Transforming Care Building improvement capability to lead

1. Transforming Care Building improvement capability to lead large scale change, learning from our work with over half England’s CCGs Charlie Keeney charlie.keeney@nhsiq.nhs.uk @CharlieKeeney

2. Large scale change usually fails Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey of company executives

3. NHS Change Model www.changemodel.nhs.uk

5. Transforming Care – just one possible route map Foundations for large scale change Clear, compelling shared purpose Culture & infrastructure Comprehensive & aligned strategy Engagement & collaboration Better decisions with data Simple, engaging narrative a menu of choices including: Engaging your member practices Leading through commitment Better pathways, processes & services Managing capacity & demand Using measurement for improvement

6. In your post-workshop resources

7. Three dimensions of large scale (transformational) change Pervasivenessof change; does it affect whole or only portionof the system? Depthof change vis-à-vis current ways of thinking and doing; a.k.a cognitive-behavioural or paradigm shift Sizeof system experiencing change; e.g. geography, numbers of people Refs: Mohrman A. et. al. Large-Scale Organizational Change.Jossey-Bass, 1989 and Levy A. Second-order planned change: definitions and conceptualizations. Org. Dynamics. Summer 1986, 15:5-20

8. Large Scale Change The emergent process of mobilising a large collection of individuals, groups and organisations toward a vision of a fundamentally new future state, by means of: • high-leverage key themes • a shift in power and a more distributed leadership • massive and active engagement of stakeholders • mutually reinforcing changes in multiple factors • a focus on changing patterns of behaviour, relationship & power

9. Our model of LSC Maybe later Identifying need for change Living with results and consequences Engaging/ connecting others Time delay Repeats many times in hard to predict ways Settling inPossible outcomes1. sustainable norm 2. plateau3. run out of energy After some time Framing/ reframing the issues Making pragmatic change in multiple processes Attracting further interest

10. Ten key principles • Moving towards a new vision that is better and fundamentally different from the status quo • Identifying and communicating key themes that people can relate to and that will make a big difference • Multiples of things (‘lots of lots’) • Framing the issues in ways that engage and mobilise the imagination, energy and will of a large number of diverse stakeholders • Mutually reinforcing change across multiple processes/subsystems

11. Ten key principles • Continually refreshing the story and attracting new, active supporters • Emergent planning and design, based on monitoring progress and adapting as you go • Enabling many people to contribute to the leadership of change, beyond organisational boundaries • Transforming mindsets, leading to inherently sustainable change • Maintaining and refreshing the leaders’ energy over the long haul

12. Implications for the change process? The importance of having: • avision and key themes – ‘to get your head around’ • a group who ‘feel’ the need for change and have some ability to begin the change process • pragmatic initial changes that have the ‘appearance of success’, deliberately communicated to attract neutral others • cycles of framing / reframing / change / attraction • afocus on ‘lots of lots’ (i.e. multiple changes in multiple processes and systems to become mutually reinforcing)