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Transformational themes that will shake the world of healthcare improvement

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This is Helen Bevan's presentation for Session F1 at the International Forum on Quality and Safety in Healthcare, Paris 10 April 2014

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Transformational themes that will shake the world of healthcare improvement

  1. 1. Helen Bevan Chief Transformation Officer, Horizons Group @HelenBevan #Quality2014 #f1 10 April 2014
  2. 2. The story • Framing the future in the past and present story • Five transformational forces that are changing the world • Five ways to thrive and survive in the new world • The future story @@HelenBevan #Quality2014 #f1
  3. 3. Time present and time past Are both perhaps present in time future, And time future contained in time past. T. S. Eliot, Four Quartets 1936 @@HelenBevan #Quality2014 #f1
  4. 4. What was once…… A digital story for our time @@HelenBevan #Quality2014 #f1
  5. 5. Here between the hither and the farther shore While time is withdrawn, consider the future And the past with an equal mind T.S Eliot, The Dry Salvages (1941) @@HelenBevan #Quality2014 #f1
  6. 6. the person next to you @@HelenBevan #Quality2014 Tell one of your own stories about change How does your past experience impact on your view of the future? @@HelenBevan #Quality2014 #f1
  7. 7. WHAT IS HAPPENING IN THE WORLD OF CHANGE? 1. Change is happening at a faster rate @@HelenBevan #Quality2014 #f1 AND is becoming more disruptive Source of image:
  8. 8. 2. New digital tools enable us to be in almost constant contact with almost everyone in the world @@HelenBevan #Quality2014 WHAT IS HAPPENING IN THE WORLD OF CHANGE? @HelenBevan #Quality2014 #f1
  9. 9. 3. The increasingly complexity of the work environment is eroding hierarchical management structures/styles @@HelenBevan #Quality2014 WHAT IS HAPPENING IN THE WORLD OF CHANGE? @@HelenBevan #Quality2014 #f1
  10. 10. 4. Work is changing: Complex work is getting more complex The pace of creative work is accelerating @@HelenBevan #Quality2014 WHAT IS HAPPENING IN THE WORLD OF CHANGE?
  11. 11. 5. Creative processes are moving to the edges of our organisations @@HelenBevan #Quality2014 WHAT IS HAPPENING IN THE WORLD OF CHANGE? @@HelenBevan #Quality2014 #f1
  12. 12. Whilst back in the world of health and care... Many of the ways we go about improving health and care were designed in a different mindset for a different set of circumstances @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  13. 13. Some warnings The organizations that survive the future will be those that are capable of changing as fast as change itself Gary Hamel If the rate of change on the outside exceeds the change on the inside, the end is near Jack Welch ‘‘ ’’ ‘‘ ’’@@HelenBevan #Quality2014 #f1
  14. 14. In the near future, the edges will be where almost all high-value work will be done in organizations……. Organizational development and change management need to move to the edges, and quickly. Harold Jarche (2014) @@HelenBevan #Quality2014 Moving to the edge @@HelenBevan #Quality2014 #f1
  15. 15. Source: @HelenBevan @@HelenBevan #Quality2014 Leading from the edge From the centre From the edge @@HelenBevan #Quality2014 #f1
  16. 16. 5 ways to lead from the edge - and thrive 1. Embrace disruption 2. Curate knowledge 3. Build bridges to connect the disconnected 4. Roll with resistance 5. It starts with me @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  17. 17. 5 ways to lead from the edge - and thrive 1. Embrace disruption @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1 lc Source of image:
  18. 18. Hierarchy alone won’t deliver the changes Source of image: ions-trolls-10-years-of-the-cipd-online- community @@HelenBevan #Quality2014 John Kotter: Accelerate! @@HelenBevan #Quality2014 #f1
  19. 19. is the new normal! “By questioning existing ideas, by opening new fields for action, change agents actually help organisations survive and adapt to the 21st Century.” Céline Schillinger Image by @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  20. 20. @chagww @corprebels Across the world, the change agent movement Is exploding! @rebelsatwork
  21. 21. Valuing radicals @@HelenBevan #Quality2014 Huxley,defendingDarwin‟s theoryofnaturalselection “New truths begin as heresies” @@HelenBevan #Quality2014 #f1
  22. 22. Rock the boat, but stay in it! Walk the fine line between difference and fit, inside and outside Source: Debra Meyerson @@HelenBevan #Quality2014 Able to challenge the status quo when we see that there could be a better way Capable of working with others to create success NOT a destructive troublemaker Conform AND rebel We need @@HelenBevan #Quality2014 #f1
  23. 23. Rebel or troublemaker? Troublemaker Rebel Complain Create Me-focused Mission-focused Anger Passion Pessimist Optimist Energy-sapping Energy-generating Alienate Attract Problems Possibilities Alone Together @@HelenBevan #Quality2014 Source : Lois Kelly @@HelenBevan #Quality2014 #f1
  24. 24. Discussion • Are you are a rebel or a troublemaker? • What moves people from being “radical” to “troublemaker”? • How do we prevent people falling out of the boat? @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  25. 25. Probably the largest simultaneous improvement initiative in the history of healthcare A disruptive case study @HelenBevan #Quality2014 #f1
