Leading transformational change Presentation to the Swedish Society of Medicine 5th December 2013 Helen Bevan NHS Horizons Group @helenbevan

1. Leading transformational
change
Presentation to
the Swedish Society of Medicine
5th December 2013
Helen Bevan
NHS Horizons Group
@helenbevan
@helenbevan

2. Most large scale change fails to
achieve its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
@helenbevan

3. Anatomy of change
Definition
Physiology of change
The shape and processes of
the system; detailed analysis;
how the components fit
together.
The vitality and life-giving forces that
enable the system and its people to
develop, grow and change.
Processes and structures
to deliver health and
healthcare
Focus
•
Leadership •
•
activities
•
@helenbevan
measurement and
evidence
improving clinical systems
reducing waste and
variation in healthcare
processes
redesigning pathways
Energy/fuel for change
•
•
•
•
•
creating a higher purpose and
deeper meaning for the change
process
building commitment to change
connecting with values
creating hope and optimism about
the future
calling to action
Source: Crump and Bevan

4. Anatomy of change
The shape and processes of
the system; how the
components fit together.
The vitality and life-giving forces that
enable the system and its people to
develop, grow and change.
Processes and structures
to deliver health and
healthcare
Definition
Physiology of change
Energy/fuel for change
Focus
•
Leadership •
•
activities
•
@helenbevan
measurement and
evidence
improving clinical systems
reducing waste and
variation in healthcare
processes
redesigning pathways
•
•
•
•
•
creating a higher purpose and
deeper meaning for the change
process
building commitment to change
connecting with values
creating hope and optimism about
the future
calling to action
Source: Crump and Bevan

5. Anatomy of change
Definition
Focus
Physiology of change
The shape and processes
of the system; how the
components fit together
The vitality and life-giving forces
that enable the system and its
people to develop, grow and
change
Processes and structures
to deliver health and care
• measurement and
evidence
Leadership • improving clinical
activities
systems
• reducing waste and
variation in healthcare
processes
• redesigning pathways
@helenbevan
Energy/fuel for change
• creating a higher purpose and
deeper meaning for the change
process
• building commitment to change
• connecting with values
• creating hope and optimism
about the future
• calling to action

6. Emerging themes in large scale change
Dominant
Organisation
approach
Power through hierarchy
Mission and vision
Emerging
Community
direction
Power through connection
Shared purpose
Making sense through
rational argument
Making sense through
emotional connection
Leadership-driven (top
down) innovation
Viral (grass-roots
driven) creativity
Tried and tested,
based on experience
Transactions
@helenbevan #Staffschange
“ Open” approaches , sharing
ideas & data, co-creating change
Relationships

7. John Kotter: “Accelerate!”
• We won’t create big change through
hierarchy on its own
• We need hierarchy AND network
• Many change agents, not just the usual few
• Changing our mindset
• From “have to” to “want to”
• Head and heart, not just head
and
@helenbevan #Staffschange

8. The Network Secrets of Great Change Agents
As a change agent, my centrality in the
informal network is far more
important than my position in the
formal hierarchy
Julie Battilana &Tiziana Casciaro
@helenbevan

9. A challenge
The way that leaders put messages across
does not tap into roughly 80% of the
primary motivators of the workforce for
putting energy into the change
programme”
Scott Keller and Carolyn Aiken (2009)
The Inconvenient Truth about Change Management
@helenbevan #Staffschange

10. If we want people to take action, we have to
connect with their emotions through values
values
values
emotion
emotion
action
action
@helenbevan
Source: Marshall Ganz

11. Learning from leaders of social movements:
Framing
Is the process by which leaders construct, articulate &
put across their message in a powerful & compelling
way in order to win people to their cause & call them
to action
Snow D A & Benford R D (1992)
@helenbevan #Staffschange

12. What is our approach to change?
Compliance
Commitment
States a minimum performance
standard that everyone must
achieve
States a collective goal that
everyone can aspire to
Uses hierarchy, systems and
standard procedures for coordination and control
Based on shared goals, values
and sense of purpose for coordination and control
Threat of penalties/ sanctions/
shame creates momentum for
delivery
Commitment to a common
purpose creates energy for
delivery
@helenbevan #Staffschange
Source: Helen Bevan

13. [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
@helenbevan

14. The largest simultaneous improvement
initiative in the history of the NHS
@helenbevan

15. Its started with a tweet!
Trainee doctors and
improvement leaders
started to talk about
how they could build a
social movement to
improve care
Damian Roland
Stuart Sutton
Helen Bevan
@helenbevan #NHSChangeDay

16. A 189,000 pledge mountain!
@helenbevan #NHSChangeDay
16

17. Example pledges
“We pledge to
introduce a test for
values and
behaviour for
recruitment into our
universities and into
employment.”
Health Education
England, West
Yorkshire
“As Director of Safety and Risk, my pledge is
to spend more time listening to patients and
staff and to act upon their concerns.” Moira
Durbridge
“We pledge to invite all individuals who make a
complaint about our services to be involved in
one of our 15 Steps Quality Challenge panels.”
Bradford District Care Trust, Yorkshire, 3001
“I pledge each month to contact a front line staff member
within my team who demonstrates inspirational clinical
practice.” East of England Ambulance Service NHS Trust
“I pledge to visit an elderly gentleman with
dementia in his own home to help him build his
life story on our Digital Reminiscence Therapy
Software.” Jo Samuels.
“I pledge to make sure every
person with a learning disability
at Turning Point has a health
action plan.” Fiona Ritchie

18. People took action all over the country
@helenbevan #NHSChangeDay

19. @helenbevan #NHSChangeDay

20. Change Day 2013 was an extraordinary moment in the
history of the NHS. It taught us that large-scale
improvement is possible in the NHS and that the best way
to do it is through collective commitment, action and by
keeping it simple.
@helenbevan #NHSChangeDay

21. 3rd March 2014
www.changeday.nhs.uk
@helenbevan #NHSChangeDay

22. @helenbevan #NHSChangeDay

23. What happens to
heretics/radicals/rebels/mavericks
in organisations?
@helenbevan #NHSChangeDay

24. @helenbevan #NHSChangeDay

25. Valuing radicals
• “New truths begin as heresies” (Huxley,
defending Darwin’s theory of natural
selection)
• big things only happen in organisations
because of heretics and radicals
@helenbevan #NHSChangeDay

26. We need boatrockers!
• Rock the boat but manage to
stay in it
• Able to challenge the status
quo when we see that there
could be a better way
• Capable of working with
others to create success NOT
a destructive troublemaker
@helenbevan #NHSChangeDay
Source: Debra Meyerson

27. Sometimes leaders see radicals as
troublemakers
@helenbevan #NHSChangeDay
Source : Lois Kelly www.foghound.com

28. www.changeday.nhs.uk/healthcare radicals
@helenbevan #NHSChangeDay

29. ....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 Speidman
@helenbevan #NHSChangeDay