Zoe Lord, profile picture
Uploaded byZoe Lord
PPTX, PDF147 views

NHS Graduate Trainees: Change and Transformation - Zoe Lord & Leigh Kendall

This document contains an agenda and materials for a workshop on change management hosted by Horizons, a team within the NHS that supports change agents. The agenda covers topics like why change is important, models of change like Kotter's 8 steps, tools for change like PDSA cycles and A3 reports, the importance of networks and informal leadership in driving change, and communicating for influence. It provides exercises and examples to illustrate different concepts around building support for change initiatives and overcoming resistance.

Embed presentation

Download to read offline
1 / 114
2 / 114
3 / 114
4 / 114
5 / 114
6 / 114
7 / 114
8 / 114
9 / 114
10 / 114
11 / 114
12 / 114
13 / 114
14 / 114
15 / 114
16 / 114
17 / 114
18 / 114
19 / 114
20 / 114
21 / 114
22 / 114
23 / 114
24 / 114
25 / 114
26 / 114
27 / 114
28 / 114
29 / 114
30 / 114
31 / 114
32 / 114
33 / 114
34 / 114
35 / 114
36 / 114
37 / 114
38 / 114
39 / 114
40 / 114
41 / 114
42 / 114
43 / 114
44 / 114
45 / 114
46 / 114
47 / 114
48 / 114
49 / 114
50 / 114
51 / 114
52 / 114
53 / 114
54 / 114
55 / 114
56 / 114
57 / 114
58 / 114
59 / 114
60 / 114
61 / 114
62 / 114
63 / 114
64 / 114
65 / 114
66 / 114
67 / 114
68 / 114
69 / 114
70 / 114
71 / 114
72 / 114
73 / 114
74 / 114
75 / 114
76 / 114
77 / 114
78 / 114
79 / 114
80 / 114
81 / 114
82 / 114
83 / 114
84 / 114
85 / 114
86 / 114
87 / 114
88 / 114
89 / 114
90 / 114
91 / 114
92 / 114
93 / 114
94 / 114
95 / 114
96 / 114
97 / 114
98 / 114
99 / 114
100 / 114
101 / 114
102 / 114
103 / 114
104 / 114
105 / 114
106 / 114
107 / 114
108 / 114
109 / 114
110 / 114
111 / 114
112 / 114
113 / 114
114 / 114
@horizonsnhs The Horizons team: Change agents and change agency • A small, diverse team of people within the NHS that supports change agents and builds change agency • We tune into the latest change thinking and practice in healthcare and other industries around the world • The team has emerged through years of supporting change in the NHS and the wider health and care system
@horizonsnhs Housekeeping and survival! Breaks… Fire alarms and exits… Mobile technology Toilet location… Security… WWW & EBI Lunch…
@horizonsnhs Plan for the day • Welcome and intros – Who are Horizons? • Plan for today… – Why is change important? – What do we know about change? – What’s changing in the world of change! – Resistance to change – Communicating for effective influence – Energy for change – TRIZ – 6 thinking hats • Close 3pm Does this cover what you want to get out of today?
@horizonsnhs
Why is change important?
How do YOU feel about change? If you feel… Go to the right If you feel… Go to the left
How do think FRONT LINE STAFF feel about change to structure and services? If you think they feel… Go to the right If you think they feel… Go to the left
How do think PATIENTS feel about change to their local services? If you think they feel… Go to the right If you think they feel… Go to the left
How do think YOUR CURRENT MANAGER feels about change? If you think they feel… Go to the right If you think they feel… Go to the left
Attitudes to change differ… Proportionate enthusiasm Healthy scepticism Annoying evangelism Irrational obstructionism Moderate interest
Attitudes to change Proportionate enthusiasm Healthy scepticism Annoying evangelism Irrational obstructionism Moderate interest Calming down Keeping in real world Perspective Focussing ? Support Direction Feedback Motivating Exploring Evidence of benefit “Unpacking” Debate (argument) Selling
People adopt ideas and innovations at different speeds Change Adoption Speed of Adoption LowHigh Innovators 2.5% Early Adopters 13.5% Laggards 16% Early Majority 34% Late Majority 34% Start with enthusiasts – but choose carefully
@horizonsnhs What do we know about change and how to go about it?
Even if you have the best idea – why doesn’t change happen?
Why do change programmes fail?
@horizonsnhs Why do people resist change?
@horizonsnhs What do resistant behaviours look like?
@horizonsnhs Mark Jaben on the science behind resistance What NOT to do But what we do do Engage people here
@horizonsnhs Mark Jaben on the science behind resistance What NOT to do Instead of buyers (who “buy-in”), we need investors What TO do Engage people here Engage people here
@horizonsnhs One size fits all???
@horizonsnhs Choose an appropriate approach Just do it Innovate Test and replicate CLEAR COMPLEX CHAOTIC COMPLICATED Source: Lisa Schilling 1 1 4
What models or tools can we use for the purposes of effective change?
Aims Measurements Change ideas The Improvement Guide Langley et al (1996) What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in the improvements that we seek ? Model for Improvement Act Plan Study Do Testing ideas before implementing changes
@horizonsnhs Plan Do ActStudy However, in this context, PDSA is: …how to explicitly test a small change …what you have planned to do …the outcomes, expected and unexpected, of the test …on the results to modify and improve
@horizonsnhs :We’ve all done at least one PDSA!
@horizonsnhs Testing and refining ideas Implementing new procedures & systems - sustaining change Bright idea! Developing improvement with PDSAs
@horizonsnhs Bright idea! Improvement Improvement ? ? Improvement ? ? ? ?
@horizonsnhs Change Model • Connect with shared purpose • Commitment not compliance • Lead with the why, the passion & intrinsic motivation Source: Leading Large Scale Change
@horizonsnhs Blended approaches • Lean • 6 sigma • Prince 2
@horizonsnhs A3
33
How the world is changing isn't often reflected in plans… 34
Change is change too… 35
Source: Innovisor
@horizonsnhs Jeremy Heimens, Henry Timms This is New Power old power new power Currency Held by a few Pushed down Commanded Closed Transaction Current Made by many Pulled in Shared Open Relationship
@horizonsnhs The predominant approach in recent years has been STRUCTURE but globally there is a big shift towards AGENCY The design dilemma at the heart of change & implementation
@horizonsnhs Source: @NHSChangeDay
@horizonsnhs Source: @NHSChangeDay
