c7/d7 leading large-scale change - h. bevan

© NHS Institute for Innovation and Improvement, 2009

Leading large scale change

Helen Bevan


Data on transformation efforts

• Only one in three transformation efforts hit the

ball out of the park

• Only one in twenty clear the car park as well

Source: McKinsey Performance Transformation Survey,

3000 respondents to global, multi-industry survey of

company executives


Risk assessment: why do large scale change efforts

fail?

• They get designed using the same mindset, beliefs and rules as

have been used before

• they get designed as top down, often structural, solutions rather

than transformation of complex adaptive systems

• lack of a holistic model or perspective which links components

together

• A “voltage drop” occurs between radical change aspirations and

the reality of implementation:

• organisations are neither capable of, nor ready for, the breadth

and depth of change

• operational and financial reality gets in the way of re-inventing the

system



fail?• They fail to mobilise clinical and managerial leaders

• Lack of emotional engagement and alignment of

incentives with core values

• Scale and pace:

• it typically takes far longer than the planning horizons

of leaders

• diffusion approach does not go to plan - we are able to

generate change (“pilots”), but unable to generalise it



fail?• They fail to mobilise clinical and managerial leaders

• Lack of emotional engagement and alignment of

incentives with core values

• Scale and pace:

• it typically takes far longer than the planning horizons

of leaders

• diffusion approach does not go to plan - we are able to

generate change (“pilots”), but unable to generalise it

In around 80% of cases, failure can be traced back to the

early stages: change programmes are most likely to go

wrong as a result of the way they are initially

conceptualised and planned


“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


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



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


The large scale change model

• “All models are wrong, some

models are useful” George E. P. Box, Statistician, UK, 1919-

• Practically speaking, how it tends to

goBased on case study evidence from a variety of

fields and settings


How large scale change happens in reality:

• There is a sufficiently well-defined topic area that people can

connect with

… on which there is a sufficient mix of pressure, will, incentive,

attraction, consequences, etc

… that it felt, by a small, but large-enough, group of people …

… who find some means to exert some influences …

… over systems at multiple levels (e.g. service delivery, hand-

over processes, clinical decision-making, finance flow, public

opinion, policy, etc) …

… to initiate some changes in a sufficiently effective and visible

way

• This pattern of framing/re-framing, engaging others, and initiating

changes at multiple levels repeats many times, in hard-to-predict

ways



• Momentum is created by the appearance of success

… that is communicated widely enough ---

… to attract others who were previously neutral to join in actively in the process of change …

… thereby creating another cycle of framing/re-framing, engaging others, and initiating changes at multiple levels

• This momentum then continues for some time until either :

1. The effort effectively “runs out of energy” and simply fades away

2. The change hits a plateau at some level and no longer attracts new supporters

3. The change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way



• The actual, full, measured results and unintended consequences from a true large scale change are often not known until some time into the future,

therefore, throughout most of the process of large scale change a certain amount of faith, intuition, judgement, and proceeding forward on incomplete evidence is inevitable


Our model of LSC

.

Identifying

need for

change

Framing/

reframing

the

issues

Engaging/

connecting

others

Making

pragmatic

change in

multiple

processesAttracting

further interest

After some

timeSettling in

Possible outcomes

1. sustainable norm

2. plateau

3. run out of energy

Living with

results and

consequences

Maybe later

Repeats

many

times in

hard to

predict

ways

Time delay


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


The ten key principles of large scale change

1. Movement towards a new vision that is better and

fundamentally different from the status quo

2. Identification and communication of key themes that

people can relate to and that will make a big difference

3. Multiples of things („lots of lots‟)

4. Framing the issues in ways that engage and mobilise a

lot of different people

5. Mutually reinforcing change across different parts of the

system


The ten key principles of large scale change

6. Continually refreshing the story and attracting new,

active supporters

7. Emergent planning and design, based on monitoring

progress and adapting as you go

8. Enabling many people to contribute to the leadership

of change, beyond organisational boundaries

9. Transforming mindsets, leading to inherently

sustainable change

10. Maintaining and refreshing the leaders‟ energy over

the long haul

© NHS Institute for Innovation and Improvement, 2009 Source: Marshall Ganz

Shared understanding

leads to Action

How did the great transformational

leaders change the world?

