Lessons from large scale change - Helen Bevan

@helenbevan #AHSN
Lessons from large scale
change:
research and practice
Helen Bevan
Delivery team
NHS Improving Quality
@helenbevan
@NHSIQ

@helenbevan #AHSN#AHSN
Some of the themes I’m hearing today
• Moving beyond “best practice”
• AHSN as source of energy, aspiration, ambition
• From hierarchy to network
• AHSNs as super-connector
• From “play safe” to risk taking
• AHSN as catalyst for innovation
• From incremental to transformational
• AHSN as accelerator of large scale change

@helenbevan #AHSN
Christine’s questions
We have years of experience
in “spreading good practice”
in the NHS but much of it
hasn’t worked
• How is it going to be
different this time?
• What are AHSNs going to
do to make it different?
Christine Camacho
Greater Manchester AHSN

In line with direction of thinking
about large scale change
From
industrial era (doing)
to
social era (connecting)

Emerging themes in large scale changeCurrent focus Emerging direction
Organisation Community
Power through hierarchy Power through connection
Mission and vision Shared purpose
Making sense through rational
argument
Making sense through
emotional connection
Leadership-driven (top down)
innovation
Viral (grass-roots driven)
creativity
Engaged patients Passionate users
Clinical networks Mass communities
Tried and tested, based on
experience
“Net Generation” principles
Transactions Relationships

John Kotter: “Accelerate!”
• Many change agents, not just the usual few
• A “want-to” - not just a “have-to” - mind-set
• The spirit of volunteerism - the desire to work with
others for a shared purpose – creates the energy to
power the network
• Head and heart, not just head
• People won’t want to do a day job in the hierarchy
and a night job in the network if we appeal only to
logic with numbers, contracts and business cases
• Much more leadership, not just more management
• The network AND the organisation

The Network Secrets of Great Change Agents
Place in the
network
• Change agents who are central in the informal network
are significantly more likely to deliver change, regardless
of their position in the formal hierarchy
bridge
networks
versus
cohesive
networks
• Change agents who bridge disconnected groups and
individuals are more effective at enabling large scale
change
• Change agents with cohesive networks are better at
delivering minor incremental changes
Links with
resisters
• Being close to “fence-sitters,” who are ambivalent about
a change, is always beneficial
• Close relationships with resisters are a double edged
sword: such ties help push through minor initiatives but
hinder major change attempts.
Julie Battilana and Tiziana Casciaro

@helenbevan #AHSN
What are the implications for the
way we organise?

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

“You can’t impose anything
on anyone and expect them
to be committed to it”
Edgar Schein, Professor Emeritus
MIT Sloan School

@helenbevan #AHSN#AHSN Source: Helen Bevan
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
What is our approach to change?
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

@helenbevan #AHSN
A 3-word concept

@helenbevan #AHSN
[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

Leaders as “signal generators”
“As a leader, think of yourself as a “signal generator”
whose words and actions are constantly being
scrutinised and interpreted, especially by those
below you [in the hierarchy]”
“Signal generators reduce uncertainty and ambiguity
about what is important and how to act”
Charles O’Reilly, Leaders in Difficult Times, 2009

Avoiding “de facto” purpose
• What leaders pay attention to matters to staff, and consequently
staff pay attention to that too
• Shared purpose can easily be displaced by a “de facto” purpose:
 hitting a target
 reducing costs
 reducing length of stay
 eliminating waste
 completing activities within a timescale
 complying with an inspection regime
• If purpose isn’t explicit and shared, then it is very easy for
something else to become a de facto purpose in the minds of the
workforce
Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector

Being a great change agent is about knowing, doing,
living and being improvement

The new economy is a passion economy, where
the function of organisations is no longer to
direct work, but to focus purpose
Greg Satell

Conversation
What do we need to
do to be the role
models for what we
espouse?
What one
commitment/pledge
do I make leaving
today?

Lessons from large scale change - Helen Bevan

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