@horizonsnhs Source: @NHSChangeDay Problematic: changing a “permission culture” can take years The good news: we can usually build agency much more quickly
@horizonsnhs The people making change happen is changing 42 Source: adapted by Helen Bevan from Leandro Herrera List A • The Delivery Board • The programme sponsors • The programme management office • The work stream leads • The Clinical Leads • The Directors of participating functions • The Change Facilitators
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
@horizonsnhs The people making change happen is changing 44 List B • The mavericks and rebels • The deviants (positive). Who do things differently and succeed • The nonconformists who see things through glasses no one else has • The hyper-connected who spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on • The hyper-trusted. Multiple reasons, doesn’t matter which onesSource: adapted by Helen Bevan from Leandro Herrera List A • The Delivery Board • The programme sponsors • The programme management office • The work stream leads • The Clinical Leads • The Directors of participating functions • The Change Facilitators
@horizonsnhs The people making change happen is changing 45 List B • The mavericks and rebels • The deviants (positive). Who do things differently and succeed • The nonconformists who see things through glasses no one else has • The hyper-connected who spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on • The hyper-trusted. Multiple reasons, doesn’t matter which onesSource: adapted by Helen Bevan from Leandro Herrera List A • The Delivery Board • The programme sponsors • The programme management office • The work stream leads • The Clinical Leads • The Directors of participating functions • The Change Facilitators
@horizonsnhs What’s the evidence? The failure of large scale transformational change projects is rarely due to the content or structure of the plans that are put into action To make transformational change happen we need to connect networks of people who ‘want’ to contribute http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787- 257163-Campaign+-+01%2F09%2F2016 Source: David Dinwoodie (2015) It’s much more about the role of informal networks in the organisations and systems affected by change
@helenbevan People who are highly connected have twice as much power to influence change as people with hierarchical power Leandro Herrero http://t.co/Du6zCbrDBC
@horizonsnhs To stay in touch, connect with the 3% Just 3% of people in the organisation or system typically drive conversations with 90% of the other people Source: research by Innovisor
@horizonsnhs Tool for building networks: Randomised coffee trials Image source: Pinterest
@horizonsnhs Randomised Coffee Trials #RCT Download resources for your RCT: https://www.slideshare.net/HorizonsCIC/how-to-set-up-a- randomised-coffee-trial
We now have the people, the groups, the networks… how are we going to work with them?
Stages of change model
@horizonsnhs Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
@horizonsnhs The model has been used with health related behaviours: smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake domestic violence HIV prevention use of sunscreens to prevent skin cancer medication compliance mammography screening It works for organisational and service change too!
@horizonsnhs Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
What qualities make an effective communicator? Communicating for effective influence
What qualities make an effective communicator? Listening Observing Empathy Questioning Being present Talking
“To effectively communicate, we must realise that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.” Anthony Robbins
What is emotional intelligence (EQ)?
What you say (or what you believe you are saying!) What is heard/ understood Expectations Hopes Fears Previous experiences Prejudice Mood/state of mind Distractions – internal and external Assumptions
Fight, flight, or freeze
The EQ seesaw
“The single biggest problem in communication is the illusion that it has taken place.” George Bernard Shaw
“The biggest communication problem is that we do not listen to understand. We listen to reply.”
Listening attentively – am I giving my full attention? Listening accurately – am I understanding what they are saying? Listening empathetically – do I really appreciate their feelings? Listen generatively – are you helping the other person through your dialogue? Ways of Listening
Reflecting – word for word Summarising– precis of their words Paraphrasing – putting their words in to mine Pre-framing– “I think I heard you say…” “Or in other words…” Ways of Demonstrating you are Listening
Transactional analysis Parent Adult Child Safe Calming Nurturing Supportive Reasonable Equitable Logical Non- threatening Curious Playful Spontaneous Creativity Negative Controlling Critical Patronising Directive Tantrums Lack of responsibility Insecure Difficult Positive
Interactional Small talk Polite, fills a gap. You might say nothing of importance. Person might not be listening. Doesn’t really achieve anything. Transactional Asking someone to do something for you. Ordering a coffee. Polite (hopefully!) and (hopefully!) achieves accomplishing a task. Transformational Engaging in genuine dialogue. Involves proper listening. Might be uncomfortable. Increases our awareness and understanding. Builds trust and rapport. Creates a shift, a change.
@horizonsnhs Personal styles Analytical •formal •measured + systematic •seek accuracy / precision •dislike unpredictability and surprises Driver •business like •fast + decisive •seek control •dislike inefficiency and indecision Amiable •conforming •less rushed + easy going •seek appreciation •dislike insensitivity and impatience Expressive •flamboyant •fast + spontaneous •seek recognition •dislike routine and boredom Controls emotions Ask Tell Shows emotions Merrill D, Reid R (1991) Personal Styles and Effective Performance, CRC Press, London
@horizonsnhs
@horizonsnhs
@horizonsnhs So What? • Nature of social media means content is fleeting, even viral content. • Millions of people might have seen your content, but has it had an impact? How do you know? OR
