BEING a change agent

@HelenBevan #womenlead
“New truths begin as heresies”
(Huxley, defending Darwin’s theory of natural selection)
Source of image:
installation by the
artist Adam Katz
www.thisiscolossal.com
Via @NeilPerkin

@HelenBevan #womenleadSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

@HelenBevan #womenleadImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

Functional
thinking
(the things we do)
Change agents skills
Capability
thinking
(our ability to do
things)
Source of images: thenounproject.com

Peter Fuda’s Transformational Change
Agent Framework
Skills and methods for creating
change
Possibilities, opportunities, things in
a different light
A role model first and a preacher
second
Source: Peter Fuda (2012) 15 qualities of a
transformational change agent

What is happening in the wider world
that sets the context for change agents?

Change is changing

Kinthi Sturtevant, IBM
13th annual Change Management
Conference June 2015
We rarely see two, three or four
year change projects any more.
Now it’s 30-60-90 day change
projects

Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
Pilots are being replaced by rapid tests and
prototypes

Digital skills are a critical capability for future leaders of
improvement

How does the NHS improvement community
prefer to communicate?
Digital
Non-digital
ProactiveReactive
Source: RAND evaluation data from the Q community of improvement leaders

Change is changing
Change is moving to
the edge

An example from the
Cabinet Office
http://www.slideshare.net/Openpolicymaking/060715-change-cardscollated?next_slideshow=1

@HelenBevan
Why go to the edge?
“ Leading from the edge brings us
into contact with a far wider range
of relationships, and in turn, this
increases our potential for diversity
in terms of thought, experience
and background. Diversity leads to
more disruptive thinking, faster
change and better outcomes
Aylet Baron

Jeremy Heimens TED talk “What new power looks like”
https://www.youtube.com/watch?v=j-S03JfgHEA
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship

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

People who are highly connected
have twice as much power to
influence change as people with
hierarchical power
Leandro Herrero
http://t.co/Du6zCbrDBC

WHO will make the change happen?
Source: adapted by Helen Bevan
from Leandro Herrera
List A
• The STP Transformation
Programme Board [or
equivalent]
• The programme sponsors
• The Programme Management
Office
• The [insert number] STP
transformation work streams
• The Clinical Leads of
workstreams
• The Directors of participating
organisations
• The Change Facilitators

List A
Programme Board [or
equivalent]
Office
workstreams
organisations
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The contrarians, because they can
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected. Good or
bad, they 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
ones Source: adapted by Helen Bevan

List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The contrarians, because they can
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected. Good or
bad, they 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
ones Source: adapted by Helen Bevan
List A
Programme Board [or
equivalent]
Office
workstreams
organisations

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

How well are we equipping NHS change leaders for
this reality?
Survey of 70 candidates for post of Head of
Transformation, NHS Horizons team, July 2016:
• Most candidates educated to at least Masters level
• PRINCE 2 almost universal with Managing Successful Projects
and Lean methods well represented
• Very few described strategic approaches to change or focussed
on social methods of change
• Only limited descriptions of team /network based or facilitative
approaches to improvement
• Most engaged in technostructure (technical
advisory roles) – away from the locus of
power in health organisations (Mintzberg typology)
• Old power/List A approaches predominated

Let’s think about resources for change in
old/new power terms
Economic resources
diminish with use
• money
• materials
• human resources
Natural resources
grow with use
• relationships
• commitment
• community
Based on principles from Albert
Hirschman and Marshall Ganz

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/energ
y_for_change/energy_for_change_.html
Creating energy to enable transformation is
a top priority
‘
“Energy for change” defined as

What happens to large scale change
efforts in reality
In order of frequency:
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
Source: http://www.nhsiq.nhs.uk/8530.aspx
Why is energy for change
important?

Psychological
Physical
Spiritual
Social Intellectual
Change is most likely to happen when five
energies are high
Source: http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html

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”

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

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

Physical energy
Energy of action, getting things done and
making progress
The flexible, responsive drive to make things
happen

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

High and low ends of each energy domain
Social isolated solidarity
Spiritual uncommitted higher purpose
Psychological risky safe
Physical fatigue vitality
Intellectual Illogical reason
LOW
HIGH

Some questions
• Which group likely to have
higher spiritual energy
scores:
• clinicians
• non clinicians
• Nearer to CEO in the
structure:
higher or lower overall
energy scores?
Source: Respondents to the energy for change questionnaire NHSIQ/Horizons team

Some questions
• Which group likely to have
higher spiritual energy
scores:
• clinicians
• non clinicians
• Nearer to CEO in the
structure:
higher or lower overall
energy scores?
Source: Respondents to the energy for change questionnaire NHSIQ/Horizons team
Answers:

Energy analysis of six STP plans

Energy analysis of six STP plans
Source: energy for change discourse analysis of six draft STP plans by the
Horizons team September 2016

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)
Emotion is the fuel for change;
data and information provide
direction
Dan Heath
(author of Switch)

There has never been a time in the history of health
and care when this advice has been more pertinent
“Leadership is not about
making clever decisions
and doing bigger deals.
It is about helping
release the positive
energy that exists
naturally within
people”
Henry Mintzberg

The Change Challenge
Tapping the collective brilliance
of the NHS

@HelenBevan
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

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

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
Buy in from front line staff is critical for
improvements in quality and safety . Don’t
overload them
Buy in from front line staff is critical
for improvements in quality and safety
Don’t overload them
http://healthaffairs.org/blog/2014/03/07/the-
dangers-of-quality-improvement-overload-insights-
from-the-field/

@HelenBevan
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

Being a great change agent is about doing,
seeing and being change

Avedis Donabedian
Ultimately, the secret
of quality is love.
…… If you have love,
you can then work
backward to monitor
and improve the
system

Project Aristotle: http://qz.com/625870/after-years-of-intensive-
analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/
After years of intensive analysis, Google
discovers that the key to high performing,
teams that deliver change is
Being nice

Tactic for change agents:
Out-love everyone else
Source of image: Bradley Burgess

BEING a change agent

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BEING a change agent