The slides that Helen Bevan presented at the SaID away day on 10th April 2018

1. Spread and scale –
the role of change agents
Source of image: @voinonen
:
SaID away day 7th April 2018

2. To explore the role of people as change
agents and what this means for our
directorate in terms of the design and
impact on our programmes.

3. 3
1 none or very limited
2 limited
3 some
4 quite a lot
5 a lot
How much experience and skill
do you have in leading change?

4. 4
1 none or very limited
2 limited
3 some
4 quite a lot
5 a lot
How much POWER do you have
to make change happen?

5. Some definitions
Diffusion: "the process in which an innovation is
communicated through certain channels over time
among the members of a social system”
Rogers 1962
Spread: “deliberate efforts to increase the impact of
innovations successfully tested in pilot or experimental
projects so as to benefit more people and to foster policy
and program development on a lasting basis”
Norton and colleagues 2012
Going to scale (or scale up): “at least 60% of the target
population that could potentially benefit from the
programme receives it”
Rabin and colleagues (2012)

6. Change AGENCY definition:
The power, individually and collectively, to make
a positive difference. It is about pushing the
boundaries of what is possible, mobilising
others and making change happen more quickly
Change AGENT definition:
Someone who is actively developing the skills,
confidence, power, relationships and courage to
make a positive difference

8. Jeremy Heimens, Henry Timms New Power: How it’s changing the 21st Century and why you
need to know (2018)
new power
Current
Made by many
Pulled in
Shared
Open
Relationship
old power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
From module one

9. Find the 3%!
Just 3% of people in the
organisation or system typically
influence 85% of the other people
Source: Organisational Network Analysis by Innovisor

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

11. The 3% rule also appears true for
social media
Source: research by Graham MacKenzie using NodeXL
In health and
healthcare globally,
tweets by 3.3% of
tweeters accounted
for 85% of retweets

12. The powerful medical “superconnectors”
Source: NodeXL analysis:

13. The skills for 2030
Nesta, Pearson and the Martin Oxford School: The future of skills: employment in 2030
Judgment and decision
making: Considering the
relative costs and benefits of
potential actions to choose
the most appropriate one.
Active learning: Learning
strategies—selecting and
using training/instructional
methods and procedures
appropriate for the situation
when learning or teaching
new things.
Originality: The ability
to come up with unusual
or clever ideas about a
given topic or situation, or
to develop creative ways
to solve a problem
Learning strategies:
Understanding the
implications of new
information for both current
and future problem-solving
and decision-making.
Graphics by @scriberian
Fluency of ideas: The
ability to come up with a
number of ideas about a
topic (the number of ideas
is important, not their
quality, correctness, or
creativity).

14. Horizontal development:
• Adding more knowledge, skills, and
competencies
• It’s about what I know
• Transmitted through experts
Vertical development:
• Ability to think in more complex, systemic,
strategic and interdependent ways
• It’s about how I think
• Learnt through experience
In an exponentially changing world, we
need to focus on vertical development
for change agents as well as horizontal

15. Stages of vertical development for
change agents
Levelof
development
Time
 I’m a team player
 I follow others
 I rely on “old
power” authority
 I align with others
 I stick to methods
&/or project
management
approaches
Dependent
Conformer
Source: adapted from Center for Creative Leadership

16. Stages of vertical development for
change agents
Levelof
development
Time
 I’m a team player
 I follow others
 I rely on “old
power” authority
 I align with others
 I stick to methods
&/or project
management
approaches
 I think in an
independent
way
 I’m self-directed
 I’m guided by my
own values
 I take a stand for
the things I
believe in
 I spark & initiate
change
Dependent
Conformer
Independent
Achiever
Source: adapted from Center for Creative Leadership

17. Stages of vertical development for
change agents
Levelof
development
Time
 I’m a team player
 I follow others
 I rely on “old
power” authority
 I align with others
 I stick to methods
&/or project
management
approaches
 I think in an
independent
way
 I’m self-directed
 I’m guided by my
own values
 I take a stand for
the things I
believe in
 I spark & initiate
change
 I think in inter
dependent ways
 I see systems,
patterns &
connections
 I think for the long
term
 I can hold multiple
perspectives at the
same time
 I’m comfortable with
tensions, paradox
and contradictions
 I lead transformation
Dependent
Conformer
Independent
Achiever
Interdependent
Collaborator
Source: adapted from Center for Creative Leadership

18. Sources: Being First team (2017) Going for the Big Win in Your Organization
Amit S. Mukherjee (2017) We Must Rescue ‘Win-Win’ From Its Buzzword Status
Interdependence
YOU WINI WIN

20. Nicolas Petrie

21. 3 ways to trigger vertical development
• Exposure to new ways of thinking
• Intense stretch experiences
• Strong developmental networks
Further reading: Nicholas Petrie (2015) The how-to of vertical leadership development

