creating the strategic conditions...o empower staff to be the leaders and activists of change o...
TRANSCRIPT
Creating the
Strategic
Conditions
Rebecca Joyce
Service Improvement Director
Mark Cobb
Clinical Director,
Therapeutics & Palliative Care
Leadership
Culture
Strategy
A future of uncertainty,
complexity, ambiguity
Increasing
expectations and
need
£22 bn funding
gap
A need to do things differently
Emerging themes in large scale change
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
Tried and tested,
based on experience
“ Open” approaches , sharing
ideas & data, co-creating
change
Transactions Relationships
Dominant
approach Emerging
direction
From Helen Bevan, 2013
A polarity (not either/or)
From Helen Bevan, 2013
To support MND research on donate via
justgiving.com/IceBucket4MND or Text ICED55 £5 to 70070.
To support MND research on donate via
justgiving.com/IceBucket4MND or Text ICED55 £5 to 70070.
The Ice Bucket Challenge…
• Origins unclear – US “cold water challenge”
– Celebrities
– Ease of spread
– Fun
– Mid July – Aug 14
• > 2.4 m Facebook videos (end Aug 14)
• 1 in 6 people in UK participated
• Estimated that $150,000,000 extra donations
Leadership
Culture
Strategy
Strategy Strategy as
orientation
Strategy as animation
Differentiation:
fixed position
Emergence:
evolving pattern
Strategy as a specialist
skill
Strategy as a shared
process
Leader as visionary Leader as orchestrator
Divergent thinking Divergent and convergent
thinking
Revolutionary change Evolutionary change
Fixed position,
perfect fit
Many positions,
changing shape
Chris Bilton (2007)
o set bold aims to improve
o establish transparent metrics of progress
o invite patients, carers, communities into
every single part of the system
o empower staff to be the leaders and
activists of change
o cease fear and blame; develop pride and
joy
o develop collaborative learning
Donald Berwick,
IHI/BMJ International Forum on Quality and Safety in Health Care, London 2015
Strategy
Culture Lawton et al (2011) BMJ Quality & Safety
The myopic focus on errors, harm and near misses
has been sending negative messages for a long
time. Politicians, bureaucrats, managers, the
media and those leading enquiries as far back as
Bristol Royal Infirmary… have essentially indicated
to clinicians:
you are prone to making mistakes, and we must
insist that you reduce the harm or potential harm
you cause; and if you do not, we will regulate your
activities, tightening the rules over time.
Culture
Culture In most organizations and communities
there are people or groups of people who
solve problems better than colleagues with
the exact same resources, who display
uncommon but successful behaviours or
strategies: these are the positive deviants
Culture Marra et al (2011) Am J Infection Control
• Positive deviants: HCWs who wanted to
change, to think, and to develop new ideas
for improving hand hygiene and who
stimulated other HCWs to use the alcohol gel
product.
• There was a statistically significant reduction
in the incidence density of all HAIs and
device-associated infections.
What do they all
have in common? Culture
….. Experimentation &
creativity… Culture
Culture
1. Doing the right things
2. Doing things right
3. Doing things better
4. Doing away with things
5. Doing things that other people are doing
6. Doing things no one else is doing
7. Doing things that cannot be done
(Smith/Plsek)
lean translation
and adoption
invention
innovation
research
“Collective leadership cultures are
characterised by all staff focusing on
continual learning and through this,
the improvement of patient care.”
Michael West et al, Developing Collective Leadership for HealthCare, King’s
Fund, 2015
Culture
Development of the
Surgical Checklist
• 8 hospital test
• 36% reduction in major complications
• Deaths fell 47%
• Post-op complications reduced 25%
• Correlation between teamwork scores
& reduction in complications
• Incorporates strategy to foster team work
& communication – ie, team huddle
• “activation phenomenon”
Atul Gawande, The Checklist Manifesto, 2011
Culture
Meet the anti-coagulation team
Reduced overtime
Reduced referral turnaround
time
Increased staff satisfaction
Increased patient satisfaction
Increased fun
How does the team feel now?
““Although work seems as difficult as ever on
some days, there are more days where I think ...I
have actually enjoyed today!!”
“Lots of hard work so far from
the team - and it has yielded
improvements! Remember
to think about what has been
achieved”
“I feel more empowered”
“Actually getting involved
and having a say about
how we are going to
change things, I must say I
have really enjoyed it”
Leadership
Leadership • We are part of the system we are
seeking to change.
• Build you own and others’ capabilities
to see the bigger picture, to be
inquisitive, to hear the voice of
patients, and to continually learn.
• Practice climate control: create the
conditions necessary for change and to
enable collective wisdom &
intelligence to emerge.
Leadership
Quality
Initiative
Directorate Ecology for Improvement
How are your team’s improvement
skills?….
RHH
S
WPH
JW
OSSCA Spec Med &
Rehabilitation
Diagnostics &
Therapeutics Head &
Neck
Emergency
Care
Corporate
Surgical Services
Emergency
Care
Surgical
Services
Spec Med &
Rehabilitation
SYRS
Diagnostics &
Therapeutics
Corporate
Community
Opportunity to
aggregate gains or
help prompt a
cultural shift?
o hear the voice of the patient as person
o Spread of change – innovation,
messiness, network, but united with
strategic intent
o strategy as “animation”, leader as
enabler/ orchestrator
o a culture which encourages the
creative and positive deviants
o improved ownership, team work and
engagement gets better performance
Culture
Strategy
Leadership
o grow an ecology in which
improvement and innovation can
flourish
o explicitly value and prioritise
improvement activity
o use the resource around you – skill up
your people
o make improvement and innovation
ubiquitous through events, learning,
permissive culture, business
agendas…
Culture
Strategy
Leadership
Table Exercise
Seven success factors for change in the NHS
Allcock et al (2015) Constructive comfort: accelerating change in the NHS
http://www.health.org.uk/sites/default/files/ConstructiveComfortAcceleratingChangeInTheNHS.pdf
Things to celebrate What you can do to help
improvement flourish
Committed and respected
leadership that engages staff
A culture hospitable to, and
supportive of, change
Management practices that
ensure rigorous execution and
implementation.
Data and analytics that
measure and communicate
impact
Capabilities and skills to
identify and solve problems
Resources and support for
change
An enabling environment
which supports and drives
change.
References
Allcock et al (2015) Constructive comfort: accelerating change in the NHS. [Available to
download from the Health Foundation]
Donald Berwick, IHI/BMJ International Forum on Quality and Safety in Health Care,
London 2015
From Helen Bevan, Slide Pack from STH Presentation 2013
Chris Bilton (2007) Management and Creativity. Oxford: Blackwell
Atul Gawande, The Checklist Manifesto, 2011
Lawton et al (2011) BMJ Quality & Safety
Marra et al (2011) Am J Infection Control
Paul Plsek (2014) Accelerating Health Care Transformation with Lean and Innovation.
Florida: CRC/Taylor Francis
Michael West et al, Developing Collective Leadership for HealthCare, King’s Fund, 2015
John Whitmore(2002) Coaching for Performance