Caroline Chipperfield 15 th September 2011 We have 60 minutes What is Leadership Mobilising and Organising and Action Introduce the five key leadership practices used within a Call to Action to make change happen ID: 776245
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Slide1
Engaging clinicians and managers to create contagious commitment to change to deliver results in challenging times
Caroline Chipperfield
15
th
September 2011
Slide2We have 60 minutes !
What is Leadership, Mobilising and Organising and Action
Introduce the five key leadership practices used within a Call to Action to make change happen
How the NHS Institute for Innovation and Improvement’s is calling people to action the NHS
Slide3A scenario
You are in charge of a trust effort to reduce costs (at an unprecedented scale and pace) by improving quality
Where would you start?
Slide4Where would you start?
create a “burning platform” and imperative for action around quality and cost improvement
Slide5Where would you start?
create a “burning platform” and imperative for action around quality and cost improvement
develop a strong narrative (story) around how cost improvement is delivered through quality
Slide6Where would you start?
create a “burning platform” and imperative for action around quality and cost improvement
develop a strong narrative (story) around how cost improvement is delivered through quality
make a clinically relevant case that makes both a rational connection and a connection to values
Slide7Where would you start?
create a “burning platform” and imperative for action around quality and cost improvement
develop a strong narrative (story) around how cost improvement is delivered through quality
make a clinically relevant case that makes both a rational connection and a connection to values
make it “real” for frontline staff (e.g., 200 patients and £5k per person per year)
Slide8More than 80% of our ability to save costs depends on clinical decision making
Brent James, Institute for Healthcare Delivery ResearchIntermountain Healthcare
Copyright 2009 NHS Institute for Innovation and Improvement
Slide9Which tradition of change?
Management
of change
Organising and mobilising
Slide10Which tradition of change?
Organisational behaviourLeadership and management studiesClinical/medical auditImprovement “science”Academic tradition(s) – 100 years
Community organising, campaigns and social movementsLearning from popular, civic and faith-based mobilisation efforts Academic tradition – 100 years
Management
of change
Organising and mobilising
Slide11“Often change need not be cajoled or coerced. Instead it can be unleashed.”
Kelman, S. (2005)
Unleashing Change. A study of organizational renewal in government
, Brookings Institution Press; Washington, D.C
Slide12Slide13FromComplianceStates a minimum performance standard that everyone must achieveUses hierarchy, systems and standard procedures for co-ordination and controlThreat of penalties/sanctions/shame creates momentum for deliveryBased on organisational accountability (“if I don't deliver this, I fail to meet my performance objectives”)
ToCommitmentStates a collective goal that everyone can aspire toBased on shared goals, values and sense of purpose for co-ordination and controlCommitment to a common purpose creates energy for deliveryBased on relational commitment (“If I don’t deliver this, I let the group or community and its purpose down”)
From the old world to the new world
Source: Helen Bevan
Slide14Focus: energy for change
imaginationengagementmovingmobilisingcalling to actioncreating the future
The ‘clinical system’ mindset for improvement
Focus: effectiveness and efficiency
metrics and measurement; clinical systems improvement, reducing variation, pathway redesign, evidence based practice
How do we create improvement at scale?
The ‘mobilisation’ mindset for improvement
NHS Institute for Innovation and Improvement 2010
Source: NHS Institute for Innovation and Improvement (2009)
The Power of One, The Power of Many
Slide15Approaches to change
Deficit basedwhat is wrong?solving problemsidentifying development and improvement needsgaps and deficiencies to be filled
Asset basedwhat is right that we can build on?exploiting existing assets and resources“positive deviance”amplifying what works
Source: Helen Bevan
Slide16How did the great social movement leaders change the world?
Source: Marshall Ganz
Shared understanding leads to
Action
Narrative
why?
Strategy
what?
Slide17What is Mobilising and Organising ?
Mobilisation...
