1. #NHSChangeDay #SHCRchat ‘Dis*ruption - an agent of constructive change' Jackie Lynton, Head of Transformation Dominic Cushnan, Actionable Knowledge Manager Horizons Group

2. #NHSChangeDay #SHCRchat Operate at the edge of current thinking and change Share the disruptive power of connecting, leading edge knowledge, transformation and innovation Connect people to empower them, to help health and care to think differently about the rules of change and make sense of it in their own context Horizons Group Small team

3. @HelenBevan Our new White Paper - Five enabling themes www.nhsiq.nhs.uk/ whitepaper

4. #NHSChangeDay #SHCRchat

5. @HelenBevan Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey Gets anywhere near achieving the change and delivering the benefits Most large scale change doesn’t fully deliver its objectives

6. @HelenBevan Most large scale change doesn’t fully deliver its objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey Delivers and sustains the change

7. ENGAGEMENT COMMITMENT ENERGY 100% of all projects evaluated as “Successful” had a good technical solution or approach 100%

8. ENGAGEMENT COMMITMENT ENERGY Over 98% of all projects evaluated as “Unsuccessful” also had a good technical solution or approach 98%

9. @HelenBevan Most change efforts are built upon the shaky foundation of five flawed assumptions; 1.That change can be managed 2.That human beings are objective 3.That there are ‘X’ steps to change 4.That we have a neutral starting point for change 5.That change, itself, is the goal Peter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda- bootstrap/content/Why-Change-Efforts-Fail.pdf

10. #NHSChangeDay #SHCRchat Why is change needed and what needs to change?

11. @HelenBevan Leading change in a new era Dominant approach Emerging direction

12. @HelenBevan Leading change in a new era Most healthcare transformation efforts are driven from this side

13. Using disruptive methods in change Source of image: www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community

14. @HelenBevan Disruptive Innovations already available for Healthcare Professionals Digital Literacy in Medical Education At the University of California, Irvine, School of Medicine (UC Irvine), for example, medical students can take the elective Health 2.0 + Digital Literacy. The school periodically offers short training sessions on digital literacy. “We talk about the basics of social media and professionalism, and also cover newly emerging technologies like Google Glass and 3-D printing. We’ve also put on a session about how to curate content on the Web.” said Warren Wiechmann, M.D., M.B.A., associate dean of instructional technologies at the school. Source: Technology in Academic Medicine: Integrating Digital Literacy into Medical Education. Stephen G. Pelletier “Today’s medical professionals must be masters of different skills that are related to using digital devices or online solutions.” - Bertalan Meskó, M.D., Ph.D.

15. @HelenBevan Virtual Dissection Disruptive Innovations already available for Healthcare Professionals With method of doing dissections on virtual cadavers, medical students can experience surgery and get view of more in-depth images of the human body. Plenty of case studies have been conducted on the way that the Virtual Dissection Table has impacted medical institutions and most of the research shows the table has immense future potential, and has thus far been implemented in various medical institutions throughout the world. Currently, over 55 institutions worldwide use the table. Source: Virtual Dissection Table, Elets News Network (ENN)

16. @HelenBevan Smartwatch Disruptive Innovations already available for Healthcare Professionals On the healthcare side, there are now wearable devices that can help you track heart rate and even blood pressure. Checking these parameters can be as easy as looking at your wrist. There are now devices that can track your sleep patterns, how fast your heart is beating, how far you have walked today and these are just the tip of the iceberg. However, right now, smartwatches are mainly used by individuals who want to keep fit or monitor their sleep cycles and not used in mainstream medicine for monitoring patients. However, it is not a stretch to see these devices being used by doctors and hospitals to track a patient’s status and disease outcomes. This would allow a doctor to have more data to help diagnose, treat and adjust a patient’s treatments, allowing for better patient outcomes. Source: How Wearable Technologies Like Smartwatches Can Improve Healthcare. The Smart Watch Review

17. @HelenBevan Operating rooms with real-time diagnostics allows physicians to use real-time intra- operative image guidance to evaluate, intervene and assess the results of minimally invasive procedures, complex minimally invasive procedures, and open surgical cases. Thanks to real-time diagnostics, there are no delays in getting patients the life-saving surgical services they need. Source: Hybrid Operating Room. Lakeland Regional Center Real-Time Diagnostics in the Operating Room Disruptive Innovations already available for Healthcare Professionals

