Transforming End of Life Care in Acute Hospitals PM Workshop 4: Achieving Transformational and Large Scale Change presented by Susie Peachey, NHS England
2. “Without innovation, public services costs tend to
rise faster than the rest of the economy.
Without innovation the inevitable pressure to
contain costs can only be met by forcing already
stretched staff to work harder.” Mulgan G. & Albury D.
(2003) Innovation in the public sector. Strategy Unit, London.
“Changing the way people think about situations
is, in fact, the most powerful and useful way to
ultimately change behaviour and thereby affect
organisational results” Pfeffer J. (2005‐p125)
7. A culture for innovation
• Leading change in a complex environment
– the culture needs to support change
– 7 dimensions identified to assess culture
– work on the culture in your team (any collection
of individuals where innovative output is required)
• Culture is hard to change
– work on the culture within your project/change
(create a bubble for change to happen in)
8. Accompanied by 29
questions across
these dimensions to
visualise your culture
and create a ‘portal
chart’ that needs to
be wide open for the
free flow of ideas.
Scored from -5 to +5
11. Scoring
Scores from ‐5 to +5
0 ‐ behaviours and practices neither aid nor
hinder innovation
Positive scores‐ behaviours and practices tend to
aid innovation
Negative scores‐ behaviours and practices tend to
hinder innovation
13. Scoring
Scores from ‐5 to +5
0 ‐ behaviours and practices neither aid nor
hinder innovation
Positive scores‐ behaviours and practices tend to
aid innovation
Negative scores‐ behaviours and practices tend to
hinder innovation
15. Scoring
Scores from ‐5 to +5
0 ‐ behaviours and practices neither aid nor
hinder innovation
Positive scores‐ behaviours and practices tend to
aid innovation
Negative scores‐ behaviours and practices tend to
hinder innovation
17. Scoring
Scores from ‐5 to +5
0 ‐ behaviours and practices neither aid nor
hinder innovation
Positive scores‐ behaviours and practices tend to
aid innovation
Negative scores‐ behaviours and practices tend to
hinder innovation
19. Scoring
Scores from ‐5 to +5
0 ‐ behaviours and practices neither aid nor
hinder innovation
Positive scores‐ behaviours and practices tend to
aid innovation
Negative scores‐ behaviours and practices tend to
hinder innovation
21. Scoring
Scores from ‐5 to +5
0 ‐ behaviours and practices neither aid nor
hinder innovation
Positive scores‐ behaviours and practices tend to
aid innovation
Negative scores‐ behaviours and practices tend to
hinder innovation
23. Scoring
Scores from ‐5 to +5
0 ‐ behaviours and practices neither aid nor
hinder innovation
Positive scores‐ behaviours and practices tend to
aid innovation
Negative scores‐ behaviours and practices tend to
hinder innovation
27. • revealing your
values
• connecting to the
values of others
• gaining
commitment to the
change sought
Professor
Marshall
Ganz
identified
the
power of
story
telling in:
“an appropriately told story
has the power to …..
communicate a strange
new idea easily and
naturally, and quickly gets
people into enthusiastic
positive action”
Denning S. (2007): The Secret
Language of Leadership, Jossey Bass
“You can’t impose anything
on anyone and expect them
to be committed to it”
Edgar Schein, Professor Emeritus
MIT Sloan School
“You can’t impose anything
on anyone and expect them
to be committed to it”
Edgar Schein, Professor Emeritus
MIT Sloan School
“You can’t impose anything
on anyone and expect them
to be committed to it”
Edgar Schein, Professor Emeritus
MIT Sloan School
34. Risk Taking
• Emotional support‐ learning from failure, not
punishing
• Balanced assessment‐ not over‐estimation of
risk (intelligent risk‐taking)‐ challenge to take
an idea forward
• Create a climate of trying new things‐ After
Action Reviews
• Don’t use humour‐ we told her we are sure
she can find work elsewhere if it doesn’t work
35. Resources
• Authority to act‐ not always having to ask
permission‐ remove perceived barriers to act
• Funding‐ change is not free!
– Link innovation efforts to waste reduction techniques
• Seek resources from non‐traditional channels‐
become a test site, third sector/charities/
universities/ local industry
• Turn strategically important innovation into
formal organisational projects
39. Thinking Differently
Creativity‐ a structured process
1. Stop before you start
2. Generate lots of ideas with stakeholders
– First burst‐ brainstorm
– Second burst‐ more structured
3. Harvest ideas and narrow selection‐ what
criteria
4. Stretch and enhance ideas
5. Test and implement final choices
…………….loop back through the process
44. Fresh Eyes
Since others have different ways of looking or approaching
challenges, Fresh Eyes is about thinking or exploring the
challenge in the mindset of another, with Fresh Eyes.
Without birds, would we have sought to fly?
This can be looking
at things through
other companies’
eyes or other
peoples’ eyes, that
may have tackled
or looked at this
challenge
differently.
Remember: this
exercise is not just for
new ideas for services
but for any challenge
you face in the changes
you are making e.g. for
maintaining momentum
as team members
change
45. Fresh eyes
• In a moment, each person will be
given a picture of a person or
organisation. We will also give you a
challenge to consider.
• Individually (and silently) take five
minutes to note down how the
person or organisation would view
the challenge
– what would they pay attention to?
(2 minutes)
– what kinds of solutions would they
consider? (3 minutes)
46. Fresh eyes – Example only
Challenge
• Reducing the waiting times
in A&E
Person or organisation
• Disney
Controlled environment, distracting
people with fun, different zones for
attractions, parades, lots of guides etc.
What do they pay
attention to?
What kinds of solution
would they consider?
•Guides to help navigate A&E
•Creating treatment zones
•Dressing all the consultants as Mickey!
47. Fresh eyes
Reducing A&E waits . . .
by dressing all the consultants
in Mickey Mouse outfits!
What a stupid idea!
Or is it?
48. Fresh eyes
Reducing A&E waits . . .
by dressing all the consultants
in Mickey Mouse outfits!
Should we make it
easier for patients
to tell who the staff
are?
Should we make
staff more
approachable?
Are the
consultants front
of house enough,
seeing more
people?
Treat ‘stupid’ ideas as a springboard
for new insights and ideas
49. Fresh eyes
• In a moment, each person will be
given a picture of a person or
organisation. We will also give you a
challenge to consider.
• Individually (and silently) take five
minutes to note down how the
person or organisation would view
the challenge
– what do they would pay attention
to? (2 minutes)
– what kinds of solutions would they
consider? (3 minutes)
50. Your challenge
How would these people or organisations
tackle . . .
Getting health and local government to
coordinate their support for individuals
more effectively
5 minutes, individually and silently
2 minutes on: What do they pay attention to?
3 minutes on: What kinds of solution would they consider?
51. Building on your
individual thoughts
Rules for idea generation
Criticism is ruled out
Go for quantity
Encourage wild ideas
Build on the ideas of others
Every person and every idea has equal worth
One conversation at a time
.
Go round the table – one ‘solution’ each
One solution = one breath and no more!
As they speak, note down builds or new ideas
Pause to think when everyone ‘passes’ then go
again 5 minutes
52. Your challenge
How would these people or organisations
tackle . . .
Getting health and local government to
coordinate their support for individuals
more effectively
Feedback
• Top innovative idea that has potential
• Most thought provoking (or wishful thinking) idea