@horizonsnhs Spread and Reach • Focus on maximising spread and reach, rather than trying to ‘go viral’. • Share good content that is consistent with your brand • Find your people – communities, social movements, hashtags • Calls to action
@horizonsnhs Influence …but numbers are not the whole picture. What is the story behind the numbers? What impact have you had?
@horizonsnhs Influence and Impact It IS about • Engagement: starting conversations • Communities: like-minded people collaborating • Quality, not quantity • Generosity and support • Inclusivity: all voices are welcome • Authenticity, not ‘playing the game’ (and these factors are why #MatExp works so well on Twitter)
@horizonsnhs Activity! How does your current Twitter brand fit with what you want to be known for? Think about • Do you need to make any changes? • If yes, what changes will they be? • How will you action those changes? • Think SMART goals
@horizonsnhs Maximise your reach, spread, influence and impact • Be authentic • Be generous – be kind, give advice, share interesting content • Pump up the volume: use complementary platforms such as blogs, Steller, Storify to give your messages and voice longevity (this can also help you become a thought leader in your area of specialism).
@horizonsnhs What kind of content has the best reach and spread? • Stories with high emotion – whether happiness or anger • The WOW or aaah factor • Social currency
@horizonsnhs
@horizonsnhs Twitter Turn Ons • Be polite • Be kind • Be relevant • Be authentic • Engage • Find your people • Share relevant content • Say thanks, give credit where due • Me, me, me • Keep saying the same thing again and again and again…. • Cliques • Rudeness • Broadcasting, no interaction • Auto-DMs Twitter Turn Offs
@horizonsnhs Lessons from Twitter Fails Beware automated tweets Sense check your hashtags! Giraffes don’t live in Ghana If you engage professional PR support, don’t make it look too obvious!
Energy for Change
“Energy for change” is defined as The capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals http://www.institute.nhs.uk/tools/energy_for _change/energy_for_change_.html #beingvisible
Energy is the strength and vitality required for sustained physical or mental activity. Change: Make or become different #beingvisible
Teams perform best when five energies are high Psychological Physical Spiritual Social Intellectual Source: http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html #beingvisible
#beingvisible
Social Energy Energy of personal engagement, relationships and connections between people It’s where people feel a sense of “us and us” rather than “us and them” #beingvisible
Spiritual energy Energy of commitment to a common vision for the future, driven by shared values and a higher purpose Gives people the confidence to move towards a different future that is more compelling than the status quo #beingvisible
Psychological energy Energy of courage, resilience and feeling safe to do things differently Involves feeling supported to make a change and trust in leadership and direction #beingvisible
Physical energy Energy of action, getting things done and making progress The flexible, responsive drive to make things happen #beingvisible
Intellectual energy Energy of analysis, planning and thinking Involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/evidence #beingvisible
High and low ends of each energy domain Social isolated solidarity Spiritual uncommitted higher purpose Psychological risky safe Physical fatigue vitality Intellectual Illogical reason HIGHLOW #beingvisible
1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 1: What’s your assessment of their energy for change? #beingvisible
The challenge of disproportionately high intellectual energy Intellectual energy on its own isn’t transformational It keeps leaders in their comfort zone (intellect to intellect) #beingvisible
What is the energy in your team like? #beingvisible
Anne Brown #beingvisible
What can YOU do to improve energies in your team? #beingvisible
#beingvisible
Tools… • Brainstorming through different viewpoints: Fresh eyes • De bono’s 6 thinking hats • Liberating Structures: TRIZ
@horizonsnhs
@horizonsnhs TRIZ • It’s a Russian acronym: “Teoriya Resheniya Izobretatelskikh Zadach” • A problem solving, analysis and forecasting tool. • Depersonalising and unpicking topics that people are passionate about. • Part of ‘Liberating Structures’ – Frameworks that make it possible for people and organisations to create, do new things, to be innovative.
@horizonsnhs TRIZ How could we could reliably create a trainee programme that NEVER works and is totally ineffective? TRIZ
@horizonsnhs Step 1 As a table, make a list of all the things that we could do to ensure we meet our goal: How could we could reliably create a trainee programme that NEVER works and is totally ineffective? • Go wild! • Use post it notes (one per action!) • 10 minutes TRIZ
@horizonsnhs Step 2 As a table group, go down your first list and ask: Is there anything that we are currently doing that in any way, shape or form resembles any of the actions on your post it notes? • If yes, move these post it notes to sheet 2. • Be unforgiving about these items and talk about their impact • 10 minutes TRIZ
@horizonsnhs Step 3 As a table group, go down your second list from step 2 and ask: What could be stopped? • Take these post it notes and move them to sheet 3. • 10 minutes TRIZ
@horizonsnhs Step 4 From the actions that can be stopped, discuss and create an action plan for the stopping these activities. • 10 minutes TRIZ
@horizonsnhs
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 Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015
@horizonsnhs Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on Increasing number of messages as information cascade through the organisation Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail- don.aspx
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
@horizonsnhs After years of intensive analysis, Google discovered that the key to high performing teams that deliver change is psychological safety Project Aristotle: https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja- xoaZybvz9f0b1_6bJyG7zZO6L

