Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013

@helenbevan
Building contagious commitment for
improvement
Helen Bevan
@helenbevan

@helenbevan
Themes for today
1. Sensemaking about change
2. Aligning aspects of change
3. Building energy for change
4. Shared purpose: change is not the goal,
the goal is the goal

@helenbevan
Most large scale change fails to
achieve its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
70%
25%
5%

@helenbevan
The factors that
impact the ability
to deliver Lean
transformation
are the same as
the factors in
other large scale
change strategies

@helenbevan
Gonna change my way of thinking
Make myself a different set of rules
Gonna put my good foot forward
And stop being influenced by fools
From
Gonna change my way of thinking
by Bob Dylan
with thanks to Jackie Lynton

Leaders ask their staff to be ready for change,
but do not engage enough in
sensemaking........
Sensemaking is not done via marketing...or
slogans but by emotional connection with
employees
Ron Weil

Anatomy of change Physiology of change
Definition The shape and processes of
the system; detailed analysis;
how the components fit
together.
The vitality and life-giving forces that
enable the system and its people to
develop, grow and change.
Focus
Processes and structures
to deliver health and
healthcare
Energy/fuel for change
Leadership
activities
measurement and
evidence
improving clinical systems
reducing waste and
variation in healthcare
processes
redesigning pathways
creating a higher purpose and
deeper meaning for the change
process
building commitment to change
connecting with values
creating hope and optimism about
the future
calling to actionSource: Crump and Bevan

Anatomy of change Physiology of change
Definition The shape and processes of
the system; detailed analysis;
how the components fit
together.
The vitality and life-giving forces that
enable the system and its people to
develop, grow and change.
Focus
Processes and structures
to deliver health and
healthcare
Energy/fuel for change
Leadership
activities
measurement and
evidence
improving clinical systems
reducing waste and
variation in healthcare
processes
redesigning pathways
creating a higher purpose and
deeper meaning for the change
process
building commitment to change
connecting with values
creating hope and optimism about
the future
calling to action

“You can’t impose anything
on anyone and expect them
to be committed to it”
Edgar Schein, Professor Emeritus
MIT Sloan School

Source: Helen Bevan
From
Compliance
States a minimum performance
standard that everyone must
achieve
Uses hierarchy, systems and
standard procedures for co-
ordination and control
Threat of penalties/ sanctions/
shame creates momentum for
delivery
What is our approach to change?
To
Commitment
States a collective goal that
everyone can aspire to
Based on shared goals, values
and sense of purpose for co-
ordination and control
Commitment to a common
purpose creates energy for
delivery

Intrinsic
motivators
build energy
and creativity

Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy
and creativity

Intrinsic
motivators
•connecting to
shared purpose
calling to action
build energy
and creativity create focus &
momentum for
delivery
Drivers
of extrinsic
motivation

Drivers
of extrinsic
motivation
create focus &
momentum for
delivery
Intrinsic
motivators
•connecting to
shared purpose
calling to action
build energy
and creativity
•System drivers &
incentives
•Payment by results
•Performance
management
•Measurement for
accountability

Internal
motivators
•connecting to
shared purpose
calling to action
build energy and
creativity
Drivers of
extrinsic
motivation
•System drivers &
incentives
•Performance
management
•Measurement for
accountability
create & focus
momentum for
delivery

@helenbevan
Transformation is not a matter of
intent.........
it is a matter of alignment
Peter Fuda

@helenbevan
NHS Change Model
www.changemodel.nhs.uk

@helenbevan
Task
With others at your table:
• Identify the component that appeals to you the
most/ that you feel the most connection with
• Explain your reasons to your colleagues

@helenbevan
Five key principles in using the
NHS Change Model
1. Start with “shared purpose” but after that there is no
prescribed linear or logical order
2. It’s important to use the model to check if all eight
components are present but it’s more important to focus
on whether they are aligned
3. Use the model to build on what you are doing already
4. Don’t “sell” the change model; “sell” the
outcomes you are seeking: change is not
the goal; the goal is the goal
5. Build commitment to, not compliance with,
the NHS Change Model

@helenbevan
In terms of your current initiative
• Where are you on a continuum between one
and ten in terms of how aligned the elements
are in your initiative?