Strategy

What?

Narrative

Why?


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


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


mobilisingversus

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

Source: Marshall Ganz


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

inertiaurgency

anger apathy

solidarity isolation

you can make

a difference

Self-

doubt

hope fear

Ov

erc

om

e

Action motivators Action inhibitors



What the framing literature tells us

People are much more likely to embrace change if it

is framed as something that builds positively on what

they are familiar with than as something that seems

far away and unachievable.

“„a new idea must be at the least couched in the

language of past ideas; often, it must be, at first,

diluted with vestiges of the past”

Saul Alinsky Rules for Radicals

(1971)


Three components of

transformational change

(Fry 2002)

• Novelty / innovation

• Transition

• Continuity


“When you have gone as far that you

can‟t manage one more step, then you

have gone just half the distance that

you are capable of”

Proverb of the Inuit people of the Arctic Circle


What do we need to do?

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


story of

Selfcall to

leadership

story of

NowStrategy

and action

story of

UsShared values and

shared experience

PURPOSE

Public Narrative

Why

I am

called to

do this

workour shared

EXPERIENCE

reveals

our shared

VALUES



story of

Selfcall to

leadership

story of

NowStrategy

and action

story of

UsShared values and

shared experience

PURPOSE

Public Narrative

Why

I am

called to

do this

workour shared

EXPERIENCE

reveals

our shared

VALUES

we frame the

urgency and

hopefulness

necessary to secure

commitment and

build momentum

towards our shared

goal



Telling your narrative

“A good narrative is drawn from the series of

choice points that have structured the “plot” of

your life – the challenges you faced; choices you

made and outcomes you experienced”

• Challenge: why did you feel it was a challenge? Why

was it your challenge?

• Choice: why did you make the choice you did? Where

did you get the courage or hope? How did it feel?

• Outcome: How did the outcome feel? Why did it feel

that way? What do you want us to feel?



Show – don’t tell!

• Specific moments

• Specific people

• Specific values

• Specific challenges

• Specific choices

• Specific outcomes

…and well chosen vivid details!



Task

• Find a “partner” to work with

• Spend two minutes quietly developing your story

– The challenge, choice and outcomes should be

explicit

• A timekeeper will make sure that everyone sticks to

timings

• Share your story of self with your partner

• Coach each other on the stories

• Time allowed – two minutes per person to tell story

– two minutes per person to feedback


Feedback

• Was the

– challenge

– choice

– outcome

explicit?

• Could you identify with the person‟s values?

Where did they come from?

• Were the details vivid in ways that helped you

to identify what the person was feeling?


Made in Dagenham

The main character, Sandra, seeks to convince her

audience to take action

• What is the call to action that she is making?

• What fundamental values does she call on?

• What are the shared experiences that revel shared

values?

• How does she create a sense of “us”?


We have a choice

“This is the true joy of life, the being used up for

a purpose recognised by yourself as a mighty

one, being a force of nature instead of a

feverish, selfish little clot of ailments and

grievances, complaining that the world will

not devote itself to making you happy”

George Bernard Shaw


Fortnightly: 8:30am GMT Friday

(hosted by Director of Learning and

Development, Julia RA Taylor)

To register go to:

www.institute.nhs.uk/LargeScaleChange

For more details contact:

[email protected]

You can also get details of the latest

virtual training programmes from this

website

Six free web seminars for senior leaders (60 minutes each) from January 2012 to March

2012. You can download the recordings

These expert led seminars are designed to give you a rapid overview of the key ideas that

represent the latest thinking on leading large scale change.

1.Delivering large scale change: the reality of how to make it happen

Sarah Fraser (13th January 2012)

2.Creating energy to drive transformation

Helen Bevan (27th January 2012)

3.The leadership of large scale change

Helen Bevan & Karen Lynas (10th February 2012)

4.Large scale change in action

Case study site (24th February 2012)

5.Building widespread commitment

Julia RA Taylor (9th March 2012)

6.Spreading and sustaining large scale change

Sarah Fraser (23rd March 2012)

Leading Large Scale Change: Web seminars for senior leaders

http://www.institute.nhs.uk/LargeScaleChange

mailto:[email protected]