Moving to Action: Spreading Change Across Complex Systems

Moving to action:
new era thinking on spreading
and scaling change
04/09/19
#nhsspread @ExpoNHS #Expo19NHS

Claire Roche
@claireroche19
Diane Ketley
@dianeketley
Ian Baines
@ihbaines
Helen Bevan
@helenbevan

What to expect in the next 60 minutes
• Polls via Slido
• 7 principles to increase spread and scale
• The 7 principles in practice
• Co-coaching
• Model of system convening
• System convening in practice

A poll
Do you know :
• The person to the right of you?
• The person to the left of you?
• The people on both sides?
• Neither of them?
Slido.com

A poll
To what extent is spreading change a
challenge in your role?
A very big
challenge
Not a
challenge
Slido.com

Question: describe your most
recent attempts to spread
change in a single phrase

The reality of spread
“Isolated islands of
improvement effect”
(lack of spread)

Spread is a…
…dynamic, reciprocal
interacting, iterative and
evolving activity...not linear
and mechanistic
…developmental,
contextualised, adaptive,
learning and social process

What is complexity?
7 interconnected principles
Complexity

Complexity
Spread in health and care is a complex
activity occurring across a system
• Complexity around innovation, process,
context
• NHS is a complex adaptive system
• Match complexity of the approach to spread
with complexity of the situation

Adaptive space an interface between innovations
and the business ‘as usual’
Source: Mary Uhl-Bien
Networks/information flows
Complexity

Innovation development and spread are
interdependent
• How an innovation is developed influences
spread
• Early involvement increases commitment and
ownership
• Increased focus on role of adopters in
adaptation and spread
Innovation Development

Focus on the value rather than the
innovation
• It’s about what others will value rather than
what you want to spread
• What problem of local priority will it solve?
• What benefit will it offer?
Value

The perspective of the individual is pivotal
• Changing behaviours is hard
• The more work routines affected the greater
the spread challenge
• Generate energy for change and agency by
building motivation
The Individual

From an
inward to
an outward
mindset
Leadership

Networks build communities, energising and
connecting individuals
• Create a “pull” for innovation by building communities
to energise individuals and maintain momentum
• Support networks and encourage connections with
other networks
• Support use of network building mechanisms; eg
platforms like WhatsApp, Slack, Facebook groups and
other social media
Networks

Knowledge flows generate learning to
enable spread
• Collate and share local feedback and
evaluation of innovation adoption and impact
• Share knowledge through networks
• Build a culture of learning and transparency,
sharing and seeking knowledge from others
Learning

Select three principles that resonate for you?
Complexity
Innovation Development
Value
The Individual
Leadership
Networks
Learning
Tweet your story of any of these principles at #nhsspread

Applying 7 principles in practice
at the Welsh Ambulance Trust
Claire and Ian in conversation

#nhsspread
@ExpoNHS
#Expo19NHS

Complex systems are driven by the
quality of the interactions between
the parts, not the quality of the
parts. Working on discrete parts or
processes can properly bugger up
the performance at a system level.
Never fiddle with a part unless it
also improves the system
@ComplexWales

Please give Claire
one piece of advice
to inform the plans
for spreading the
WAST falls
framework across
Wales

Table discussion
Discuss your
thoughts on
what you have
heard about the
7 principles

• Matching approach to spread with
complexity of the situation
• Applying the seven principles in practice
• Providing enabling activities delivered by a
team or a number of people
• All levels in the system
System Convening involves

An independent initiative An interdependent initiative
Improve needle
safety when taking
bloods
Improve
the emergency
response to people
in mental health
crisis
Police Voluntary
sector
Emergency
room
Mental
health
service
Supported by specific
tools & information
• Social and
collaborative
• Built on shared
purpose
• Multiple methods
Within a
clear
boundary

System convening and
programme management
Interdependent
We need
both to
enable
spread

What system convening means
in practice
Claire and Ian in conversation

Discuss with the
person next to you
your thoughts on what
you have heard about
system convening
then share them on
Slido Interdependent

• Follow #nhsspread
• Horizons blogs https://nhshorizons.passle.net
• Spread publication early 2020
Want to learn more about
this approach to spread?

Thank You
#nhsspread @HorizonsNHS
Diane.ketley@nhs.net
horizonsnhs.com

Moving to Action: Spreading Change Across Complex Systems

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