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• Move one step forward

@helenbevan
• Move one step forward
• Move one point higher on the continuum
(i.e., if you are a five, move to a six)
• What would it take to improve your score by
one?

@helenbevan
What happens to large scale
change efforts in reality?
In order of frequency:
1. the effort effectively “runs out of energy” and
simply fades away
2. the change hits a plateau at some level and no
longer attracts new supporters
3. the change becomes reasonably well established;
several levels across the system have changed to
accommodate or support it in a sustainable way
Source: Leading Large Scale Change:
a practical guide (2011), NHS Institute

@helenbevan
Research shows that more than almost
any other factor affecting an
organisation, organisational energy can
lead to either a wellspring of corporate
vitality or the destruction
of its very core
Source: Bruch and Vogel

@helenbevan
Bruch and Vogel research
Organisations with HIGH productive
energy scored higher on:
• overall performance - 14% higher
• productivity – 17%
• efficiency – 14%
• customer satisfaction – 6%
• customer loyalty – 12%

@helenbevan
http://bit.ly/ZUCbfI

@helenbevan
the capacity and
drive of a
team, organisati
on or system to
act and make
the difference
necessary to
achieve its goals
Psychological
Physical
Spiritual
Social Intellectual
Energy for change is:

@helenbevan
Five energies for change
Energy Definition
Social energy of personal engagement, relationships and connections
between people. It’s where people feel a sense of “us and us”
rather than “us and them”
Spiritual energy of commitment to a common vision for the future, driven
by shared values and a higher purpose. It gives people the
confidence to move towards a different future that is more
compelling than the status quo
Psychological energy of courage, resilience and feeling safe to do things
differently. It involves feeling supported to make a change and
trust in leadership and direction
Physical energy of action, getting things done and making progress. It is
the flexible, responsive drive to make things happen
Intellectual energy of analysis, planning and thinking. It involves gaining
insight as well as planning and supporting processes, evaluation,
and arguing a case on the basis of logic/ evidence

@helenbevan
High and low ends of each energy domain
Low High
Social isolated solidarity
Spiritual uncommitted higher purpose
Psychological risky safe
Physical fatigue vitality
Intellectual Illogical reason

@helenbevan
Key conclusions from our work so far
• Psychological energy is central
• Dispersed leadership model
• Explanation not judgement
• Making explicit the issues that
remain hidden/unarticulated and
that really impact on team
performance and achievement of
improvement goals
Psychological
Physical
Spiritual
Social Intellectual

@helenbevan
The energy for change index
• The energy of any team, organisation or system – its capacity and
drive to act and make the difference necessary to achieve its goals
– determines its agility for change
• We have developed an online tool which is simple and rewarding as
it provides an immediate insight into one’s own personal energy for
change
• It is the first of a two-stage process for teams to identify areas that
need a shift in focus in order to get wider engagement in change
and faster action towards achieving it
• It is a powerful tool for organisations and teams undergoing
perpetual change

@helenbevan
Facilitated questions -
examples
• Are particular energy
domains more dominant
than others for our team at
the moment?
• Is this the optimal energy
profile to help us achieve
our change goals?
• What would the optimal
energy profile look like for
our team or community?
Physical
Psychological
SpiritualSocial
Intellectual
Energy for change profile

@helenbevan
Facilitated questions -
examples
• Are particular energy
domains more dominant
than others for our team at
the moment?
• Is this the optimal energy
profile to help us achieve
our change goals?
• What would the optimal
energy profile look like for
our team or community?
Physical
Psychological
SpiritualSocial
Intellectual
Energy for change profile
LOW
HIGH

