| +44(0) © ICE LTD 2009 All rights reserved. August 2009 version 1.3 System Thinking Champions 5 th March 2015

| +44(0) © ICE LTD 2009 All rights reserved. Welcome Agenda What will we do today?

| +44(0) © ICE LTD 2009 All rights reserved. This is How Warren Puts it Introductions Outcomes Theory & Background The model we are going to follow Getting started

| +44(0) © ICE LTD 2009 All rights reserved. This is How Warren Puts it Who are you? Why are we here?

| +44(0) © ICE LTD 2009 All rights reserved. The Desired Outcomes for this work are: Transfer skills to Systems Thinking Champions Make improvement to the identified processes from the perspective of the customer. And… Scope Patient contact and handover to teams that will deal with patients needs

| +44(0) © ICE LTD 2009 All rights reserved. The role of the Systems Thinking Champion isn’t to lead change, rather to facilitate it. The role of Service Manager(s) is to lead change in their service.

| +44(0) © ICE LTD 2009 All rights reserved. Theory & Background What do we mean by Systems Thinking?

| +44(0) © ICE LTD 2009 All rights reserved. Brian Joiner refers to it as 4th Generation Management

| +44(0) © ICE LTD 2009 All rights reserved. The first three generations: Management by doing (just do it yourself) Management by directing (get others to do it) Management by results (employee figures out how to get the result) Three ways to get better results Improve the system (fundamental changes that improve quality, reduce error & waste) Distort the system (get demanded results at the expense of other results) Distort the figures (use creative accounting) Which option would you most want people to use?

| +44(0) © ICE LTD 2009 All rights reserved. Avoid limited capacity (1st) Avoid micromanagement (2nd) Avoid distorted systems & figures (3rd) Still care about results but have knowledge that better results can reliably be obtained only through fundamental improvement By what method?

| +44(0) © ICE LTD 2009 All rights reserved.

| +44(0) © ICE LTD 2009 All rights reserved.

| +44(0) © ICE LTD 2009 All rights reserved. Clarity of purpose in customer terms Measuring what matters to your customer Considering the whole system – End to End Understand Demand – Value/Failure Understand Flow – Value/Waste Design against demand to create value for your customer No Targets – seek perfection and continuous improvement Taking a customer perspective

| +44(0) © ICE LTD 2009 All rights reserved. Welcome The 7Es Model Following the steps in the methodology

| +44(0) © ICE LTD 2009 All rights reserved.

| +44(0) © ICE LTD 2009 All rights reserved. Voice of the customer Understand their demands and needs on the service Interdependencies and interconnections “Those who Create Own” Customers Front Line Staff Operational Managers Strategic Leaders Directors and Executives

| +44(0) © ICE LTD 2009 All rights reserved. One to one meetings / group workshops to: Co-Create Understand the issues Develop and agree OMaR

| +44(0) © ICE LTD 2009 All rights reserved. Any change should be based on evidence & knowledge Data about the current state of the organisation is gathered Data will enable people at all levels of the organisation to see their business in a different way, always from the customer’s perspective

| +44(0) © ICE LTD 2009 All rights reserved.

| +44(0) © ICE LTD 2009 All rights reserved. Sharing the learning from the Establish and Explore stage Creating a compelling and agreed vision for the organisation Agree the first steps to achieve that vision.

| +44(0) © ICE LTD 2009 All rights reserved. Translating the vision into reality This means creating a plan for transforming the delivery of the system to its customer Build a Proof of Concept Repeatable Scalable Affordable Your legacy

| +44(0) © ICE LTD 2009 All rights reserved. It is during this stage that the design is applied. Making the proven new way of working business as usual Leading to the continuous improvement of the system delivered to its customers

| +44(0) © ICE LTD 2009 All rights reserved. It is during this stage that the design is applied. Making the proven new way of working business as usual Leading to the continuous improvement of the system delivered to its customers

| +44(0) © ICE LTD 2009 All rights reserved. Not Additional – Core to 7Es Capability to repeat the improvement cycle You learn by doing – Normative Approach You make improvement "business as usual“

| +44(0) © ICE LTD 2009 All rights reserved. Establish Getting started

| +44(0) © ICE LTD 2009 All rights reserved. Purpose Activities Tools & templates Outcomes

| +44(0) © ICE LTD 2009 All rights reserved. Purpose Set up clean Key stakeholders Establish Outcomes, Methods and Resources Activities sessions System walk Creation of OMaR document

| +44(0) © ICE LTD 2009 All rights reserved. Stakeholders Identify stakeholders Meet stakeholders Stakeholder analysis System walk Tools Stakeholder analysis Contracting questions System Walk template OMaR template

| +44(0) © ICE LTD 2009 All rights reserved. Outcomes Set up clean & ready to start Common purpose Agreed outcomes Wider organisation understands and supports Leaders are engaged and bought in Facilitators understand system dynamics & have undertaken system walk Relationships are established

| +44(0) © ICE LTD 2009 All rights reserved. Models DVFR Resistance Tools Stakeholder Analysis System Walk template OMaR template Contracting questions

| +44(0) © ICE LTD 2009 All rights reserved. DVFR XX> Change will only happen if the product of D, V, and F is greater than R D = Dissatisfaction with the current situation V = Vision of a future state F = We know what the First Steps towards that vision are R = Our inherent Resistance or Reluctance to change

| +44(0) © ICE LTD 2009 All rights reserved.

| +44(0) © ICE LTD 2009 All rights reserved. Assess stakeholders against Interest and Influence. Mark the current assessment on the graph. Analyse where the stakeholders needs to be. Mark an arrow to this place on the graph. Identify a course of action to move from current to desired. Continue to assess this throughout the engagement. Influence low high Interest high low Stages Stakeholder Analysis

| +44(0) © ICE LTD 2009 All rights reserved. Influence low high Interest high low Example Service – Stakeholder Analysis Stakeholder Legend Chief Exec Deputy Chief Exec Head of Environment Head of Operational Services Cabinet Member Head of Policy & Improvement Head of Communications Internal facilitator & support Head of HR HR Manager Unison Head of Leisure & Culture

| +44(0) © ICE LTD 2009 All rights reserved. Logistics Working groups Plan Timings Roles Communicating this to your teams Support from ICE

| +44(0) © ICE LTD 2009 All rights reserved. Is this working for you? Any issues or concerns? Anything you want to change?