More Related Content

PPTX
The new era of change and transformation
byHelen Bevan
 
PPTX
Being ready for change
byHelen Bevan
 
PPTX
Are you SURE that's co-design?
byDesign Lab
 
PDF
Virtual Health + Care Design School - Week 7: Bring it all Together
byDesign Lab
 
PPTX
improvement training Winterbourne Medicines Launch
byNHS Improving Quality
 
PPTX
Setting up an organisation wide QI programme
byAmar Shah
 
PPTX
Engaging staff and service users to partner in Quality Improvement
byAmar Shah
 
PPTX
Leading effectively in a world that is increasingly volatile and uncertain
byHelen Bevan
 
The new era of change and transformation
byHelen Bevan
 
Being ready for change
byHelen Bevan
 
Are you SURE that's co-design?
byDesign Lab
 
Virtual Health + Care Design School - Week 7: Bring it all Together
byDesign Lab
 
improvement training Winterbourne Medicines Launch
byNHS Improving Quality
 
Setting up an organisation wide QI programme
byAmar Shah
 
Engaging staff and service users to partner in Quality Improvement
byAmar Shah
 
Leading effectively in a world that is increasingly volatile and uncertain
byHelen Bevan
 

Similar to NHS Graduate Trainees: Change and Transformation - Zoe Lord & Leigh Kendall

PDF
NHS Change Model hack day full report
byNHS Improving Quality
 
PPTX
The power of one: the power of many: what healthcare improvement can learn fr...
byHelen Bevan
 
PPTX
Catalyzing students and trainees as agents of change
byHelen Bevan
 
PPTX
School for Change Agents Module 5 slides
byNHS Horizons
 
PPTX
Looking Back, Looking Forward, Look Around
byHorizons NHS
 
PPT
Change is changing - how to lead large scale change
byNHS Improving Quality
 
PDF
Rocking the boat and staying in it: a presentation for Healthcare Improvement...
byNHS Improving Quality
 
PPTX
How to be a great change agent
byHelen Bevan
 
PDF
Fab Change Day Activists School (Newcastle)
byNHS Horizons
 
PDF
Fab Change Day Activists School (Leeds)
byNHS Horizons
 
PPT
Effective leadership in a world that is increasingly volatile and uncertain
byNHS Horizons
 
PPTX
It's the era of the improvement platform
byHelen Bevan
 
PPTX
Leading change into the future
byHelen Bevan
 
PPTX
Making transformation happen: creating the conditions
byHelen Bevan
 
PPTX
Change and Innovation: it's time to rewrite the rules
byHorizons NHS
 
PPTX
The coming era of change and some implications for the NHS research and devel...
byHelen Bevan
 
PPTX
Leading in a changing world - British Lymphology Society Conference - Zoe Lord
byZoe Lord
 
PPTX
Transformation minicourse
byNHS Improving Quality
 
PPTX
School for Change Agents - Module 4 Slides
byNHS Horizons
 
PPT
Rewrite rules of change in healthcare
byNHS Improving Quality
 
NHS Change Model hack day full report
byNHS Improving Quality
 
The power of one: the power of many: what healthcare improvement can learn fr...
byHelen Bevan
 
Catalyzing students and trainees as agents of change
byHelen Bevan
 
School for Change Agents Module 5 slides
byNHS Horizons
 
Looking Back, Looking Forward, Look Around
byHorizons NHS
 
Change is changing - how to lead large scale change
byNHS Improving Quality
 
Rocking the boat and staying in it: a presentation for Healthcare Improvement...
byNHS Improving Quality
 
How to be a great change agent
byHelen Bevan
 
Fab Change Day Activists School (Newcastle)
byNHS Horizons
 
Fab Change Day Activists School (Leeds)
byNHS Horizons
 
Effective leadership in a world that is increasingly volatile and uncertain
byNHS Horizons
 
It's the era of the improvement platform
byHelen Bevan
 
Leading change into the future
byHelen Bevan
 
Making transformation happen: creating the conditions
byHelen Bevan
 
Change and Innovation: it's time to rewrite the rules
byHorizons NHS
 
The coming era of change and some implications for the NHS research and devel...
byHelen Bevan
 
Leading in a changing world - British Lymphology Society Conference - Zoe Lord
byZoe Lord
 
Transformation minicourse
byNHS Improving Quality
 
School for Change Agents - Module 4 Slides
byNHS Horizons
 
Rewrite rules of change in healthcare
byNHS Improving Quality
 

More from Zoe Lord

PPTX
Collective leadership - Zoe Lord & Kate Pound
byZoe Lord
 
PPTX
Thinking differently in the NHS - Zoe Lord - Change Management Institute
byZoe Lord
 