It’s like lots of helium balloons going up into the skyCommunity organising... grabs the strings of all of those established through 1.1sThis collective, based on common values and relationships gives you the power (extra resources) to lift you off the ground towards your goal and cause
Slide18Slide19A Call to Action
is
Achieving Common Purpose through
Shared Values and Commitment
Slide20What is leadership in a call to action?
Slide21Leadership is taking responsibility for enabling others to achieve shared purpose in the face of uncertainty
Prof. Marshall
Ganz
Harvard Kennedy School
Slide22The ‘Lone Ranger’ model…
I’m the Leader
Slide23The “we’re all leaders” model…
We’re all leaders
Slide24Empowered Leadership
Slide25Key practices of empowered leadership
DISORGANISATIONPassiveDividedDriftReactiveInaction
ORGANISATIONMotivatedUnitedPurposefulInitiativeChange
LEADERSHIP
Shared Story
(Public Narrative)
Relational Commitment
(Relationships)
Clear Structure
Creative Strategy
Effective Action
(Measurable)
Slide26Public Narrative is…
a skill to motivate others… …to join you in action
story of
self
story ofnow
story ofus
Slide27Why I am called to do this work
Slide28our
shared
EXPERIENCE
reveals
our
shared
VALUES
Slide29we frame the urgency and hopefulness necessary to secure commitment and build momentum towards our shared goal
Slide30Values into action
action
values
emotion
Source: Marshall Ganz
Slide31Emotion and action
ACTIONINHIBITORS
ACTIONMOTIVATORS
inertia
urgency
apathy
anger
fear
hope
isolation
solidarity
self doubt
Y.C.M.A.D.
OVERCOMES
Source: Marshall Ganz
Slide32Relationship as Interest
Common Interests
New Interests
New Resources
Common Resources
Relationship as Resource
Interests
Resources
Commitment
Interests
Resources
Creating a shared commitment
Slide33FromComplianceStates a minimum performance standard that everyone must achieveUses hierarchy, systems and standard procedures for co-ordination and controlThreat of penalties/sanctions/shame creates momentum for deliveryBased on organisational accountability (“if I don't deliver this, I fail to meet my performance objectives”)
ToCommitmentStates a collective goal that everyone can aspire toBased on shared goals, values and sense of purpose for co-ordination and controlCommitment to a common purpose creates energy for deliveryBased on relational commitment (“If I don’t deliver this, I let the group or community and its purpose down”)
From the old world to the new world
Source: Helen Bevan
Slide34strong tiesversusweak ties
Slide35Strong and weak ties
When we seek to spread change through strong ties:we interact with “people like us”, with the same life experiences, beliefs and valuesChange is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist Influence is spread through people who are strongly connected to each other, like and trust each other IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied
When we seek to spread change through weak ties
:
we
build bridges
between groups and individuals who were previously different and separate
we create
relationships based
not on pre-existing similarities but
on common purpose and commitments
that people make to each other to take action
our aim is to mobilise all the resources
in our organisation. system or community that can help achieve our goals
Slide36Discretionary effort
what we willingly do because we want to
extent to which we are interested and involved in assisting the organisation in accomplishing its goals
an unmanaged and unrealised resource for most organisations
represents a range of performance 30-40% above that which is actively realised by an organisation
Slide37Discretionary effort
Work
is contractual
Effort
is personal
Slide38Creating shared strategy
Turning what you have
Into what
you need
To get what you
want
Resources
Power
Outcome
Slide39Resources to improve quality and cost at scale
Economic resources
diminish
with use
money
materials
technology
Natural resourcesgrow with usediscretionary effortrelationshipscommitment
Based on principles from Albert Hirschman, Against Parsimony
diminish
grow
Slide40Power
Not a thing, a quality or a traitThe influence created by the relationship between interests and resourcesWe grow our capacity for example by… Building relationships with different kinds of peopleBuilding different kinds of relationships with people we already work alongside with Enabling others to take action by developing leadership and acquiring new skillsMotivating others to act togetherGiving voice
Slide41Change
Specific – measurable and clearConcrete – “real” change that is felt and livedSignificant – challenging and consequential
Slide42Key practices of empowered leadership
DISORGANISATIONPassiveDividedDriftReactiveInaction
ORGANISATIONMotivatedUnitedPurposefulInitiativeChange
LEADERSHIP
Shared Story
(Public Narrative)
Relational Commitment
(Relationships)
Clear Structure
Creative Strategy
Effective Action
(Measurable)
Slide43Slide44Slide45Dementia Action Alliance
Our goal
By 31
st
March 2012,
all people with dementia who are receiving antipsychotic drugs will have undergone a clinical review to ensure that if they are receiving these drugs they are doing so appropriately and that alternatives to their prescription have been considered and a shared decision has been agreed regarding their future care
Slide46Launched a nationwide “call to action” on 9
th
June 2011
We work in partnership with the Dementia Action Alliance , other networks and organisations, that can make a contribution
We engage with everyone who can play a part in helping to achieve our goalWe have 8 commitment groups We move beyond mobilising to organising to make this happen
How do we work?
