1. @helenbevan What’s happening? Discussions with AquA 20 th August 2013 Helen Bevan Delivery team NHS Improving Quality @helenbevan @NHSIQ

2. @helenbevan “There’s no denying it—we’re knee-deep in an era of radical change that may well transform the way our world works” Gina Amaro Rudan

3. @helenbevan You can’t cross a chasm in two small steps David Lloyd George

4. @helenbevan The aim of the NHS Horizons team is to bring the future forward to the by making some “great leaps” rather than small incremental steps: Skipping a generation of thinking about how to create large scale improvement in healthcare Connecting with the clinicians in training and young leaders (“the Net Generation”) that will take responsibility for delivering transformational change in the NHS over the next three decades and helping them to be powerful agents for change Creating and spreading knowledge, skills and ideas using Net Generation principles: “connecting” rather than “doing” improvement building massive networks of engagement through social media utilising informal as well as formal networks on a large scale, building a vibrant grassroots movement that delivers change across the whole system Acting as the “futures department” for NHS Improving Quality Curating knowledge about transformational change to create more relevance and effectiveness Being a source of inspiration, ideas and hope that helps people to move more confidently towards a different future

5. @helenbevan The Horizons team is identifying, creating and spreading actionable knowledge for large scale change Knowledge that is “actionable” is that which creates specific value for an organisation because it can be implemented in ways that lead to tangible improvements for patients and the public (Pearson 2004)

6. @helenbevan Discussion question: emerging trends in large scale change When you think about our ideas for large scale change, spread, scale and roll out, what’s different now compared to five years ago? What are some of the emerging directions?

7. @helenbevan From industrial era (doing) to social era (connecting) Direction of thinking about large scale change

8. @helenbevan Emerging themes in large scale change Current focusEmerging direction OrganisationCommunity Power through hierarchyPower through connection Mission and visionShared purpose Making sense through rational argument Making sense through emotional connection Leadership-driven (top down) innovation Viral (grass-roots driven) creativity Engaged patientsPassionate users Clinical networksMass communities Tried and tested, based on experience “Net Generation” principles TransactionsRelationships

9. John Kotter: “Accelerate!” Many change agents, not just the usual few A “want-to” - not just a “have-to” - mind-set The spirit of volunteerism - the desire to work with others for a shared purpose – creates the energy to power the network Head and heart, not just head People won’t want to do a day job in the hierarchy and a night job in the network if we appeal only to logic with numbers, contracts and business cases Much more leadership, not just more management The network AND the organisation

10. @helenbevan The Network Secrets of Great Change Agents Place in the network Change agents who are central in the informal network are significantly more likely to deliver change, regardless of their position in the formal hierarchy bridge networks versus cohesive networks Change agents who bridge disconnected groups and individuals are more effective at enabling large scale change Change agents with cohesive networks are better at delivering minor incremental changes Links with resisters Being close to “fence-sitters,” who are ambivalent about a change, is always beneficial Close relationships with resisters are a double edged sword: such ties help push through minor initiatives but hinder major change attempts. Julie Battilana and Tiziana Casciaro

11. @helenbevan Implications for improvement leaders From “doing” improvement to “connecting” for improvement at scale Rethinking: who’s in the improvement community How we lead change Metrics of success New roles Curators Relationship leaders Storytellers Co-creators New mechanisms for connecting: Social media Web seminars Tweet chats New methods for enabling integration open innovation hacks/hackathons crowdsourcing Ideas channels

12. @helenbevan Organisations with transformational goals are increasingly using “hackathon” type processes Example : Hacking HR to Build an Adaptability Advantage Chartered Institute for Personnel and Development

13. @helenbevan