2. @horizonsnhs #civilservicelive
The Horizons team:
Change agents and change agency
• A small, diverse team of people within
NHS England that supports change
agents and builds change agency
• We tune into the latest change thinking and
practice in healthcare and other industries
around the world –translating this learning
into practical approaches to change
• The team has emerged through years of supporting
change in the NHS and the wider health and care
system
• Currently in the process of spinning out to become
a public sector mutual (PSM) owned by the staff
3. The seeds of radically different futures are
in the margins of the present
FORECASTING
Focus on expected future
Future is an extension of
the present
Surprises come from
changes in the value of
known variables
Focus on range of futures
The present contains the
seeds of radically different
futures
Surprises come from
changes that disrupt the
system
FORESIGHT
Source: CoLab Alberta
7. @horizonsnhs #civilservicelive
A changing world
We are witnessing the collapse of expertise
and rise of collaborative sensemaking
David Holzmer
Source of image: ACCA
8. @horizonsnhs #civilservicelive
The implosion of trust
”A person like yourself (60 percent) is now just as
credible a source of information about an
organisation as is a technical (60 percent) or
academic (60 percent) expert, and far more credible
than a CEO (37 percent) and government official (29
percent)”
http://www.edelman.com/news/2017-edelman-trust-barometer-reveals-global-implosion/
9. @horizonsnhs #civilservicelive
Jeremy Heimens, Henry Timms
This is New Power
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship
10. @horizonsnhs #civilservicelive
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
11. @horizonsnhs #civilservicelive
The 3% phenomena for change
Just 3% of people
in the organisation
typically drive
conversations with
90% of the other
people
Source: research by IC Kollectif
12. @horizonsnhs #civilservicelive
WHO will make the change happen?
List A
• The Delivery Board
• The programme sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Clinical Leads
• The Directors of
participating organisations
• The Change Facilitators
Source: adapted by Helen Bevan
from Leandro Herrera
13. @horizonsnhs #civilservicelive
WHO will make the change happen?
List A
• The Delivery Board
• The programme sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Clinical Leads
• The Directors of
participating organisations
• The Change Facilitators
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who 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
onesSource: adapted by Helen Bevan
from Leandro Herrera
14. @horizonsnhs #civilservicelive
WHO will make the change happen?
List A
• The Delivery Board
• The programme sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Clinical Leads
• The Directors of
participating organisations
• The Change Facilitators
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who 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
from Leandro Herrera
15. @horizonsnhs #civilservicelive
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
17. @horizonsnhs #civilservicelive
Mark Jaben on the science behind resistance
What NOT to do
Instead of buyers (who “buy-in”),
we need investors
What TO do
Engage
people here
Engage
people here
18. @horizonsnhs #civilservicelive
The predominant approach in recent years has been STRUCTURE
but globally there is a big shift towards AGENCY
The design dilemma at the heart of policy
implementation
19. @horizonsnhs #civilservicelive
Power is linked to AGENCY
• The capacity of individuals to make their own
choices and to take action in a given environment
• Words that are connected to agency:
• Action
• Activity
• Effect
• Influence
• Power
• Choice
23. @horizonsnhs #civilservicelive
Change agency and change agents
illuminate the way
We need more people willing to step outside of
expectations because our world is changing
exponentially, and if all we do is meet
expectations and the status quo - we will fall
behind as organisations, as teams, and as
societies.
David Bray
WE CAN DO IT
24. @horizonsnhs #civilservicelive
Individual AND collective agency
Individual agency:
People get more power
and control in their own
lives: patient activation,
shared decision-making
and self-care
Collective agency:
People act together,
united by a common
cause, harnessing the
power and influence of
the group and building
mutual trust
25. @horizonsnhs #civilservicelive
Building agency for large scale change
We do not become transformed alone, we
become transformed when we’re in
relationship with others
Hahrie Han
Source of image: Idahoc Community Action
29. @horizonsnhs #civilservicelive
• 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”
31. 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
32. @horizonsnhs #civilservicelive
Front line teams get inundated with high priority
messages from leaders each day, making it
difficult for them to know where to focus
Increasing number of messages
as information cascade through
the organisation
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-fail-
don.aspx
33. 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
34. @horizonsnhs #civilservicelive
After years of intensive analysis,
Google discovered that the key to high
performing teams that deliver change is
psychological safety
Project Aristotle:
https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-
xoaZybvz9f0b1_6bJyG7zZO6L
35. @horizonsnhs #civilservicelive
1. Frame issues in ways that will engage and mobilise the
imagination, energy and will of a large number of diverse
stakeholders
2. Take steps to be social leaders, investing in digital skills and
social connections and leading through networks as well as
formal leadership systems
3. Align structure and agency
4. Find your B-listers and give them important tasks
5. Make space for collective sensemaking: build change
platforms for important issues
6. Harness the power of advanced analytics
7. Adopt emergent approaches to planning and design, based
on monitoring progress, learning and adapting as you go
Ideas for
36. @horizonsnhs #civilservicelive
... the last era of management was about how
much performance we could extract from
people
... the next is all about how much humanity we
can inspire
Dov Seidman
A changing world
Notas do Editor
Wanting to control the orchestra better, moving to bringing out each instrument – the ability to facilitate and convene
SASHA
Experience of working in both worlds
Balance between two ways of conceiving change