Building the future: perspectives on large scale change

@HelenBevan #SWBHconf16
Change is changing

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

In contrast, Uber, a little over
five years old, competes
around the world
Source: P Choudray

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

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

How does the NHS improvement community
prefer to communicate?

Change is changing
Leading with PARADOX

The need for sustainability
£
M9 deficit £2.26 billion
179 providers reporting an in-year deficit
(75% of sector)
A&E Q3 90.7%
RTT
Q3 91.6%
Quality
54% trusts require improvement
8% trusts inadequate
16 in Special Measures

“The test of a first-rate
intelligence is the
ability to hold two
opposed ideas in the
mind at the same time
and still retain the
ability to function”
F Scott Fitzgerald
Author, 1896-1940

Paradox: co-existence of competing demands
• Often difficult to see in such a dynamic
world
• Not problems that can be solved, as they
are unsolvable
• Can polarise individuals
• Managing them involves developing a
mindset beyond either/or logic
Source: http://media.ccl.org/wp-
content/uploads/2015/11/Managing-
Paradox.pdf#_ga=1.191923690.1381254047.1453632999

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

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

People who are highly connected
have twice as much power to
influence change as people with
hierarchical power
Leandro Herrero
http://t.co/Du6zCbrDBC

Future health and care leaders
will need to be leaders at the edge!

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

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 outcomes
Aylet Baron

“Tomorrow’s management systems
will need to value diversity, dissent
and divergence as highly as
conformance, consensus and
cohesion.”
Gary Hamel
Image by neilperkin.typepad.com
is the new normal!

“Tomorrow’s management systems
will need to value diversity, dissent
and divergence as highly as
conformance, consensus and
cohesion.”
Gary Hamel
Image by neilperkin.typepad.com
“The single biggest mistake to
avoid? Creating disruption at work.
Focus on developing relationships,
not disrupting and alienating
people. Peter Vander Awera on
learning from setbacks and failures
is the new normal!

We need rebels!
•The principal champion of a change initiative, cause
or action
•Rebels don’t wait for permission to lead, innovate,
strategise
•They are responsible; they do what is right
•Conform AND rebel
•They point to new horizons
•Without rebels, the storyline never
changes
Source : @PeterVan http://t.co/6CQtA4wUv1

If you put fences around people, you
get sheep. Give people the room they
need
William L McKnight

Is your change process a cathedral or a bazaar?
http://www.unterstein.net/su/docs/CathBaz.pdf

We have a lot of cathedrals
Source: Sewell (2015) : Stop training our project managers to be process junkies

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

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

Two kinds of people at work
• Feel connected to a higher
purpose
• Controlled & coordinated
through shared goals &
values
• Collaborate
• Embrace change
• Work to who they are
The contributors The compliant
• Feel disconnected from
purpose
through performance
management & standardised
procedures
• Hold back
• Resist change
• Work to a role specification
Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-
business-are-taking-the-time-to-build-a-positive-kind-social-culture/

Two kinds of people at work
• Feel connected to a higher
purpose
through shared goals &
values
• Collaborate
• Embrace change
• Work to who they are
The contributors The compliant
• Feel disconnected from
purpose
through performance
management & standardised
procedures
• Hold back
• Resist change
• Work to a role specification

Avedis Donabedian
Ultimately, the secret
of quality is love.
…… If you have love,
you can then work
backward to monitor
and improve the
system

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

Tactic for leaders:
Out-love everyone else
Source of image: Bradley Burgess

....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

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@HelenBevan @TheEdgeNHS @School4Radicals
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