PPTX
Creating Tomorrow Today: Unleashing Learning as a Power for Transformation
byZoe Lord
 
PPTX
#Endpjparalysis Enabling Change
byZoe Lord
 
PPTX
Stories for Change. How Mums used their stories for Change to influence mater...
byZoe Lord
 
PPTX
Using our power to make a difference - CQC - Zoe Lord
byZoe Lord
 
PDF
FINAL NHSIQ_Winterbourne_Medicines
byZoe Lord
 
PPTX
Accelerating the pace of change. Zoe Lord
byZoe Lord
 
PPTX
Empowering people and communities taskforce overview
byZoe Lord
 
Collective leadership - Zoe Lord & Kate Pound
byZoe Lord
 
Thinking differently in the NHS - Zoe Lord - Change Management Institute
byZoe Lord
 
Creating Tomorrow Today: Unleashing Learning as a Power for Transformation
byZoe Lord
 
#Endpjparalysis Enabling Change
byZoe Lord
 
Stories for Change. How Mums used their stories for Change to influence mater...
byZoe Lord
 
Using our power to make a difference - CQC - Zoe Lord
byZoe Lord
 
FINAL NHSIQ_Winterbourne_Medicines
byZoe Lord
 
Accelerating the pace of change. Zoe Lord
byZoe Lord
 
Empowering people and communities taskforce overview
byZoe Lord
 

Recently uploaded

PPTX
“A comprehensive and systematic research critique
byMedical PPT
 
PPTX
Virginia_Henderson_theory_group_B_2.pptx
byMedical PPT
 
PPTX
Human Organ Transplantation Act 2014, THOTA- 2014 Legal basics by Dr MB Singh...
byBalajiSinghM
 
PPTX
Progesterone primed Ovarian stimulation- PPOS
byRudriAgrawal
 
PDF
Surgery for Peptic ulcer disease (PUD).pdf. KCH-Malawi
byTimWiyuleMutafyaMD
 
PPTX
Understanding-Disease-Causation-Epidemiological-Triad-and-Multifactorial-Mode...
bydrasifk
 
PPTX
Enteric-Typhoid-and-Paratyphoid-Fever-2025-Update.pptx
byamarnath970868
 
PDF
Human Anatomy and Physiology - I Practical Manual.pdf
bySreenivasa Reddy Thalla
 
PPTX
Pulmonary thromboembolism PTE ppt, Cardiovascular System
byNasirAbubakarMailafi
 
PPTX
Biochemistry
byDr. Sankalp Bhargava
 
PPTX
Intro +Cholinergic System.pptx,ANS,acetylcholine
byDr. Swati Rai
 
PPTX
goniometer and range of motion lecture pptx
byraedalobaidi
 
PDF
Medicinal Plants: Uses, Benefits and Mechanisms of Action
byazamsaleembilgrami
 
PDF
Shock for General Surgery BDS final year \ ppt.pdf
byArundhotiRay
 
PPT
Healing(repair and regeneration) Pathology lecture.ppt
byvishakhakothikar1120
 
PPTX
A Detailed Description of Raktagulma wrt PTSR
byDr Chandrika Kulkarni
 
PDF
Charting New Paths in the Treatment of ER+, HER2- MBC: Seeking Clarity and Co...
byPVI, PeerView Institute for Medical Education
 
PPT
Anaethesia for cardiothoracic surgery.ppt
byummuumaradanzumi
 
PDF
Mechanisms of Drug Action (PH 1.8) - Complete Pharmacology Flowcharts
byShivankan Kakkar
 
PDF
Dr.Pothireddy Surednranath Reddy explains on management of hip pain.pdf
bybvsubbareddy1
 
“A comprehensive and systematic research critique
byMedical PPT
 
Virginia_Henderson_theory_group_B_2.pptx
byMedical PPT
 
Human Organ Transplantation Act 2014, THOTA- 2014 Legal basics by Dr MB Singh...
byBalajiSinghM
 
Progesterone primed Ovarian stimulation- PPOS
byRudriAgrawal
 
Surgery for Peptic ulcer disease (PUD).pdf. KCH-Malawi
byTimWiyuleMutafyaMD
 
Understanding-Disease-Causation-Epidemiological-Triad-and-Multifactorial-Mode...
bydrasifk
 
Enteric-Typhoid-and-Paratyphoid-Fever-2025-Update.pptx
byamarnath970868
 
Human Anatomy and Physiology - I Practical Manual.pdf
bySreenivasa Reddy Thalla
 
Pulmonary thromboembolism PTE ppt, Cardiovascular System
byNasirAbubakarMailafi
 
Biochemistry
byDr. Sankalp Bhargava
 
Intro +Cholinergic System.pptx,ANS,acetylcholine
byDr. Swati Rai
 
goniometer and range of motion lecture pptx
byraedalobaidi
 
Medicinal Plants: Uses, Benefits and Mechanisms of Action
byazamsaleembilgrami
 
Shock for General Surgery BDS final year \ ppt.pdf
byArundhotiRay
 
Healing(repair and regeneration) Pathology lecture.ppt
byvishakhakothikar1120
 
A Detailed Description of Raktagulma wrt PTSR
byDr Chandrika Kulkarni
 
Charting New Paths in the Treatment of ER+, HER2- MBC: Seeking Clarity and Co...
byPVI, PeerView Institute for Medical Education
 