@helenbevan
Team 1
Physical
Psychological
SpiritualSocial
Intellectual

@helenbevan
Team 1
Physical
Psychological
SpiritualSocial
Intellectual
Team 1’s energy profile is characterised by an environment that has harnessed
their interest and momentum for change, but which has failed to engage people
fully. This imbalance results in their feeling some uncertainty regarding how they
can contribute fully to the change, and therefore a sense of risk and lack of hope
for the future. We can build energy by building team solidarity and developing
shared purpose

@helenbevan
Team two
Psychological
Social Spiritual
Physical
Intellectual

@helenbevan
Team two
Psychological
Social Spiritual
Physical
Intellectual
Team 2 enables strong connections between people, a true sense
of solidarity, which gives them enough hope for the future, but this
energy is undirected, because the rational argument and shared
purpose has not been agreed.

@helenbevan
Saskatchewan Energy for Change
SSPPI Energy Index (V2)
Analysis generated on 8th April 2013
by Rosanna Hunt and Paul Woodley
43 respondents
rosanna.hunt@nhsiq.nhs.uk
+44 777 070 4056
Energy for Change Model and SSPPI Energy Index by NHS Improving Quality is licensed under a
Creative Commons Attribution-ShareAlike 2.0 UK: England & Wales License.

@helenbevan
The following two slides show the SSPPI Energy Index, which is presented in
two parts.
PART 1 is a psychometric profiling tool – it generates the group “energy for
change” profile.
PART 2 asks individuals to self-evaluate their energy for change using the
energy definitions – it tells us whether there are any gaps between current
energy levels, preferred energy levels and perceived energy levels in the
work environment.
The remaining slides show several perspectives on the results, from which
some general conclusions are made, on the last slide.

@helenbevan
The SSPPI Energy Index – V2, Part I
This questionnaire enables teams to measure their energy for change.
Please agree the nature of the change context with your team before answering the following statements.
Then answer all statements with your particular change context in mind.
1 = Strongly disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree
I am energised by the momentum of change____
I have gained insight into the case for change____
I feel a sense of solidarity with those I work with ____
I am weary of change____
I am able to keep expressing hope for the change when presented with setbacks_____
The reasoning for the change is not compelling___
I don’t feel appreciated by others at work_____
I will be blamed if I try something new and it fails____
I feel isolated from others____
I feel depleted of energy when others express doubt about the change_____
The case for change has stimulated my creativity_____
I feel disconnected from others____
I am committed to our common vision for the future____
I feel safe enough to do things differently____
I am driven by shared values____
I am experiencing change fatigue____
The change does not fit with my sense of purpose_____
I am not driven by a shared purpose for change_____
I think there is no rational argument for change____
The case for change is interesting to me_____
I feel that we are getting things done to achieve the change_____
I feel the change may conflict with my values___
I feel personally engaged in the change___
Clear thinking and analysis underpins the change___
I feel fearful about the change___
I sense openness about the potential to change___

@helenbevan
Social energy is the energy of personal engagement, relationships
and connections between people. It reflects a “sense of us” and is
therefore a collective concept that captures a situation where
people are drawn into an improvement or change because they
feel a connection to it as part of the collective group.
My social energy is ____
The social energy of those I work with is____
The importance of social energy to me is____
Psychological energy is the energy of courage, trust and feeling
safe to do things differently. It involves feeling supported to make
a change as well as belief in self and the team, organisation or
system, and trust in leadership and direction.
My psychological energy is ____
The psychological energy of those I work with is____
The importance of psychological energy to me is____
Physical energy is the energy of action, getting things done and
making progress. It is the flexible, responsive drive to make
things happen, with vitality and kinetic force (motion)
My physical energy is ____
The physical energy of those I work with is ____
The importance of physical energy to me is____
Intellectual energy is the energy of curiosity, analysis, thinking and cognition. It involves gaining insight, a thirst for new knowledge as
well as planning and supporting processes, evaluation, and arguing a case on the basis of logic and evidence.
My intellectual energy is ____
The intellectual energy of those I work with is____
The importance of intellectual energy to me is____
Complete these statements on a scale of 1 = low - 5 = high
Spiritual energy is the energy of commitment to a common vision
for the future, driven by shared values and a higher purpose. It
involves giving people the confidence to move towards a
different future that is more compelling than the status quo, by
finding the deep meaning in what they do.
My spiritual energy is ____
The spiritual energy of those I work with is____
The importance of spiritual energy to me is____
The SSPPI Energy Index – V2, Part 2

