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New Lens on Change in Healthcare
1.
2. The Million Dollar Question
âą Our biggest challenge?
âą Why are we failing
âą Whatâs possible?
âą Big things to tackle
âą Your contribution
3.
4. @HelenBevan #QS2015
Most change programmes fail to
deliver their objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
Gets anywhere near
achieving the
change and
delivering the
benefits
5. @HelenBevan #QS2015
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
Delivers and
sustains the change
Most change programmes fail to
deliver their objectives
6. 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
HSJ journal: Crowdsourced barriers to Change
7. @HelenBevan #QS2015
Three types of levers for large scale change
âProd mechanismsâ
targets
performance
management
price & payment incentives
regulation
competition
âProactive supportâ
relies on building
âintrinsic motivationâ in
staff to make
the right changes to
improve
âPeople focusedâ
education and training
national contracts
professional
regulation
Clinical quality
Type one:
Type two: Type three:
Source: Health Foundation report Constructive
comfort: accelerating change in the NHS 2015
8. @HelenBevan #QS2015
Three types of levers for large scale change
âProd mechanismsâ
targets
performance
management
price & payment incentives
regulation
competition
âProactive supportâ
relies on building
âintrinsic motivationâ in
staff to make
the right changes to
improve
âPeople focusedâ
education and training
national contracts
professional
regulation
Clinical quality
Type one:
Type two: Type three:
Source: Health Foundation report Constructive
comfort: accelerating change in the NHS 2015
Less than 10%
of the
potential for
improvement
at system
level can be
delivered
through type
one change
18. What cool and innovative health
related practices
have you heard of?
19. Traditional Healthcare Culture
âą Need to get things done immediately
âą Evidence-based practice (scientific proof)
âą Information and data are trusted
âą Culture change is complicated
âą Leaders need to âstep-upâ
âą Top-down leadership
âą âStandardize and roll it outâ
Zimmerman et. al. Healthcare Papers 2013
20. How we tend to view the healthcare world:
A B
What it tends to be like:
W BBLACK BOXBLACK BOX
22. In a Linear World
âą One size can fit all
âą Process solutions work (Lean, Model
for improvementâŠ)
âą Copying best practices makes sense
âą Top down leadership (âdevelop the
program and roll it outâ) works
âą Checklists work
23.
24. For every complex problem
there is a solution that is
clear, simple, and wrong
HL Mencken
26. Kinds of people at work
The
Contributors
The
Compliant
The
Contras
Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-
winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/
27. Kinds of people at work
The
Contributors
The
Compliant
The
Contras
Gallup global research:
âąOnly 13% of the workforce are
engaged (Contributors)
âąContributors create six times the
value to an organisation compared
to the Compliant
http://www.gallup.com/poll/165269/wo
rldwide-employees-engaged-work.aspx
Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-
winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/
28.
29. The Reality
âWhat the leader cares about (and typically bases at
least 80% of his or her message to others on) does
not tap into roughly 80% of the workforceâs primary
motivators for putting extra energy into the change
programmeâ
Scott Keller and Carolyn Aiken (2009)
Source of image: swedenbourg-openlearning.org.uk
30. Jeremy Heimens TED talk âWhat new power looks likeâ
https://www.youtube.com/watch?v=j-S03JfgHEA
31.
32. Old Power Managers Words New Power Manager Words
A project charter is a fundamental step to
making sure our project succeeds.
A general direction is a good first step; we
have no idea what is around the first corner
and we want to adjust if we have to.
I think that we need to strike a steering
committee to make sure we are heading in
the right direction.
I want to gather as many ideas and
opportunities from as many people as
possible.
Role clarity is important to avoid confusion. Letâs see who feels they are good and
interested at the task at hand.
A thoughtful project plan will keep us on
track.
Assessing where we need to go as we start
the work will be our guide.
A literature review at the outset of our project
will give us an environmental scan and help
us set the course.
Observing blogs, social media and
conference discussions on an ongoing basis
will inform our work along the way.
A clear vision by our leaders is
fundamentally important.
A shared purpose that invokes passion and
excitement will grow our community.
Consulting experts to establish a direction is
a key objective.
Crowd sourcing ideas from outsiders and
inviting diversity of thought is a key way for
us to know what to do!
@tweetvandijk
33. What are some of your behaviours
that could be seen as old power?
34. New Power
WAYS of Working
âą Change Platforms
âą Dual Operating Systems
âą Innovation Labs
âą Hackathons
âą Holacracy
âą Design Thinking
49. Indicators of Bureaucratic Mass
Overhead Number of management layers
Friction Percentage of time non-managerial
employees spend on internal compliance
Insularity Percentage of total headcount that is not
directly customer-facing
Disempowerment The percentage of employee time that is
not self-directed
Conservatism Extent of perceived disincentives to
personal risk-taking
Mistrust The percentage of employees who donât
have the opportunity to weigh in on key
policy decisions
Gary Hamel, 2016
50.
51.
52. Some Inconvenient truths
1. What motivates you may not motivate
them
2. Let them write/tell their own story
3. Both positive and negative are important
4. You are part of the problem
5. Influence leaders may not be influential
Keller and Aiken, McKinsey and Company, 2000
53. Some Inconvenient truths
6. Money may not motivate
7. The process is as important as the
outcome
8. Employees are what they think
9. Good intentions are not enough
Keller and Aiken, McKinsey and Company
56. How is this different from âsharingâ
best practices?
âPoint of Careâ Ownership
âą Winning practices are highly
sensitive to the local
context
âą Winning practices come
from those who are
âtouching the problemâ
âą Practices are spread virally
peer to peer
âą Sustained
Sharing Best Practices
âą What worked there should
work here. Variability is
discouraged
âą Winning practices come
from experts
âą Practices are spread in top
down fashion
âą Often not sustained
57. Iâm sorry I broke your company
We have been led to believeâŠthat businesses are
logical and run by the numbers and that their
models and theories will provide step-by-step
instructions on how to succeed.
But
Businesses are peopleâirrational, emotional,
unpredictable, creative, oddly gifted, and
sometimes ingenious people who donât operate
according to the theories.
Karen Phelan, 2013
Big strategic moves fail â as they are using old processes. Organizations are struggling to be nibble â the small start ups are outperforming the big companies.
Hierarchical structures and organizational processes we have used for decades to run and improve our enter prises are no longer up to the task of winning in this faster moving world. A company should reconsider strategies every few years.
Hierarchy is good for running a company; but it essential that a company identified hazards and opportunities early enough. To formulate creative strategic initiatives nimbly enough â and implement the fast enough.
John Kotter proposes a secondary operating system â one that complements rather than overburdens the traditional hierarchy âboth andâ
One is rational and one is emotional.
2 essential elements of hierarchy: 1) political: managers loathe to take chances without risk and 2) culturally: we cling to the habits and fear loss of power and stature.
Change management works if you have to get from A to B
Smart phone becomes the epicentre of health
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