Anaethesia for cardiothoracic surgery.ppt
byummuumaradanzumi
 
Mechanisms of Drug Action (PH 1.8) - Complete Pharmacology Flowcharts
byShivankan Kakkar
 
Dr.Pothireddy Surednranath Reddy explains on management of hip pain.pdf
bybvsubbareddy1
 

NHS Graduate Trainees: Change and Transformation - Zoe Lord & Leigh Kendall

  • 2.
    @horizonsnhs The Horizons team: Changeagents and change agency • A small, diverse team of people within the NHS that supports change agents and builds change agency • We tune into the latest change thinking and practice in healthcare and other industries around the world • The team has emerged through years of supporting change in the NHS and the wider health and care system
  • 3.
    @horizonsnhs Housekeeping and survival! Breaks… Firealarms and exits… Mobile technology Toilet location… Security… WWW & EBI Lunch…
  • 4.
    @horizonsnhs Plan for theday • Welcome and intros – Who are Horizons? • Plan for today… – Why is change important? – What do we know about change? – What’s changing in the world of change! – Resistance to change – Communicating for effective influence – Energy for change – TRIZ – 6 thinking hats • Close 3pm Does this cover what you want to get out of today?
  • 6.
  • 7.
    Why is changeimportant?
  • 8.
    How do YOUfeel about change? If you feel… Go to the right If you feel… Go to the left
  • 9.
    How do thinkFRONT LINE STAFF feel about change to structure and services? If you think they feel… Go to the right If you think they feel… Go to the left
  • 10.
    How do thinkPATIENTS feel about change to their local services? If you think they feel… Go to the right If you think they feel… Go to the left
  • 11.
    How do thinkYOUR CURRENT MANAGER feels about change? If you think they feel… Go to the right If you think they feel… Go to the left
  • 12.
    Attitudes to changediffer… Proportionate enthusiasm Healthy scepticism Annoying evangelism Irrational obstructionism Moderate interest
  • 13.
    Attitudes to change Proportionate enthusiasm Healthy scepticism Annoying evangelism Irrational obstructionism Moderate interest Calmingdown Keeping in real world Perspective Focussing ? Support Direction Feedback Motivating Exploring Evidence of benefit “Unpacking” Debate (argument) Selling
  • 14.
    People adopt ideasand innovations at different speeds Change Adoption Speed of Adoption LowHigh Innovators 2.5% Early Adopters 13.5% Laggards 16% Early Majority 34% Late Majority 34% Start with enthusiasts – but choose carefully
  • 15.
    @horizonsnhs What do weknow about change and how to go about it?
  • 16.
    Even if youhave the best idea – why doesn’t change happen?
  • 17.
    Why do changeprogrammes fail?
  • 18.
  • 19.
    @horizonsnhs What do resistantbehaviours look like?
  • 20.
    @horizonsnhs Mark Jaben onthe science behind resistance What NOT to do But what we do do Engage people here
  • 21.
    @horizonsnhs Mark Jaben onthe science behind resistance What NOT to do Instead of buyers (who “buy-in”), we need investors What TO do Engage people here Engage people here
  • 22.
  • 23.
    @horizonsnhs Choose an appropriateapproach Just do it Innovate Test and replicate CLEAR COMPLEX CHAOTIC COMPLICATED Source: Lisa Schilling 1 1 4
  • 24.
    What models ortools can we use for the purposes of effective change?
  • 25.
    Aims Measurements Change ideas The ImprovementGuide Langley et al (1996) What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in the improvements that we seek ? Model for Improvement Act Plan Study Do Testing ideas before implementing changes
  • 26.
    @horizonsnhs Plan Do ActStudy However,in this context, PDSA is: …how to explicitly test a small change …what you have planned to do …the outcomes, expected and unexpected, of the test …on the results to modify and improve
  • 27.
  • 28.
    @horizonsnhs Testing and refining ideas Implementingnew procedures & systems - sustaining change Bright idea! Developing improvement with PDSAs
  • 29.
  • 30.
    @horizonsnhs Change Model • Connectwith shared purpose • Commitment not compliance • Lead with the why, the passion & intrinsic motivation Source: Leading Large Scale Change
  • 31.
  • 32.
  • 33.
  • 34.
    How the worldis changing isn't often reflected in plans… 34
  • 35.
  • 36.
  • 37.
    @horizonsnhs Jeremy Heimens, HenryTimms This is New Power old power new power Currency Held by a few Pushed down Commanded Closed Transaction Current Made by many Pulled in Shared Open Relationship
  • 38.
    @horizonsnhs The predominant approachin recent years has been STRUCTURE but globally there is a big shift towards AGENCY The design dilemma at the heart of change & implementation
  • 39.
  • 40.
  • 41.
    @horizonsnhs Source: @NHSChangeDay Problematic: changing a “permission culture”can take years The good news: we can usually build agency much more quickly
  • 42.
    @horizonsnhs The people makingchange happen is changing 42 Source: adapted by Helen Bevan from Leandro Herrera List A • The Delivery Board • The programme sponsors • The programme management office • The work stream leads • The Clinical Leads • The Directors of participating functions • The Change Facilitators
  • 43.
    The Network Secretsof 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
  • 44.
    @horizonsnhs The people makingchange happen is changing 44 List B • The mavericks and rebels • The deviants (positive). Who do things differently and succeed • The nonconformists who see things through glasses no one else has • The hyper-connected who spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on • The hyper-trusted. Multiple reasons, doesn’t matter which onesSource: adapted by Helen Bevan from Leandro Herrera List A • The Delivery Board • The programme sponsors • The programme management office • The work stream leads • The Clinical Leads • The Directors of participating functions • The Change Facilitators
