@HelenBevan #hsemasterclass

Shaking up the world of

healthcare improvement

Helen Bevan

@HelenBevan

#hsemasterclass

@HelenBevan #hsemasterclass

This talk is bought to you by the Horizons team

We tune into and engage with the best change thinking and practice in healthcare and other industries around the world and seek to translate this learning into practical approaches

to change

The team has emerged through years of supporting change in the NHS and wider health and care system

A small team of people within the English NHS who support improvement and change

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Change is changing

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After World War 2, it took Japanese companies three

decades to seize leadership roles in car making and electronics from their global competitors

Source: P Choudray

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In contrast, Uber, a little over five years old, competes

around the worldSource: P Choudray

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Kinthi Sturtevant, IBM 13th

annual Change Management Conference

June 2015

We rarely see two, three or four year change projects anymore. Now it’s 30-60-90 day change

projects

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Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”

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DIGITALCONNECTIVIty

Change is changing

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Hierarchical power

Change is changing

DIGITALCONNECTIVIty

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“In a connected world, power no longer emanates from the top of the heap, but the centre of the

network.”Greg Satell, 2015

Greg Satell: http://www.digitaltonto.com/2015/how-power-is-shifting-from-corporations-to-platforms/

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Change is changing

Hierarchical power

DIGITALCONNECTIVIty

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DIGITALCONNECTION

Change is changing

Hierarchical power

Change from the edge

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http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final

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Why go to the edge?

“Leading from the edge brings us into contact with a far wider range

of relationships, and in turn, this increases our potential for diversity in terms of thought, experience and

background. Diversity leads to more disruptive thinking, faster

change and better outcomesAylet Baron

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Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

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The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

As a change agent, my centrality in the informal network is more important

than my position in the formal hierarchy

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People who are highly connected have twice as much power to

influence change as people with hierarchical power

Leandro Herrerohttp://t.co/Du6zCbrDBC

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How does the NHS improvement community prefer to communicate?

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Is your change process a cathedral or a bazaar?

http://www.unterstein.net/su/docs/CathBaz.pdf

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We have a lot of cathedrals

Source: Sewell (2015) : Stop training our project managers to be process junkies

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The power of the platform“Facebook, YouTube, Twitter and their lesser cousins have proved the power of the platform. They have shown that if

your average 21st century citizen is given the tools to connect and the freedom to create, they will do so with

enthusiasm, and often with an originality that blindsides the so-called creative industries. …..

Good leadership is no longer about ‘taking charge’ or imposing a strategic vision but about creating the

platforms that allow others to flourish and create” Ashoka

http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in-the-21st-century

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• 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”

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Why platforms?Platforms today power learning and innovation

at the speed of change by providing collaborative and sometimes exponentially

productive spaces for people to create valueJohn Hagel

Source of image: Pinipa

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Evolving kinds of change platforms:

They overlap!

1. Connecting platforms

2. Mobilising platforms

3. Learning platforms

4. Knowledge platforms

5. Crowdsourcing platforms

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Platform principles have long been part of change practice

• Building on traditions in the field of organisation development of communities of interest and communities of practice

• Technology enables us to connect more widely and at greater speed

Source of image: Socialserviceinstitute.sg

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Example platforms

Source of image: @JenniferClemo

@HelenBevan #hsemasterclasshttp://biggerboat.org/exploring-moodocs/

MOODOCs(Massive, Online, Open, Disease Oriented Communities)

60,000 online diabetes communities and

around 80 million online patient communities

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The Academy of NHS Fabulous Stuff

• Half a million page views • Over 700 fab shares• 1,500 to 4,000 page views

a day• Nottingham Safe staffing

app: 2,500 views• Dovetailing vaccinations

Scheme: 160 direct queries

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A platform for system-wide transformationLeeds Teaching Hospitals NHS Trust & Clever Together

WayFinder – a Crowdsourcing methodology and platform • Step 1: 4,500 staff and stakeholders shared 45,000 contributions to

• co-create The Leeds Way – a redefinition of their vision and their values

• co-design a five year strategy – a shared agreement of what needs to happen to achieve their vision

• co-define a new behavioural framework – a new agreement of the acceptable ways in which staff will live their values embedded into recruitment, induction, training and appraisals

• Step 2: WayFinder local – every department trained to use its own crowdsourcing platform • 19 clinical service units trained • A new way of working – online workshops – to ensure staff always

have a say in what’s happening in the Trust, bringing people together to co-create solutions.

Examples of results:• Staff satisfaction is up / buy-in to vision and values at an all time

high / complaints down 17% / 18weeks RTT down by 66% / CQC acknowledgement of staff engagement and impact on quality and safety

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Knowledge platforms

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Because there’s a problem….

Source of quote: Harold JarcheSource of image: http://gotcll.com/about-2/

Gettinginformation off the

internet is like taking a drink from a fire hydrant

Mitchell Kapor

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What is the best way to spread new knowledge?