Slide47National Clinical Director for Dementia
QIPP Lead for Medicines management
Alzheimer’s Society Policy Lead
Dementia Action Alliance ChairGP leadJunior Drs LeadCare Homes LeadNational Clinical Director for PharmacyDH Social Care and Dementia Lead NHS Institute Call to Action support team
National Taskforce for Dementia and Antipsychotics
Slide48Junior Doctor Call to Action
The Department of Health and Dementia Alliance
We commit to carefully considering whether or not a prescription for antipsychotic medication is appropriate for someone with dementia who is in hospital and to reviewing the prescription on transfer or discharge from hospital
Slide49energy.....
One of the most important leadership tasks in the era of quality and cost improvement is to manage our own energies and those of the people around us
Slide50Four sources of energy
EnergyDescriptionIntellectualEnergy of analysis, logic, thinking, rationality. Drives curiosity, planning and focusEmotionalEnergy of human connection and relationships. Essential for teamwork, partnership, alignment and collaborationSpiritualEnergy of vitality, passion, the future and sense of possibility. Brings hope and optimism and helps people feel more ready and confident to build the futurePhysicalEnergy of action, making things happen and getting them done. Key part of vitality, maintaining concentration and commitment
Source: adapted from Steve Radcliffe
Slide51Question
Which energies do we use most in our quality and cost improvement efforts?
What are the consequences?
Slide52What’s wrong with using intellectual energy?
connecting intellect to intellect keeps us in our comfort zone
it isn’t transformational
We will achieve greater results (pace and scale) if we link physical energy to emotional and spiritual energy
In these difficult times, we
particularly
need spiritual energy
Slide53Who understood the need for spiritual energy?
“Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.” Aneurin Bevan, founder of the NHS
Slide54The challenge
”
What 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 workforce’s primary motivators for putting extra energy into the change programme”
Scott Keller and Carolyn Aiken (2009)
The Inconvenient Truth about Change Management
Slide55What is the potential for organising in healthcare?
*Need to change the terminology as the terms such as “patient” or “user” suggests a passive receiver/ consumer of care Source: adapted from the work of Bill Doherty
Professionally led healthcarePatient/ family as consumer/ receiver of careClinical professional leads the process, defines the problem and designs the interventionWork occurs at site determined by professional at a time determined by professional
Collaborative healthcarePatient/ family active, engaged but still a receiver/ consumer of careProfessional proposes, consults, shares decisions on how to proceedMore power to patient but this is about isolated individuals in a one to one relationship with the system
Citizen healthcarePatient*/ family as co-creator, producer of healthMay begin with collaborative professional leadership but becomes patient/ family/community ledCommunities of patients/ families/volunteers are the main definers and contribute to the intervention with professional inputJointly determined sites and locations
Slide56And as for learning Call to action: mobilising leadership…..
Slide57We have a choice
“This is the true joy of life, the being used up for a purpose recognised by yourself as a mighty one, being a force of nature instead of a feverish, selfish little clot of ailments and grievances, complaining that the world will not devote itself to making you happy”
George Bernard Shaw