  • 45.
    @horizonsnhs The people makingchange happen is changing 45 List B • The mavericks and rebels • The deviants (positive). Who do things differently and succeed • The nonconformists who see things through glasses no one else has • The hyper-connected who spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on • The hyper-trusted. Multiple reasons, doesn’t matter which onesSource: adapted by Helen Bevan from Leandro Herrera List A • The Delivery Board • The programme sponsors • The programme management office • The work stream leads • The Clinical Leads • The Directors of participating functions • The Change Facilitators
  • 46.
    @horizonsnhs What’s the evidence? Thefailure of large scale transformational change projects is rarely due to the content or structure of the plans that are put into action To make transformational change happen we need to connect networks of people who ‘want’ to contribute http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787- 257163-Campaign+-+01%2F09%2F2016 Source: David Dinwoodie (2015) It’s much more about the role of informal networks in the organisations and systems affected by change
  • 47.
    @helenbevan People who arehighly connected have twice as much power to influence change as people with hierarchical power Leandro Herrero http://t.co/Du6zCbrDBC
  • 48.
    @horizonsnhs To stay intouch, connect with the 3% Just 3% of people in the organisation or system typically drive conversations with 90% of the other people Source: research by Innovisor
  • 49.
    @horizonsnhs Tool for buildingnetworks: Randomised coffee trials Image source: Pinterest
  • 50.
    @horizonsnhs Randomised Coffee Trials#RCT Download resources for your RCT: https://www.slideshare.net/HorizonsCIC/how-to-set-up-a- randomised-coffee-trial
  • 51.
    We now havethe people, the groups, the networks… how are we going to work with them?
  • 52.
  • 53.
    @horizonsnhs Transtheoretical model ofbehaviour change Prochaska, DiClemente & Norcross (1992)
  • 54.
    @horizonsnhs The model hasbeen used with health related behaviours: smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake domestic violence HIV prevention use of sunscreens to prevent skin cancer medication compliance mammography screening It works for organisational and service change too!
  • 55.
    @horizonsnhs Transtheoretical model ofbehaviour change Prochaska, DiClemente & Norcross (1992)
  • 56.
    What qualities make aneffective communicator? Communicating for effective influence
  • 57.
    What qualities make aneffective communicator? Listening Observing Empathy Questioning Being present Talking
  • 59.
    “To effectively communicate, wemust realise that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.” Anthony Robbins
  • 60.
    What is emotionalintelligence (EQ)?
  • 61.
    What you say(or what you believe you are saying!) What is heard/ understood Expectations Hopes Fears Previous experiences Prejudice Mood/state of mind Distractions – internal and external Assumptions
  • 62.
  • 63.
  • 64.
    “The single biggestproblem in communication is the illusion that it has taken place.” George Bernard Shaw
  • 65.
    “The biggest communication problemis that we do not listen to understand. We listen to reply.”
  • 66.
    Listening attentively –am I giving my full attention? Listening accurately – am I understanding what they are saying? Listening empathetically – do I really appreciate their feelings? Listen generatively – are you helping the other person through your dialogue? Ways of Listening
  • 67.
    Reflecting – wordfor word Summarising– precis of their words Paraphrasing – putting their words in to mine Pre-framing– “I think I heard you say…” “Or in other words…” Ways of Demonstrating you are Listening
  • 68.
  • 69.
    Interactional Small talk Polite, fillsa gap. You might say nothing of importance. Person might not be listening. Doesn’t really achieve anything. Transactional Asking someone to do something for you. Ordering a coffee. Polite (hopefully!) and (hopefully!) achieves accomplishing a task. Transformational Engaging in genuine dialogue. Involves proper listening. Might be uncomfortable. Increases our awareness and understanding. Builds trust and rapport. Creates a shift, a change.
  • 70.
    @horizonsnhs Personal styles Analytical •formal •measured +systematic •seek accuracy / precision •dislike unpredictability and surprises Driver •business like •fast + decisive •seek control •dislike inefficiency and indecision Amiable •conforming •less rushed + easy going •seek appreciation •dislike insensitivity and impatience Expressive •flamboyant •fast + spontaneous •seek recognition •dislike routine and boredom Controls emotions Ask Tell Shows emotions Merrill D, Reid R (1991) Personal Styles and Effective Performance, CRC Press, London
  • 71.
  • 72.
  • 73.
    @horizonsnhs So What? • Natureof social media means content is fleeting, even viral content. • Millions of people might have seen your content, but has it had an impact? How do you know? OR
  • 74.
    @horizonsnhs Spread and Reach •Focus on maximising spread and reach, rather than trying to ‘go viral’. • Share good content that is consistent with your brand • Find your people – communities, social movements, hashtags • Calls to action
  • 75.
    @horizonsnhs Influence …but numbers arenot the whole picture. What is the story behind the numbers? What impact have you had?
  • 76.
    @horizonsnhs Influence and Impact ItIS about • Engagement: starting conversations • Communities: like-minded people collaborating • Quality, not quantity • Generosity and support • Inclusivity: all voices are welcome • Authenticity, not ‘playing the game’ (and these factors are why #MatExp works so well on Twitter)
  • 77.