  26. 26. Aim: to create a mass movement of grass roots NHS staff and people who work with and use the NHS to pledge a simple act that can contribute to better patient care
  27. 27. It started with a tweet in June 2012! Young clinical leaders and improvement leaders started to talk about how they could improve care Damian Roland Stuart Sutton Helen Bevan @HelenBevan #Quality2014 #f1
  28. 28. Probably the only winner of a global challenge to develop leaders in the corporate world that names Saul Alinsky and Marshall Ganz as major influencers @HelenBevan #Quality2014 #f1
  29. 29. NHS Change Day: vital statistics Nearly 750,000 pledges to take action • 81 separate Campaigns • 86 million twitter impressions • 35,400 video views on YouTube and Vimeo • 95,000 daily reach on Facebook @HelenBevan #Quality2014 #f1
  30. 30. Insert Change Day film
  31. 31. Evaluating NHS Change Day • We‟re evaluating intention (pledging), initiation (doing) and their outcomes (delivering) • We‟re developing and testing new methods to show impact • We want to build new theory of large scale change @HelenBevan #Quality2014 #f1
  32. 32. Change Day is spreading……. Australia Sweden N Ireland Denmark Canada Netherlands Saudi Arabia Finland…….and many more @HelenBevan #Quality2014 #f1
  33. 33. 5 ways to lead from the edge - and thrive 2. Curate knowledge @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1 Source of image: John Curran
  34. 34. Finding things out and determining what’s valid from what’s just noise CURATION …It’s about identifying networks and communities and seeing where the nodes and amplifiers sit …It’s about quality and coherence, not volume and mass Julian Stodd @@HelenBevan #Quality2014 #f1
  35. 35. Because there’s a problem…. Source of quote: Harold Jarche Source of image: Getting information off the internet is like taking a drink from a fire hydrant Mitchell Kapor @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  36. 36. A big challenge for improvement leaders Tacit knowledge is where the action is…. • It‟s the people with tacit knowledge who deliver the results • Tacit knowledge is critical for large scale change ...but The only way tacit knowledge can be broadly shared… …is to turn it into explicit knowledge VERY difficult Few organisations succeed Gray D (2012) The Connected Company Source: Harold Jarche @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  37. 37. Tacit knowledge... “ best developed through conversations and social relationships” Source of image: Harold Jarche @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  38. 38. Curating knowledge from the edge @@HelenBevan #Quality2014 Finding things out and keeping up to date • “pulling” information, but also having it “pushed” to us by trusted sources Making sense and meaning of information • Reflecting and putting into practice what we have learned • Plugging information into our own mental models and turning it into knowledge Connecting and collaborating • Sharing complex knowledge with our own work teams • Testing new ideas with our own networks • Increasing connections through social networks Source: Harold Jarche @@HelenBevan #Quality2014 #f1
  39. 39. 5 ways to lead from the edge - and thrive 3. Build bridges to connect the disconnected @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  40. 40. The Network Secrets of Great Change Agents As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy @@HelenBevan #Quality2014 If you want to create small scale change, work through a cohesive network If you want to create big change, create bridge networks between disconnected groups Julie Battilana &Tiziana Casciaro @@HelenBevan #Quality2014 #f1
  41. 41. 5 ways to lead from the edge - and thrive @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  42. 42. Diagnostic and dialogic approaches to “resistance to change” @@HelenBevan #Quality2014 #f1
  43. 43. Resistance: a diagnostic approach • Change is something that happens “out there” in the organisation or system • Resistance is a force to overcome • Resistance prevents change • Change agents must diagnose, manage and/or overcome resistance • Resisters otherwise known as “laggards”, “blockers”, “in denial” @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  44. 44. Much of the resistance literature is “diagnostic”
  45. 45. Diagnostic: the role of the change agent “The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to implement successfully and may not succeed at all” David Stonehouse The change agent: the manager‟s role in change British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445 @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  46. 46. Resistance: a dialogic approach • People make their own reality • Change results from transformational conversations – involving more and different people in change discussions – altering how and which people engage with each other – by stimulating different perspectives to shape how people think about things • Resistance is an inevitable consequence of a complex change process (based on diversity) • Resistance should be embraced and worked with @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  47. 47. Dialogic: the role of the change agent 1. Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system, and by being welcoming 2. Creat-e opportunities for everyone to express their views, spot opportunities and build on each other‟s ideas 3. Create ways for people to reflect together to find meaning, understanding and shared purpose in the change @@HelenBevan #Quality2014 Source: Peggy Holman @@HelenBevan #Quality2014 #f1