18. @HelenBevan Robotic Interventions Disruptive Innovations already available for Healthcare Professionals Robotic surgery being used today enables surgeons to perform complex surgeries in a minimally invasive manner. The robot acts as an extension of the doctor’s hands, allowing him or her to perform surgery with pinpoint accuracy and very little damage to surrounding tissue. The benefits of robot surgery include a faster return to daily activities; fewer complications; shorter hospital stays; reduced hospitalization costs; reduced trauma; significantly less pain; and less scarring. Source: Medical Breakthroughs Using Robotic Surgery. John Joseph Parker

19. @HelenBevan Artificial Intelligence in Medical Decision Support Disruptive Innovations already available for Healthcare Professionals Artificial Intelligence is an integral part of Decision Support Systems. Decision Support Systems that are implemented with the aid of Artificial Intelligence have the ability to adopt in new environment and to learn with time. Source: Clinical Decision Support Systems: A discussion on different methodologies used in Health Care. M.M.Abbasi, S. Kashiyarndi Patient with high-risk factors or symptoms or predicted to be highly effected with certain diseases or illness, could be short listed to see the specialist for further treatment. Artificial intelligence can be used to analyze healthcare data and generate a representation of knowledge that can in turn be used for information and process modeling. Employing Artificial Intelligence (AI) techniques in medical applications could reduced the cost, time, human expertise and medical error. Source(s): Intelligent decision support in healthcare. Runki Basu, Norm Archer and Basudeb Mukherjee Artificial Intelligence in Medical Application: An Exploration. Wan Hussain Wan Ishak, Fadzilah Siraj

20. @HelenBevan Digestible Sensors Digestible or swallowable sensors are meant to be ingested by a patient; it then gathers information about the digestive system as it travels through it, transmitting the information to a receiver worn by the patient. These devices, with the size and shape of a large vitamin pill, helps clinicians diagnose digestive disorders of their patients. Source: Swallowable Sensors. Courtney Humphries Disruptive Innovations already available for Patients

21. @HelenBevan Personalized Genomics In the long term, sequencing of many individuals could provide new information on the genetic basis of poorly understood diseases, with the potential to provide new therapies. However, there may also be immediate benefits based on our current understanding of genetics and health. Knowledge of elevated risks for known diseases could allow you to make proactive decisions about your health; visiting the doctor for more frequent check ups or screenings, choosing one type of prescription drug over another based on your metabolism, altering your diet or exercise plan, informing reproductive decisions, or making certain kinds of arrangements Disruptive Innovations already available for Patients for your future medical care are all ways that you might use the information that you learn from your sequence. Source: What are the likely benefits and risks of learning about your DNA? Personal Genetics Education Project

22. @HelenBevan Telemedicine Telemedicine is most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains. Source: Telemedicine Benefits. News-Medical.net Proven Telemedicine applications widely adopted today include the use of live video conferencing, transmission of still and video images from scopes and other diagnostic equipment, and remote monitoring. Telemedicine provides consistency along the continuum of care, via templated software applications. In Telemedicine there is no longer a need to transport patients over long distances to specialist sites. A timely, efficient cost-effective medical practice is delivered, providing electronic access to specialists, for physicians, healthcare providers and patients. Source: What is Telemedicine? MedWeb Disruptive Innovations already available for both Healthcare Professionals and Patients

23. @HelenBevan One major reason why people do not participate in clinical trials is simply the hassle of it; the time and effort required to go back and forth to a site location multiple times on a fixed schedule. That is why trials invest significant resources into creating multiple locations, add inducements such as daycare, and sometimes even compensate participants. Virtual Trials reduce some of these barriers to participation, and also reduce the time and money needed to get results. Source: From Virtual Trials to Active Patients, Experts Say Clinical Trials Must Adapt to New Demands. Bob Roehr Virtual Trials Disruptive Innovations already available for both Healthcare Professionals and Patients

24. @HelenBevan Facebook didn’t exist Twitter was still a sound The cloud was still in the sky 4G was a parking place LinkedIn was a prison Applications were what you sent to college Skype was a typo Thomas Friedman, World Economic Forum, Quoted by http://ayeletbaron.comhttp://ayeletbaron.com

25. @HelenBevan Jackie

26. Its about people not technology! If the ‘change’ were a patient and the symptoms were found to be persisting despite intensive therapy, the diagnosis should be questioned and new interventions considered. Technology is not the goal – the goal is the goal

27. Source: Helen Bevan 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 Changing our mindset about change? 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

28. Innovation is not a mystical state “It's a natural state - a human birthright. The people in your organisation, in fact, already are innovative. The only thing is: their natural ability to be innovative is being obscured by their own habits of mind and a variety of bothersome organisational constraints.” Source and picture: Name: The heart of innovation: How we spark innovation, Oct 24, 2013. Ideas champions.com

29. @HelenBevan is the new normal! “By questioning existing ideas, by opening new fields for action, change agents actually help organisations survive and adapt to the 21 st Century.” Céline Schillinger Image by neilperkin.typepad.com

30. @HelenBevan @HelenBevan #APACForum Probably the largest simultaneous improvement initiative in the history of healthcare A disruptive case study @HelenBevan #Quality2014 #f1

31. www.changeday.nhs.uk NHS Change Day is supported and coordinated by NHS Improving Quality. NHS Change Day is a grassroots movement with the purpose of empowering each other to take action to improve health and care. It connects people, bringing them together to in turn do something better together. It celebrates and shares every improvement we make better together. Date March What is NHS Change Day?

