Leading into the future

@HelenBevan #HQT2016
Joining in this session
• The theme of the session is
connectivity and platforms
for change
• Please tweet using hashtag
#HQT2016
• A challenge: make our
Twitter conversational
• We will get some feedback
on Twitter activity during the
session

What is happening in the field of
change and transformation in the
wider world?

Change is changing

What approaches to change are needed
in this environment?

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

Starts on the fringe
(at the edge)
Starts with the activists
Gary Hamel
always

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

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

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/systems affected
by change

The essential flaw of quality improvement
approaches
The essential flaw of [quality
improvement ] is that, when
implemented, it tends to reinforce
the mechanistic and hierarchical
models that are consistent with
the mental maps of most
managers
Chris Argyris, Flawed advice and
the management trapSource of image:
www.biblicalcreation.org.uk Read more at: http://www.slideshare.net/jurgenappelo/management-30-workout

Is your change process a cathedral or a
bazaar?
http://www.unterstein.net/su/docs/CathBaz.pdf

We have a lot of cathedrals
Source: Sewell (2015) : Stop training our project managers to be process junkies

The power of the platform
“Facebook, YouTube, Twitter and their lesser cousins have
proved the power of the platform. They have shown that if
your average 21st century citizen is given the tools to
connect and the freedom to create, they will do so with
enthusiasm, and often with an originality that blindsides
the so-called creative industries. …..
Good leadership is no longer about ‘taking charge’ or
imposing a strategic vision but about creating the
platforms that allow others to flourish and create”
Ashoka
http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in-
the-21st-century

“Change comes
naturally when
individuals have a
platform that
allows them to
identify shared
interests and to
brainstorm
solutions.”
Gary Hamel & Michele
Zanini, 2014
Build a change platform not a
change program

• systematic “change
management”
• too often, leaders
prescribe outcome
and method of change
in a top-down way
• change is experienced
by people at the front
line as “have to”
(imposed) rather than
“want to” (embraced)
Change
Programmes
• everyone (including
service users and families)
can help tackle the most
challenging issues
• value diversity of thought
• connect people, ideas and
learning
• Role of formal leaders is to
create the conditions and
get out of the way
Change
Platforms
“Tear down the walls”

Why platforms?
“Platforms today power learning and innovation
at the speed of change by providing
collaborative and sometimes exponentially
productive spaces for people to create value”
John Hagel
Source of image: Pinipa

Evolving kinds of change platforms:
They overlap!
1. Connecting platforms
2. Mobilising platforms
3. Learning platforms
4. Knowledge platforms
5. Crowdsourcing platforms

Example platforms
Source of image: @JenniferClemo

http://biggerboat.org/exploring-moodocs/
MOODOCs
(Massive, Online, Open, Disease Oriented Communities)

The Academy of Fabulous Stuff
• Half a million page views
• Over 700 fab shares
• 1,500 to 4,000 page views
a day
• Nottingham Safe staffing
app: 2,500 views
• Dovetailing vaccinations
Scheme: 160 direct queries

https://youtu.be/eUApgJBZU8M

Source: OpenIdeo https://challenges.openideo.com/challenge/end-of-life/refinement

Our Sli.do change platform
What one thing would make the biggest
difference in improving the healthcare system?

Adding your idea about “one thing”
• Go to Sli.do
• Add the event code #7674 and click “join
event”
• In the space that says add
your tip
• Don’t forget to add your name before you
click
• Vote for the answers you like best by clicking
on the thumbs up

The prize

A collaboration maturity model
We aspire to get to the “innovate” (platform) level
Source: Simonterry.com

Organisations that are nearing the innovate
(platform) level

Source: @NHSChangeDay

Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

10,000
Nearly

The School was formally evaluated by the Chartered
Institute for Personnel & Development
#EdgeTalks WebEx
http://theedge.nhsiq.nhs.uk/expert
/how-has-the-school-for-health-
and-care-radicals-made-a-
difference/
How has the School for Health and Care
Radicals made a difference?