22. The jury is out for the “pilot and roll-out” model
for spread of change
Pilot project Rolling out
“If we opened our eyes we would see the wonderful irony. Trying
to manage human change through pilot and roll-out has actually
grown something. A proliferation of project managers”.
John Atkinson

23. Because the reality is often different

24. Over the past 20 years there have been more than 500
NHS-wide pioneer/pathfinder/pilot/demonstration sites

25. Beware the chasm!
Source of image: @voinonen

26. Beware the chasm!
Source of image: @voinonen

27. The literature and practitioner experiences are
pointing in the same direction
Transformational change in health and care: Four stories of
bravery, four conundrums (not yet published) The Kings Fund
New Power: how it's changing the 21st century - and why you
need to know (April 2018) Heiman J and Timms H
Overcoming Challenges In Codifying And Replicating Complex
Health Care Interventions (February 2018) Horton T,
Illingworth J, Warburton W
Against the odds: Successfully scaling innovation in the NHS
(January 2018) Innovation Unit and Health Foundation
Adoption and spread of innovation in the NHS (January 2018)
King’s Fund
Falling short: Why the NHS is still struggling to make the most
of new innovations (December 2017) Nuffield Trust
Leading large scale change: a practical guide (September
2017) NHS Horizons team and Sustainable Improvement team

28. Emerging themes in successful spread
efforts
• Increasing attention to the demand side, to
better understand the adopter’s point of view
• Coalition building and focus on power (social
movements, virtual connectivity, social media)
• Connectors and super-connectors
• Increasing attention to system conditions
• Roles: innovators, adopters and choreographers
• The importance of co-design and co-production
for subsequent scaling

29. Three key roles (all are change agents)
Innovators
Adopters

30. Three key roles
Innovators
Adopters
Choreographers

31. System leader as choreographer for
enabling the spread of change
”:
“An analogy can be made to the role a
choreographer takes in a dance company. Their job
is to produce a finished work that integrates many
different performance elements; music, dance, and
storytelling. This must be done by making trade offs
and finding synergies within the available resources
of the [organisation or system], and all the while
driving toward an ultimate vision.”
McClure and Gray (2015)

32. 3 design principles for change agents to
spread change
ACTIONABLE: The idea is designed to make you
do something. It might start with sharing but it’s a
call to action
CONNECTED: The idea promotes a closer
connection with people you care about or share
values with. It makes you feel part of a community
and the network effect creates further spread
EXTENSIBLE: The idea can be easily customised,
remixed, reshaped by people taking part. It’s
structured with a common stem that encourages
communities to alter and extend it
Jeremy Heimens, Henry Timms New Power: How it’s changing the 21st
Century and why you need to know (2018)

33. 70 day challenge:
to give patients
back one million
days of their
precious time that
would otherwise
be wasted in bed
in a hospital or
care home.

36. #endpjparalysis: connected social
communities

37. Some of our graphics
have had over a
million link clicks
and downloads via
social media

38. CHC collaborative impact and spread
Agency, connectedness and confidence have all significantly increased
Themes identified
Process
Commissioning
Date quality coding
System capacity
Demography
Cost shifting
Workforce
Activities
30 virtual meetings
8 face to face meetings
17 focus groups
313 ideas
515 regular participants

39. Transforming perceptions of nursing
A digital platform was set up to capture ideas on how about
transform perceptions of nursing and midwifery. It was live for
five weeks between December 2017 and January 2018.
As a result there were:
• 11,300 interactions
• 212 ideas
• 8,520 post views
• Nearly 1,000 original tweets in twitter chat which generated 40
more ideas
An expert panel and an implementation group have organised this information into
“enemies and “building blocks” for positive participation. 167 “Nurse ambassadors”
took part in a hackathon to develop the building blocks into positive action

40. Ten building blocks for positive
perceptions of nursing and
midwifery
Hello My
Name
is …
Uniting across
boundaries
9
Inspiring &
supportive
leadership
6
Investing in
innovation
10
Growing the
talent
2
An extraordinary
career for young
people
Showing pride in
the
professions
3 4 Valuing
diversity
5
Connecting
with our
values
7 8
Giving everyone
a voice
1
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41. 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

42. The School for Change Agents
15th February to 15th March 2018
• 6,500 people signed up
in 2018 (against a goal of
3,000 people)
• The largest virtual
training sessions ever in
the NHS
• 20,000+ contributions to
the live sessions
• 3,500 tuned in via
YouTube
• 92% new attenders

43. The ability to design and lead improvement and
transformational change
The ability to design / innovate healthcare services and changes to the wider system,
and oversee transformation across the system.
Transformation capability
The ability to stimulate, co-create and support the
delivery of transformational change
Initial definition
Strictly confidential: work in progress

44. What does this mean for our
directorate in terms of the design
and impact on our programmes?