  48. 48. “The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities.” Source of image: Diversity: critical to innovation @@HelenBevan #Quality2014 “Do this before you start hiring consultants and rethinking your innovation process; there is no process that works without true diversity.” Idris Moore @@HelenBevan #Quality2014 #f1
  49. 49. 5 ways to lead from the edge - and thrive 5. It starts with me @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  50. 50. Source of image: „I do not think you can really deal with change without a person asking real questions about who they are and how they belong in the world‟ David Whyte, The Heart Aroused (1994) @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  51. 51. Transformational Change Agent: Peter Fuda Skills and methods for creating change Ability to make sense of, and reshape perceptions of „reality‟ Personal characteristics and qualities @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  52. 52. Peter Fuda’s framework: my perspective “Doing” • Where most change agents in health and care put most of their effort and emphasis • What others typically judge us on • What we often perceive we need to do to add value • What most change and improvement training focuses on @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  53. 53. Peter Fuda’s framework: my perspective “Seeing ” and “Being” • We can only do effective “doing” if we build on strong foundations of “seeing and being” • Change begins with me • Hopeful futures, creative opportunities and potential • Multiple lenses for change • See myself in the context of my higher purpose @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  54. 54. A case study in “it starts with me”: The School for Health and Care Radicals @@HelenBevan #Quality2014 #f1
  55. 55. Source: @NHSChangeDay @@HelenBevan #Quality2014 Can I, dare I? @@HelenBevan #Quality2014 #f1
  56. 56. The School for Health and Care Radicals • A virtual school • Anyone can join • Five weeks of virtual lectures, study guides, materials, tweet chats • Set up with three weeks notice • Demonstrate learning to get a virtual badge
  57. 57. The School for Health and Care Radicals  More than 1,500 enrollees from 27 countries  Around 150 people will complete full certification  90 volunteer mentors  Average weekly twitter reach 2.6 million  Over 10,000 shares of the slides on SlideShare  More than 2,000 shares of the study guides  More than 5,000 tweets using #SCHRchat  Storify has been viewed 1,000 times @@HelenBevan #Quality2014
  58. 58. We learnt... 1. There is a massive untapped reservoir of energy and talent out there and the potential is outstanding 2. The core audience is different to that which we anticipated 3. The most important need is for connection and community 4. How to build the relationship between tacit and explicit knowledge 5. It‟s early days but this is an efficient, high leverage way to build capability for motivated individuals @@HelenBevan #Quality2014
  59. 59. 5 ways to lead from the edge - and thrive 1. Embrace disruption 2. Be a curator of knowledge 3. Bridge bridges to connect the disconnected 4. Roll with resistance 5. It starts with me @@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1
  60. 60. @@HelenBevan #Quality2014 What might be… a digital story for the future It’s 2020… @@HelenBevan #Quality2014 #f1
  61. 61. A call to action • Identify your own opportunities to move to the edge • Think about the mindset, skills and relationships you need for the future • Start changing at a faster rate of than the outside world @@HelenBevan #Quality2014
  62. 62. References @@HelenBevan #Quality2014 Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Change Agents Worldwide (2013) Moving forward with social collaboration SlideShare Diaz-Uda A, Medina C, Schill E (2013) Diversity‟s new frontier Feitler D (2014) The case for team diversity gets even better Fuda P (2012) 15 qualities of a transformational change agent Gray D (2012) The Connected Company Hamel G (2014) The busting bureaucracy hackathon: escaping the management tax Jarche, H (2013) Rebels on the edges Jarche H (2014) Moving to the edges Llopis G (2014) Every leader must be a change agent or face extinction Meyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BP Moore I (2013) Diversity is the short cut to building an innovation culture Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated Shinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadership Williams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activism Verjans S (2013) How social media changes the way we work together SlideShare @@HelenBevan #Quality2014 #f1
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This is Helen Bevan's presentation for Session F1 at the International Forum on Quality and Safety in Healthcare, Paris 10 April 2014


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