This document discusses leadership and managing change in an increasingly complex world. It notes that change is happening faster, in shorter cycles, and emphasizes the importance of networks and grassroots involvement over rigid hierarchies and top-down directives. Successful change requires engaging a diverse range of people, including "rebels" and those outside formal leadership structures. It also highlights the value of psychological safety, collective sensemaking, and adaptive approaches in responding to challenges.

1. #CivilServiceLive
Effective leadership in a world that is
increasingly volatile and uncertain
Helen Bevan Chief Transformation Officer, Horizons team, NHS @HelenBevan

2. #CivilServiceLive
@horizonsnhs
A small, diverse team of people within the
NHS 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
The Horizons team:
Change agents and change agency

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Change is changing

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

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Acceleration ofconnectedness
Change is changing

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To stay in touch, connect with the 3%
Just 3% of people in the
organisation or system
typically drive
conversations with 85%
of the other people
Source: research by Innovisor

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What is the best way to spread new knowledge?
Source of data: Nick Milton
http://www.nickmilton.com/2014/10/why-knowledge-
Social connection/discussion is
14 times more effective
than
written word/best practice
databases/toolkits etc.
Source of image: www.happiness-one-quote-time.blogspot.com

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Hierarchical
power is diminishing
Change is changing
Acceleration ofconnectedness

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We still organise public services like the Tabulating Machine
Co. of 1917
Source of image: @corp_rebels

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Source: Innovisor

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@horizonsnhs
old power
new powerOld power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship
Jeremy Heimens, Henry Timms
This is New Power

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@horizonsnhs
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

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@horizonsnhs
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

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@horizonsnhs
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
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

16. #CivilServiceLive
@horizonsnhs
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
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
People who live and
perform in formal
organisation land and
people with the power
to make or break
change are two
different lists
(and we need BOTH)

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@horizonsnhs
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
It’s much more about the role of
informal networks in the
organisations and systems
affected by change
To make transformational change
happen we need to connect networks of
people who ‘want’ to contribute
Source: David Dinwoodie (2015)
http://iedp.com/articles/vertical-leadership/?utm_source=Sign-
Up.to&utm_medium=email&utm_campaign=13787-257163-Campaign+-+01%2F09%2F2016

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@horizonsnhs
Mark Jaben on the science behind resistance
Engage
people here
What NOT to do
Instead of buyers (who “buy-in”),
we need investors

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@horizonsnhs
Mark Jaben on the science behind resistance
Engage
people here
What TO do
Engage
people here
What NOT to do
Instead of buyers (who “buy-in”),
we need investors

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@horizonsnhs
The design dilemma at the heart of
policy implementation
The predominant approach in recent years has been STRUCTURE
but globally there is a big shift towards AGENCY

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@horizonsnhs
Source: @NHSChangeDay

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@horizonsnhs
Source: @NHSChangeDay
What is the issue here?
Structure?
(sense of “permission” externally generated)
orAgency?
(Sense of permission internally generated)

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@horizonsnhs
Source: @NHSChangeDay
What is the issue here?
Structure?
(sense of “permission” externally generated)
orAgency?
(Sense of permission internally generated)
Problematic:
changing a
“permission
culture” can
take years
The good news:
we can usually
build agency
much more
quickly

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@horizonsnhs
Building agency for large scale change
We do not become transformed
alone, we become transformed when
we’re in relationship with others
Hahrie Han

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@horizonsnhs
MOODOCs
(Massive, Online, Open, Disease Oriented Communities)
http://biggerboat.org/exploring-moodocs/
60,000 online diabetes communities
and around 80 million online patient
communities

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New Public
Passion:
a growing
global
movement

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@horizonsnhs
Big drive to bring social movement
thinking and practice into delivery

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The era of the PLATFORM
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

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Platform-based, collaborative innovation methods are
outpacing traditional R&D
Source: PWC Innovation benchmarking survey 2017

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“Adaptive space” allows people, ideas, information, and
resources to flow across the system and spurs innovation
Source: Michael Arena, Rob Cross, Jonathan Sims,
and Mary Uhl-Bien (2017)

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@horizonsnhs
Change
Programmes
• 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
Platforms
• 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
“Tear down the walls”

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@horizonsnhs
The Change Challenge
Tapping the collective brilliance
of the NHS

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@horizonsnhs
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

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@horizonsnhs
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

35. 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
14,000 contributions identified
11 building blocks for change:

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@horizonsnhs
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

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@horizonsnhs
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

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@horizonsnhs
A changing world
... 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

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Free five week virtual learning programme
for change agents in public service
•Shown to make a significant improvement in individual & organisational change
agency
•A module a week for five weeks
•Handbook and study guides
•Guided social learning
Join more than 10,000 people who have taken part from 44 countries
globally
How to rock the boat and stay in it!
Join
the
Starts 15th
February 2018
Join here:
http://theedge.nhsiq.nhs.uk/school/

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@horizonsnhs
Contact us!
dominic.cushnan@nhs.net
@domcushnan
@HelenBevan