@helenbevan
min max %
Social 32 100 72
Spiritual 47 100 80
Psychological 47 97 75
Physical 50 95 76
Intellectual 48 100 82
Total 45 98 77
1. The group’s Energy for Change
profile
The group’ energy for change is 77% (43 respondents). NHS groups previously analysed
have demonstrated energy levels between 54% and 84%.
The table below shows that spiritual and intellectual energies are particularly high in this
group (82% and 80% respectively).
Although social energy appears to be more depleted than the other energy types
(72%), this may be skewed by a small number of individuals scoring particularly low
(32%) on this energy type.

@helenbevan
Profiling data Self-Evaluation
Social 72 74
Spiritual 80 80
Psychological 75 72
Physical 76 70
Intellectual 82 82
Total 77 76
Overall, the two perspectives on energy support each other
This indicates that respondents show good self-awareness of their energy for
change. The group may perceive its physical energy to be more depleted than
it is in reality (they self-evaluate their levels of physical energy to be at 70%
whereas their profile indicates they have higher physical energy in reality
(76%).
2. How does your Energy for Change
profile compare with your self-
evaluated view of your energy?

@helenbevan
3. Gaps between current energy levels and
desired energy levels
These results, taken from self-evaluations of energy for change (Part 2 of the questionnaire)
indicate that there are large gaps (> 1) between the group’s perceived energy for change (on the
green line) and its desired energy level (the red line) on the physical and psychological energies.
The group would like to enhance its energy for change in these particular domains.
On average, individuals within the group measure the energy of those they work with (the blue
line) to be lower than their own energy to be lower than the energy of those around them.
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual My Energy Average
The Energy of those I work with Average
The importance of this energy to me Average

@helenbevan
4. Frequency of high (>3) self-evaluated
current and desired energy levels
So far, we have used average (mean) scores to understand the group’s energy
levels. However, since the mean can hide patterns in the data, it is important to
look at frequency data to gain another perspective and check conclusions.
The bar chart above backs up the view that there is a particularly strong need to
build an environment for change that enhances physical and psychological energy
for individuals.
0
5
10
15
20
25
30
35
40
45
Social Spiritual Psychological Physical Intellectual
My Energy
The Importance of this energy
to me

@helenbevan
5. Is Energy for Change influenced by “distance
from CEO” and “clinical/non-clinical” role?
Our NHS dataset of 200 respondents showed that individuals in clinical roles have higher
levels of energy for change than those in non-clinical roles*, which is mostly influenced by
their higher levels of spiritual energy** and may also be influenced by higher levels of social
energy***.
The NHS data also showed that individuals in roles that are closer to the CEO (in hierarchical
terms) have higher levels of energy for change**** in four out of the five energy domains
(there were no differences in the physical energy levels of individuals at different levels of
the hierarchy).
In the Saskatchewan dataset there were no differences between individuals in clinical roles
(n=13) compared with those in non-clinical roles (n=30). Interestingly, the only difference to
emerge between the various levels of the hierarchy, was on Physical Energy: those closest to
the CEO had higher physical energy for change than those two steps away from the CEO++.
However, caution should be exercised in the interpretation of these results. A larger
Saskatchewan dataset would be required, as the groups are certainly too small to be
representative (clinical = 13, proximity to the CEO = approximately 6 in each group).
*t=2.1,df=190,p=0.03 ++F= 2.7,df=4,p=0.05
**t=3.9,df=201,p<0.001
***t=1.9, df=198,p=0.056
****F=5.3,df=4,p<0.001