Source of data: Nick Milton http://

www.nickmilton.com/2014/10/why-knowledge-transfer-through.html

Social connection/discussion is 14 times more effective

than written word/best practice

databases/toolkits etc.

Source of image: www.happiness-one-quote-time.blogspot.com

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Platforms as the new documentation

Source of image:Flickr user acaben

@HelenBevan #hsemasterclass Source: Oliver Benson

If you’re a programmer, you don’t even bother reading the manual, you simply

use stackoverflow to answer all your questions”

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Source: @NHSChangeDay

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8,000

@HelenBevan #hsemasterclassSource: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

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1. Being a health and care radical: change starts with me

2. Forming communities: building alliances for change

3. Rolling with resistance

4. Making change happen

5. Moving beyond the edge

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The School is being formally evaluated by the Chartered Institute for Personnel & Development

http://theedge.nhsiq.nhs.uk/expert/how-has-the-school-for-health-and-care-radicals-made-a-difference/

How has the School for Health and Care Radicals made a difference?

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The School is being formally evaluated by the Chartered Institute for Personnel & Development

• Change knowledge• Sense of purpose & motivation to improve practice• Ability to challenge the status quo• Rocking the boat & staying in it• Connecting with others to build support for change

Statistically significant positive effect on EVERY dimension of impact at both individual

and organisational level

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Nearly 100,000

connections(defined as a viewing, a download of material or

an original tweet)

• Latest no-cost solutions

• 150 speakers• 28 topics

• Live broadcast and on-demand

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NHS Transformathon: the maker movement

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Should we undertake routine radiology investigations overnight for all our inpatients?

How to build a change

platform in an hour

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• Platform established and presented to global audience in less than three days

• 60 minute sprint followed by a two week window for further ideas and discussion

• 3,000+ connections• good level of support for a 24/7 service for inpatients• consensus that the decision to receive a scan during

unsocial hours was patient led• yet many participants commented that it should be a joint

decision between clinician and patient• Panel at Nottingham University Hospitals is reviewing

findings, ideas and agreeing next steps for implementation

Help create a change platform in an hourRather than a consultation exercise that can take weeks, we set up a crowdsourcing platform to get an answer in an hour

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Activists from 120 countries

21,000 active users

Used by 5,000 people each month

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The Change Challenge

Tapping the collective brilliance of the NHS

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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

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14,000 contributions identified 11 building blocks for change:

Inspiring & supportive leadershipCollaborative 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

@HelenBevan #hsemasterclassProject Aristotle: http://qz.com/625870/after-years-of-intensive-analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/

After years of intensive analysis, Google discovers that the key to high performing, innovative teams is psychological safety

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Some lessons

1. You can’t control the outputs of the crowd2. People want a relationship3. Always, always, follow up

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The Natural Environment Research Council asked the crowd to name its new £200 million polar research vessel

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TEN TIMES as

many votes as the next

most popular answer

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

Nilofer Merchant

Once you start down this path, you have to follow up and continue

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Three ways to connect!

1. Follow us on Twitter@HelenBevan @TheEdgeNHS @School4Radicals

2. Subscribe to theedge.nhsiq.nhs.uk

3. Get materials from theedge.nhsiq.nhs.uk/school

…and sign up for our monthly #EdgeTalkstheedge.nhsiq.nhs.uk/edgetalks

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Ashoka (2014) What does leadership mean in the 21st century?Berg O (2014) The Collaboration Pyramid revisitedBevan H (2015) From change programmes to platformsBriggs D (2015) The elements of council as a platformBromford P (2015) What’s the difference between a test and a pilot?Chesbrough H et al (2016) Why does open innovation work?Choudray P (2015) The platform manifesto: 16 principles for digital transformationDawson R (2015) The future of work and organisations Deloitte University Press (2014) A movement in the makingDeloitte University Press (2015) Business ecosystems come of ageHagel J (2015) The power of platformsHagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movementsHagel J (2014) Platforms are not created equal: harnessing the full potential of platformsHamel G, Zanini J (2014) Build a change platform not a change programHealth Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’ interactive toolkitHeimans J (2014) What new power looks like [YouTube]

References cited in the slide deck (1/2)

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Heimens J, Timms J (2014) Understanding “New Power”Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers Little J (2016) Change management is deadMilton N (2014) Why knowledge transfer through discussion is 14 times more effective than writingO’Reilly T (2010) Government as a platformPearce D (2013) Social business discussions are the new documentationRaymond E S (2001) The Cathedral and the BazaarSatell G (2015) 4 things you should know about platformsSatell G (2012) How power is shifting from corporations to platformsSatell G (2015) Leaders must do more than inspire – we must shape networksSchillinger C (2015) Forget social networks, think social impact [YouTube]Scrivens J (2015) Enabling the experience of wholeness within enterprise social networksSewell S (2015) Stop training our project managers to be process junkiesShaw K (2015) Placing a digital platform at the heart of organisational change with OxfamSimon P (2011) The Age of the PlatformVan Alstyne et al (2016) Pipelines, platforms, and the new rules of strategy

References cited in the slide deck (2/2)