    @horizonsnhs Activity! How does yourcurrent Twitter brand fit with what you want to be known for? Think about • Do you need to make any changes? • If yes, what changes will they be? • How will you action those changes? • Think SMART goals
  • 78.
    @horizonsnhs Maximise your reach,spread, influence and impact • Be authentic • Be generous – be kind, give advice, share interesting content • Pump up the volume: use complementary platforms such as blogs, Steller, Storify to give your messages and voice longevity (this can also help you become a thought leader in your area of specialism).
  • 79.
    @horizonsnhs What kind ofcontent has the best reach and spread? • Stories with high emotion – whether happiness or anger • The WOW or aaah factor • Social currency
  • 80.
  • 81.
    @horizonsnhs Twitter Turn Ons •Be polite • Be kind • Be relevant • Be authentic • Engage • Find your people • Share relevant content • Say thanks, give credit where due • Me, me, me • Keep saying the same thing again and again and again…. • Cliques • Rudeness • Broadcasting, no interaction • Auto-DMs Twitter Turn Offs
  • 82.
    @horizonsnhs Lessons from Twitter Fails Bewareautomated tweets Sense check your hashtags! Giraffes don’t live in Ghana If you engage professional PR support, don’t make it look too obvious!
  • 83.
  • 85.
    “Energy for change”is defined as The capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals http://www.institute.nhs.uk/tools/energy_for _change/energy_for_change_.html #beingvisible
  • 86.
    Energy is thestrength and vitality required for sustained physical or mental activity. Change: Make or become different #beingvisible
  • 87.
    Teams perform bestwhen five energies are high Psychological Physical Spiritual Social Intellectual Source: http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html #beingvisible
  • 88.
  • 89.
    Social Energy Energy ofpersonal engagement, relationships and connections between people It’s where people feel a sense of “us and us” rather than “us and them” #beingvisible
  • 90.
    Spiritual energy Energy ofcommitment to a common vision for the future, driven by shared values and a higher purpose Gives people the confidence to move towards a different future that is more compelling than the status quo #beingvisible
  • 91.
    Psychological energy Energy ofcourage, resilience and feeling safe to do things differently Involves feeling supported to make a change and trust in leadership and direction #beingvisible
  • 92.
    Physical energy Energy ofaction, getting things done and making progress The flexible, responsive drive to make things happen #beingvisible
  • 93.
    Intellectual energy Energy ofanalysis, planning and thinking Involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/evidence #beingvisible
  • 94.
    High and lowends of each energy domain Social isolated solidarity Spiritual uncommitted higher purpose Psychological risky safe Physical fatigue vitality Intellectual Illogical reason HIGHLOW #beingvisible
  • 95.
  • 96.
    The challenge of disproportionatelyhigh intellectual energy Intellectual energy on its own isn’t transformational It keeps leaders in their comfort zone (intellect to intellect) #beingvisible
  • 97.
    What is theenergy in your team like? #beingvisible
  • 98.
  • 99.
    What can YOUdo to improve energies in your team? #beingvisible
  • 100.
  • 101.
    Tools… • Brainstorming throughdifferent viewpoints: Fresh eyes • De bono’s 6 thinking hats • Liberating Structures: TRIZ
  • 102.
  • 103.
    @horizonsnhs TRIZ • It’s aRussian acronym: “Teoriya Resheniya Izobretatelskikh Zadach” • A problem solving, analysis and forecasting tool. • Depersonalising and unpicking topics that people are passionate about. • Part of ‘Liberating Structures’ – Frameworks that make it possible for people and organisations to create, do new things, to be innovative.
  • 104.
    @horizonsnhs TRIZ How could wecould reliably create a trainee programme that NEVER works and is totally ineffective? TRIZ
  • 105.
    @horizonsnhs Step 1 As atable, make a list of all the things that we could do to ensure we meet our goal: How could we could reliably create a trainee programme that NEVER works and is totally ineffective? • Go wild! • Use post it notes (one per action!) • 10 minutes TRIZ
  • 106.
    @horizonsnhs Step 2 As atable group, go down your first list and ask: Is there anything that we are currently doing that in any way, shape or form resembles any of the actions on your post it notes? • If yes, move these post it notes to sheet 2. • Be unforgiving about these items and talk about their impact • 10 minutes TRIZ
  • 107.
    @horizonsnhs Step 3 As atable group, go down your second list from step 2 and ask: What could be stopped? • Take these post it notes and move them to sheet 3. • 10 minutes TRIZ
  • 108.
    @horizonsnhs Step 4 From theactions that can be stopped, discuss and create an action plan for the stopping these activities. • 10 minutes TRIZ
  • 109.
  • 110.
    The Change Challenge Tappingthe collective brilliance of the NHS
  • 111.
    14,000 contributions identified 10barriers 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 Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015
  • 112.
    @horizonsnhs Front line teamsget inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on Increasing number of messages as information cascade through the organisation Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail- don.aspx
  • 113.
    14,000 contributions identified 11building 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
  • 114.
    @horizonsnhs After years ofintensive analysis, Google discovered that the key to high performing teams that deliver change is psychological safety Project Aristotle: https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja- xoaZybvz9f0b1_6bJyG7zZO6L