The School was formally evaluated by the Chartered
Institute for Personnel & Development
• Change knowledge
• Sense of purpose & motivation to improve practice
• Ability to challenge the status quo
• Rocking the boat & staying in it
• Connecting with others to build support for change
Statistically significant positive effect on at
both individual and organisational level

Nearly
100,000
connections
(defined as a viewing, a
download of material or an
original tweet)
• Latest no-cost
solutions
• 150 speakers
• 28 topics
• Live broadcast and
on-demand

The People’s Transformathon
#CoPro16
“A new relationship with patients and
communities”
Global online event co-created by
patients, caregivers, the voluntary
sector & NHS England Horizons team.
Showcasing the range of innovation and
improvement initiatives in which citizens
are involved as equal partners in the UK &
worldwide. #EveryoneIncluded
Join us on 28th November. 12-8pm GMT

Should we undertake routine radiology
investigations overnight for all our inpatients?
How to build
a change
platform in
an hour

Some lessons
1. You can’t control the outputs of the crowd
2. People want a relationship
3. Always, always, follow up

The Natural Environment Research Council asked the
crowd to name its new £200 million polar research vessel

TEN TIMES
as many
votes as the
next most
popular
answer

”If people give to a cause,
they expect a relationship,
not a transaction”
Nilofer Merchant
Once you start down this path, you
have to follow up and continue

1. Frame the issues in ways
that will engage and
mobilise the imagination,
energy and will of diverse
stakeholders
2. Take steps to be more social
leaders, invest in digital
skills & social connections &
lead through networks as
well as formal leadership
systems
3. Find your B-list people &
give them important tasks
4. Consider what/where your
equivalent of ‘the edge’ is, so
that you incubate radical &
disruptive ideas & lead
healthcare from the future
5. Build change platforms for
important issues – create
bazaars alongside the cathedrals
6. Adopt emergent approaches to
planning & design, based on
monitoring progress, learning &
adapting as you go

Four ways to connect!
1. Follow us on Twitter
@HelenBevan
@School4Radicals
2. Subscribe to
theedge.nhsiq.nhs.uk
3. Get materials from
theedge.nhsiq.nhs.uk/school
…and sign up for our monthly #EdgeTalks
theedge.nhsiq.nhs.uk/edgetalks

Ashoka (2014) What does leadership mean in the 21st century?
Berg O (2014) The Collaboration Pyramid revisited
Bevan H (2015) From change programmes to platforms
Briggs D (2015) The elements of council as a platform
Bromford P (2015) What’s the difference between a test and a pilot?
Chesbrough H et al (2016) Why does open innovation work?
Choudray P (2015) The platform manifesto: 16 principles for digital transformation
Dawson R (2015) The future of work and organisations
Deloitte University Press (2014) A movement in the making
Deloitte University Press (2015) Business ecosystems come of age
Hagel J (2015) The power of platforms
Hagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movements
Hagel J (2014) Platforms are not created equal: harnessing the full potential of platforms
Hamel G, Zanini J (2014) Build a change platform not a change program
Health Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’
interactive toolkit
Heimans J (2014) What new power looks like [YouTube]
References cited in the slide deck (1/2)

Heimens J, Timms J (2014) Understanding “New Power”
Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers
Little J (2016) Change management is dead
Milton N (2014) Why knowledge transfer through discussion is 14 times more effective
than writing
O’Reilly T (2010) Government as a platform
Pearce D (2013) Social business discussions are the new documentation
Raymond E S (2001) The Cathedral and the Bazaar
Satell G (2015) 4 things you should know about platforms
Satell G (2012) How power is shifting from corporations to platforms
Satell G (2015) Leaders must do more than inspire – we must shape networks
Schillinger C (2015) Forget social networks, think social impact [YouTube]
Scrivens J (2015) Enabling the experience of wholeness within enterprise social networks
Sewell S (2015) Stop training our project managers to be process junkies
Shaw K (2015) Placing a digital platform at the heart of organisational change with Oxfam
Simon P (2011) The Age of the Platform
Van Alstyne et al (2016) Pipelines, platforms, and the new rules of strategy
References cited in the slide deck (2/2)

Leading into the future

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