@helenbevan
Conclusions
• The group’s energy profile is 77%, but this varies
widely across energy domains and individuals
• To build energy for change, the team should focus
on the physical and psychological domains
• Physical energy is enhanced by creating
opportunities for regular renewal, ensuring
workload is appropriate and investing in a healthy
work environment
• Psychological energy is enhanced by a safe, secure
environment that provides role-models that
exhibit courage for, and trust in change

@helenbevan
Resources for building and aligning energy
Title and source S S P P I
Quality and Service Improvement Tools – NHS X X X X X
Energy Project tips – The Energy Project X X X X
Emotional Resilience Toolkit – DH/Business in
the Community
X X X X
IHI Improvement Map – Institute for Healthcare
Improvement
X X X X
P3M Resource Centre – NHS Connecting for
Health
X X X X
i-resilience assessment – RobertsonCooper X X X X
Appreciative Inquiry – Appreciative Inquiry
Commons
X X X
Good Day at Work network – RobertsonCooper X X X

@helenbevan
burning platform
versus
burning ambition
@PeterFuda

@helenbevan
Lessons for transformational change
1. In order to sustain
transformational change, we as
leaders need to move from a
burning platform (fear based
urgency) to a burning ambition
(shared purpose for a better
future)
2. We as leaders need to articulate
personal reasons for change as
well as organisational reasons
3. If the fire (the energy) goes out,
all other factors are redundant
@PeterFuda

@helenbevan
Task
Talk to the person next to you
• What is “my burning ambition” for my service, my
community and /or my patients
• Try to make it personal: tell others why this ambition
connects with your personal motivations

@helenbevan
You get the best efforts from
others not by lighting a fire
beneath them but by building
Source: Bob Nelson

@helenbevan
There has never been a time in the history
of healthcare when this advice has been
more pertinent
“Leadership is not about making clever
decisions and doing bigger deals. It is
about helping release the positive energy
that exists naturally within people”
Henry Mintzberg

@helenbevan
Framing
Is the process by which leaders construct, articulate
and put across their message in a powerful and
compelling way in order to win people to their cause
and call them to action
Snow D A and Benford R D (1992)

@helenbevan
If we want people to take action, we have to
connect with their emotions through values
action
values
emotion
Source: Marshall Ganz

@helenbevan
What do we need to do?
1. Tell a story

@helenbevan
1. Tell a story
2. Make it personal

@helenbevan
1. Tell a story
2. Make it personal
3. Be authentic

@helenbevan
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us”
is)

@helenbevan
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us”
is)
5. Build in a call for urgent action

@helenbevan
Outwitted
He drew a circle that shut me out -
Heretic, rebel, a thing to flout.
But Love and I had the wit to win:
We drew a circle that took him in.
Edward Markham

@helenbevan
What’s our approach to change?
Deficit based
• what is wrong?
• solving problems
• identifying what
we need to
improve
• gaps and
deficiencies to be
filled
Asset based
• what is right that
we can build on?
• working with
existing assets and
resources
• “positive deviants”
• amplifying what
works

@helenbevan
6
9
Build on strengths or fix problems?
To what extent did you balance
identifying strengths with
understanding problems?
Focused exclusively
on problems 83
Focused mostly on
problems & a little on
strengths
77
Focused more on
problems than on strengths 61
Equal focus on problems
and strengths 49
x 3.0
A study of two bowling teams at
University of Wisconsin showed
that the team that was coached
using video tape of their
successes improved twice as
much as the team that was
shown only their mistakes
51
38
23
17
%, n = 2,043
SOURCE: McKinsey Quarterly Transformational Change survey, January 2010

@helenbevan
“A shared sense of
corporate purpose,
grounded in universal
values, is the highest
octane source of fuel
for organisational
action.”
Schwartz and Loehr (2004)

@helenbevan
“Money incentives do not create energy
for change; the energy comes from
connection to meaningful goals”
Ann-Charlott Norman, Talking about improvements: discursive
patterns and their conditions for learning, March 2012