32. @HelenBevan @HelenBevan #APACForum NHS Change Day Aim: Our shared purpose for NHS Change Day is to ignite thousands of actions that will improve care for people. If you are inspired, then join us in delivering actions that make a difference.

33. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Resources to improve health and care Economic resources diminish with use money materials technology Natural resources grow with use relationships commitment community Based on principles from Albert Hirschman, Against Parsimony diminish grow

34. Simple Rules Commitment vs Compliance How can we innovate in a complex system and how can we make innovation everyday business? Underlying principles: Small inputs can make big change, collective action, holding yourself and each other to account, intrinsic motivation, large-scale change, social movement principles. Call to action 1.Make a pledge, publically, website 2.Chose a pledge that means something to you 3.Pledge (action), share, do, inspire (improvement cycle) 4.Goal: 1 st year 65,000 pledges, 2 nd year 802,000 pledges 3 rd pledge to action 5.Date We just did it! – The change is not the goal the goal is the goal

35. @HelenBevan @HelenBevan #APACForum NHS Change Day 2014 More than 800,000 pledges to take action 81 separate Campaigns 86 million twitter impressions 35,400 video views 95,000 daily reach on Facebook More than 98% of the activity through volunteers

36. ENGAGEMENT COMMITMENT ENERGY Example pledge – Jeharna’s story Member of the public The way my brother was looked after by the NHS staff was just brilliant and I wanted to say thank you. “ ”

37. ENGAGEMENT COMMITMENT ENERGY Example pledge – Damian’s story Individual It has prompted myself, and others to discuss with our pharmacies methods of improving the taste of one of the common medicines for children. “ ”

38. ENGAGEMENT COMMITMENT ENERGY Louise's Story 2 nd year student nurse – York University Louise carrying out her change day pledge ‘Mock ward’ 2013

39. ENGAGEMENT COMMITMENT ENERGY Example pledge – Ashley’s story – Barking Havering and Redbridge Trust Change Day gave me permission to use my energy in the direction that I wanted to use it “ ” Main Trust wide pledge for NHS Change day in 2013 Guardian Service Informal way of raising concerns

40. THE GUARDIAN SERVICE Themes: – 10 x aggressive, bullying, harassment and intimidating behaviour reporting – 3 x HR or employment advice – 3 x significant patient safety reporting – 2 x gross misconduct reporting by colleagues – 2 x unsafe work practices – 1 x reporting on poor patient experience – 2 x cases no explanation / no show – 2 x HR or employment advice – 2 x reporting on improper use of process – 1 x fraudulent behaviour – 6 x cases wanted no further action / withdrew their concern

41. BHRUT & THE GUARDIAN SERVICE Total2012Total2013TotalAll* Would you feel safe raising your concern? Yes75258%107280%45,02571% No19215%26920%6,99911% Would you feel confident your Trust would address your concern? Yes51640%93270%3420054% Staff Feedback: The following responses in the 2013 NHS Staff Survey in the Health, Wellbeing and Safety at Work category had the largest overall shifts in the Trust when compared to 2012:

42. What is The Edge A platform for change activists in health and care to learn, connect and grow. Mobilising and organising and connecting with other change activists. Curation vs Content creation. Seek, Sense, Share what does it mean. Why curation?

43. Getting information off the internet is like taking a drink from a fire hydrant Mitchell Kapor

44. Curating knowledge Finding things out and keeping up to date “pulling” information, but also having it “pushed” to us by trusted sources Making sense and meaning of information Reflecting and putting into practice what we have learned Plugging information into our own mental models and turning it into knowledge Connecting and collaborating Sharing complex knowledge with our own work teams Testing new ideas with our own networks Increasing connections through social networks Source: Harold Jarche

45. #NHSChangeDay #SHCRchat Friends of the Edge theedge.nhsiq.nhs.uk

47. Harvard Business Review McKinsey M-Prize Leaders Everywhere Challenge Nesta and Observer 50 New Radicals