ to contribute
http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-
257163-Campaign+-+01%2F09%2F2016
Source: David Dinwoodie (2015)
It’s much more about the role
of informal networks in the
organisations and systems
affected by change

Mark Jaben on the science behind resistance
What NOT to do
But what we do do
Engage
people here

Mark Jaben on the science behind resistance to change
What NOT to do
(but what we usually do)
We don’t need buyers (who “buy-in” to change)
We need investors
What TO do
Engage
people here
Engage
people here

The design dilemma at the heart of change
The predominant approach in recent years has been STRUCTURE
but globally there is a big shift towards AGENCY

Source: @NHSChangeDay

Source: @NHSChangeDay
Problematic:
changing a
“permission
culture” can
take years
The good news:
we can usually
build agency
much more
quickly

Individual AND collective agency
Individual agency:
People get more power
and control in their own
lives: patient activation,
shared decision-making
and self-care
Collective agency:
People act together,
united by a common
cause, harnessing the
power and influence of
the group and building
mutual trust

Building agency for large scale change
We do not become transformed alone, we
become transformed when we’re in relationship
with others
Hahrie Han
Source of image: Idahoc Community Action

http://biggerboat.org/exploring-moodocs/
MOODOCs
(Massive, Online, Open, Disease Oriented Communities)

Big drive to bring social movement thinking
and practice into delivery

New Public
Passion:
a growing
global
movement

The era of the PLATFORM
Platforms today power learning and innovation
at the speed of change by providing
collaborative and sometimes exponentially
productive spaces for people to create value
John Hagel
Source of image: Pinipa

Platform-based, collaborative innovation
methods are outpacing traditional R&D
Source: PWC Innovation benchmarking survey 2017

• systematic “change
management”
• too often, leaders
prescribe outcome
and method of change
in a top-down way
• change is experienced
by people at the front
line as “have to”
(imposed) rather than
“want to” (embraced)
Change
Programmes
• everyone (including
service users and families)
can help tackle the most
challenging issues
• value diversity of thought
• connect people, ideas and
learning
• Role of formal leaders is to
create the conditions and
get out of the way
Change
Platforms
“Tear down the walls”

The Change Challenge
Tapping the collective brilliance
of the NHS

14,000 contributions identified
10 barriers to change:
Confusing strategies
Over controlling
leadership
Perverse incentivesStifling innovation
Poor workforce
planning
One way
communication
Inhibiting
environment
Undervaluing staff
Poor project
management
Playing it safe

A global survey by Gallup into the reasons why
change initiatives fail, identified the same issue
Increasing number of messages
as information cascade through
the organisation
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-fail-
don.aspx

14,000 contributions identified
11 building blocks for change:
Inspiring & supportive
leadership
Collaborative working
Thought diversityAutonomy & trust
Smart use of resources
Flexibility &
adaptability
Long term thinking
Nurturing our people
Fostering an open
culture
A call to action
Source: Health Service Journal, Nursing Times, NHS Improving
Quality, “Change Challenge” March 2015
Challenging the
status quo

After years of intensive analysis,
Google discovered that the key to high
performing teams that deliver change is
being nice
Project Aristotle:
https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-
xoaZybvz9f0b1_6bJyG7zZO6L

... 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
A changing world

1. Frame issues in ways that will engage and mobilise the
imagination, energy and will of a large number of diverse
stakeholders
2. Take steps to be social leaders, investing in digital skills and
social connections and leading through networks as well as
formal leadership systems
3. Align structure and agency
4. Find your B-listers and give them important tasks
5. Make space for collective sensemaking: build change
platforms for important issues
6. Harness the power of advanced analytics
7. Adopt emergent approaches to planning and design, based
on monitoring progress, learning and adapting as you go
Ideas for

Leading change into the future

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