@helenbevan
We know that ...
• Shared purpose is a common thread in successful
change programmes*
• Organisations and change initiatives with strong
shared purpose consistently outperform those
without it.**
*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)
**Management Agenda 2013 Boury et al (Roffey Park Institute)

@helenbevan
Shared purpose aligns.....
Shared purpose allows
many communities to
engage with us without us
having to invest resources
in controlling their actions
Nilofer Merchant

@helenbevan
Discretionary effort
is contractual
is personal

@helenbevan
[Shared] purpose goes way deeper than
vision and mission; it goes right into your gut
and taps some part of your primal self. I
believe that if you can bring people with
similar primal-purposes together and get
them all marching in the same direction,
amazing things can be achieved.
Seth Carguilo

@helenbevan
From compliance to commitment
“We come from a culture of compliance
and top down performance management,
… It’s task-orientated to get things done. It
needs to be much more about
cooperation, about leading across
boundaries … Being able to focus on
shared purpose in those circumstances is
absolutely crucial.” NHS interviewee

@helenbevan
Avoiding “de facto” purpose
• What leaders pay attention to matters to staff, and consequently
staff pay attention to that too
• Shared purpose can easily be displaced by a “de facto” purpose:
 hitting a target
 reducing costs
 reducing length of stay
 eliminating waste
 completing activities within a timescale
 complying with an inspection regime
• If purpose isn’t explicit and shared, then it is very easy for
something else to become a de facto purpose in the minds of the
workforce
Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector

@helenbevan @SimonJGuilfoyle Police Inspector and systems thinker

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Police
@SimonJGuilfoyle Police Inspector and systems thinker

@helenbevan
Education

@helenbevan
Healthcare

@helenbevan
How de facto purpose is creeping into NHS improvement
projects: how 100 young and emerging clinical leaders framed
their projects
0
5
10
15
20
25
1 2 3 4 5 6 7 8 9
Noofprojects
Project ScoreMainly focussed on
quality, safety &/or
patient experience
Mainly focussed
on
cost, productivity
or efficiencySource: project information from 100 young clinical
and managerial leaders taking part in national
improvement skills programme October 2012

@helenbevan
How de facto purpose is creeping into NHS improvement projects: how 100
young and emerging clinical leaders framed their projects
0
5
10
15
20
25
1 2 3 4 5 6 7 8 9
Noofprojects
Project ScoreMainly focussed on
quality, safety &/or
patient experience
Mainly focussed
on
cost, productivity
or efficiency
Very few framed their
projects as quality, safety
or experience

@helenbevan
How do we create shared purpose?

@helenbevan
Create a safe space
• This can be in small, medium or large groups
• Online forums can also be used
• Create a level playing field, free from hierarchy
• Include patients and service users – they are
expert about their needs

@helenbevan
Creating a safe space
“Just creating the space for people to
come together as individuals and feel
safe enough to share things … perhaps
their vulnerabilities; and how the group
built as an entity and a supporting
mechanism. I think the thing for me that
was really important was that it was
across what are conventional
boundaries. Focus group participant

@helenbevan
Look for commonalities
• Start with each individual talking about their
own values and stories
• Talk about the parts of the stories that unite
the group
• Capture some statements that reflect your
shared understanding and ambitions

@helenbevan
Finding commonalities
“The perspective of the patient
might be quite different than the
perspective of the staff nurse on
the ward who looks after them ... I
think it was really interesting for all
the participants to realise that they
were talking about the same things
essentially.” Focus group
participant

@helenbevan
How many of you have worked
with driver diagrams?

@helenbevan
Creating a driver
diagram
These directly affect the aim These directly affect one or
more primary drivers
PRIMARY DRIVERS SECONDARY DRIVERS
?
Write them as “We need to improve . ..”

