Building Contagious Commitment for Improvement Bevan... · goals are a subset of quality and ......

Building Contagious

Commitment for Improvement

Helen Bevan

Leaders ask their staff to be ready for

change, but do not engage enough in

sensemaking........

Sensemaking is not done via marketing...or

slogans but by emotional connection with

employees

Ron Weil

“Revolution begins with

transformation of

consciousness” Paul Bate

Different thinking for different results

First order change

More of, or less of… the same thing


First order change

More of, or less of… the same thing

across the board budget

reductions

cost improvement goals are

separate from quality

improvement goals and are

of primary importance

make the current system

“leaner” and less wasteful

assess and understand

performance

work harder

capture data


First order change

tighter control and scrutiny; management grip

across the board budget

reductions

cost improvement goals are

separate from quality

improvement goals and are

of primary importance

make the current system

“leaner” and less wasteful

assess and understand

performance

work harder

capture data

Stand back…........Reframe…...See the big picture…


Second order change


Second order change unwarranted variation is driven out

across the system

productivity and cost improvement

goals are a subset of quality and

patient goals

build meaning and understanding of

the need for change, connected to

higher purpose and NHS values

build commitment to take action across

the organisation and the wider system

create the capacity and capability for

change

Stand back…........Reframe…...See the big picture…


Second order change unwarranted variation is driven out

across the system

productivity and cost improvement

goals are a subset of quality and

patient goals

build meaning and understanding of

the need for change, connected to

higher purpose and NHS values

build commitment to take action across

the organisation and the wider system

create the capacity and capability for

change

Call to action to secure the future

Which tradition of change?

Management

of

change

Organising

and

mobilising

• Organisational behaviour

• Leadership and management studies

• Clinical/medical audit

• Improvement “science”

• Academic tradition(s) – 100 years


Management of change

• Community organising,

campaigns and social

movements

• Learning from popular, civic and

faith-based mobilisation efforts

• Academic tradition– 100 years


Organising and mobilising


• Organisational behaviour

• Leadership and management studies

• Clinical/medical audit

• Improvement “science”

• Academic tradition(s) – 100 years

• Community

organising, campaigns

and social movements

• Learning from

popular, civic and

faith-based

mobilisation efforts

• Academic tradition –

100 years

Management of change

Organising and mobilising

Discussion

In relation to our quest for healthcare improvement

• what can we take from the Earth Hour

experience?

Anatomy of change

Physiology of change

Definition

The shape and structure 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.

Focus

Processes and structures

to deliver health and

healthcare.

Energy/fuel for change.

Leadership

activities

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

“You can’t impose anything

on anyone and expect them

to be committed to it” Edgar Schein, Professor Emeritus

MIT Sloan School

Source: Helen Bevan

From

Compliance

States a minimum

performance standard that

everyone must achieve

Uses hierarchy, systems and

standard procedures for co-

ordination and control

Threat of penalties/

sanctions/ shame creates

momentum for delivery

From the old world to the new world

To

Commitment

States a collective goal that

everyone can aspire to

Based on shared goals,

values and sense of purpose

for co-ordination and control

Commitment to a common

purpose creates energy for

delivery

“Large scale change is fuelled by

the passion that comes from the

fundamental belief that there is

something very different and better

that is worth striving for”

Leading Large Scale Change (2011)

NHS Institute for Innovation and Improvement

Source: Marshall Ganz

Shared understanding

leads to Action

How did the great transformational

leaders change the world?

Strategy

What?

Narrative

Why?

A challenge

“What the leader cares about (and typically

bases at least 80% of his or her message to

others on) does not tap into roughly 80% of

the workforce’s primary motivators for

putting extra energy into the change

programme”

Scott Keller and Carolyn Aiken (2009)

The Inconvenient Truth about Change Management

More than 80% of our ability to

save costs depends on clinical

decision making

Brent James,

Institute for Healthcare Delivery Research

Intermountain Healthcare

Copyright 2009 NHS Institute for Innovation and Improvement

“When the tuning fork in [clinicians’]

hearts goes off, everyone can feel it”

Denham C R (2009) Are You Infected? Journal of Patient

Safety 5(3): pp 188-196

mobilising versus

organising

“A cynic, after all,

is a passionate

person who does

not want to be

disappointed again” Zander R and Zander B (2000) The art of

possibility. Harvard Business School

Press. As quoted by Steve Onyett

Framing

Is the process by which leaders construct,

articulate and put across their message in a

powerful and compelling way in order to win

people to their cause and call them to action

Snow D A and Benford R D (1992)

If we want people to take action, we have

to connect with their emotions through

values

action

values

emotion


But not all emotions are equal.........

inertia urgency

anger apathy

solidarity isolation

you can make

a difference Self-doubt

hope fear

Ov

erc

om

e

Action motivators Action inhibitors


What do we need to do?

1. Tell a story


1. Tell a story

2. Make it personal


1. Tell a story

2. Make it personal

3. Be authentic


1. Tell a story

2. Make it personal

3. Be authentic

4. Create a sense of “us” (and be clear who the

“us” is)


1. Tell a story

2. Make it personal

3. Be authentic

4. Create a sense of “us” (and be clear who the

“us” is)

5. Build in a call for urgent action

Engage and

mobilise

for change at scale

Align the

change

process

with

changes

in the

drivers

of system behaviour

Design for

the spread

of innovation

Build

Leadership

skills for transformation

Utilise an evidence based quality improvement methodology

Harness the power of measurement and transparency of information as drivers for change

Underpin change efforts by an effective programme / performance management approach

Connect the change process to a higher purpose

The Bevans

Name Dates Place of birth Occupation

Stephen BEVAN 1794- 1850 Bristol, England

Edwin Verry

BEVAN

1832-1879 Bristol, England

Edwin Verry

BEVAN


Ernest Verry

BEVAN


Mervyn Ernest

BEVAN

1929 - Bristol, England

Helen Joyce

BEVAN

1960- Bristol, England

The Bevans



Sailmaker

Edwin Verry

BEVAN


Shipper

Edwin Verry

BEVAN


Ship’s captain

Ernest Verry

BEVAN


Ship’s engineer

Mervyn Ernest

BEVAN


Sailmaker

Helen Joyce

BEVAN

1960- Bristol, England

“You don’t need an engine when you

have wind in your sails”

Paul Bate

The Bevans



Sailmaker

Edwin Verry

BEVAN


Shipper

Edwin Verry

BEVAN


Ship’s captain

Ernest Verry

BEVAN


Ship’s engineer

Mervyn Ernest

BEVAN


Sailmaker

Helen Joyce

BEVAN

1960- Bristol, England Sailmaker

Building Contagious Commitment for Improvement Bevan... · goals are a subset of quality and ......

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