@helenbevan
Getting Andy Murray to be Wimbledon champion
Increase
skill level
Better
intelligence on
rivals
Improve backhand accuracy
Decrease double faults
Increase stamina
Increase serve / volley
Reserve challenges
Create top 50 dossiers
Wimbledon
champion
Increase
fitness
Improved
tactics
Improved hydration
Increase success rate for top
3 tactics per player

Turn
round the
deficit in
General
Surgery
Reduce bed
requirements (and
therefore staffing)
1. Reduce day before admissions
5. Decrease bed capacity buffer
6. Streamline elective demand
7. Increase discharge timeliness (social factors)
8. Increase discharge timeliness (weekend holdups)
3. Improve recording and income capture
10. Improve out-patient profitability
9. Match staffing levels / mix to demand (via flexibility)
11. Increase theatre utilisation
2. Shift elective procedures to high margin day cases
Increase income
Improve resource
usage (and
therefore reduce
staffing)
Decrease other
costs
12. Decrease consumables costs
4. Decrease controllable DNAs
From a hospital
system
Quick win Longer term

To deliver harm free
care as defined by the
absence of pressure
ulcers, falls, UTI with
Catheter and VTE by
March 2013
Strategic
Leadership
Accountability
In Care
Focus On Care
Enabler To Care
Leadership
Walk Rounds
Commissioner Visits
Risk Assessment
Incidence
95% Harm Free Care
Root Cause Analysis
Collaborative
Learning Events
Primary Drivers Secondary Drivers
Large Scale
Change Team
Contracting
Aim Care Planning
Adult Safeguarding
Patient Stories
Chief Nurse 6Cs

© NHS Institute for Innovation and Improvement, 2012
Reduce the negative
impact of alcohol on
health, well-being, and
society in the North
West.
Increase opportunities
to directly influence
individual decision
making about alcohol Increase use of communication/
messaging/campaigns etc.
Create a grass roots social movement among the
public (re: alcohol)
Create leadership and mindset change among
professional groups to become advocates for
alcohol awareness
Creating more leaders who can influence others
and lead the agenda
Align/create/enhance the performance
management system to promote alcohol related
activities
Create an alternatives for economic
development (e.g. not nightlife based)
Influence the
environment that
determines alcohol
consumption and
alcohol related
services
Work with alcohol industry to improve labelling
and reduce instances of below cost sales
Future activities
Activities currently underway
Increase the number of targeted programmes for
specific groups of alcohol users
Educate directly-employed staff in the public
sector serve as role models/champions
A large scale example . . .

@helenbevan
Task: stage one
As a group or table, select one of the driver
diagrams to work on:
• Familiarise yourself with the diagram
• You are going to create a shared purpose to sit at
the beginning of the driver diagramme
• Who needs to be involved in creating the shared
purpose?
• Can you “stand in the shoes” of these people and
reframe the aims statement as a shared purpose?
• How can you utilise spiritual and social energy as
well as intellectual and physical energy?
• Can you create a shared purpose rather than a
de-facto purpose?

@helenbevan
Task stage two
Review the entire driver diagram from the point
of view of the change model:
• Are all eight components represented?
• What should be added?
• Are the components aligned?

@helenbevan
Level 3: Keeping on track
Have we remained
true to our original
purpose?
Do we need to re-
calibrate to ensure
we’re not just doing
‘the wrong things
righter?’

@helenbevan
Keeping on track
“It’s challenging sometimes to
find time and it’s
uncomfortable sometimes to
discover how far we have
strayed from [our shared
purpose].” NHS interviewee.

@helenbevan
Re-energise
Re-visiting the
original purpose can
help re-energise
when a programme
has plateaued or run
out of steam

@helenbevan
Re-energise
“There is a need for change leaders to
be reminded about [shared purpose’s]
centrality and therefore for it to be
continually
revisited, checked, refreshed, that even
if the value and the purpose stay the
same the messaging might need to be
revisited and checked.” NHS
Interviewee.

@helenbevan
We need to build capability for knowing, doing, living
and being improvement

@helenbevan
‘Hurihia to aroaro
ki te ra, tukuna to
atarangi kia taka ki
muri i a koe’
“Turn your face to
the sun and the
shadows fall
behind you”
Māori whakatauki

Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013

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