How change platforms can help transform the NHS

Jodi Brown @JodiOlden and HelenBevan @HelenBevan

This blog is written to complement the workshop we ran at Health and Care Innovation Expo, 2nd September 2015, entitled “How change platforms can help transform the NHS”

Here is the extended slide set from the presentation:

 

For the Storify summary of the presentation click here

Horizons

Imagine a health and care system where change is everyone’s business- not because it has to be but because people want it to be. Imagine groups of people coming together to solve problems creatively and collaboratively, taking the lead from personal commitment to quality improvement, rather than a mandate from senior leaders. Imagine a culture where skills, talents, knowledge, know-how and experience are shared and traded as readily as discussion over the coffee maker. We are entering the era of the change platform, and if what is happening in other industries, elsewhere in the world, is an indicator of future direction, change platforms are increasingly going to replace large scale change programmes as the preferred approach to change in the health and care system.

There’s been a lot of talk about change platforms at Expo this year, far more than at Expo 2014. We think this is indicative of a growing frustration and realisation that the ways in which we have previously gone about trying to ‘manage’ and ‘direct’ change are often ineffective. So what is a change platform? This is our definition-in-progress since our knowledge and understanding of change platforms is continuously evolving:

“A change platform is a space (physical or virtual) that is created so people get the choice and opportunity to collaborate without boundaries to achieve a common purpose, tackle a challenge or improve a situation

Change platforms tackle silo thinking and other barriers to the exchange of knowledge. They enable a diverse group of people to come to the table, share ideas, insight and learned experience, co-create solutions and launch experiments. Platforms thrive on trust, relationships and the collisions of minds. They build energy for change.” 

Jodi Brown & Helen Bevan, 2015 

Change platforms are nothing new, but we have only just scratched the surface of grasping their power and potential in the NHS and wider health and care system. There are some outstanding examples of health and care platforms that we have discovered and learned from, enabling us to distil the essential ingredients of what makes a great change platform. We’ve extracted some of our key learning from a variety of change platforms including:

• Many examples from local NHS organisations and Academic Health Science
Networks of “crowdsourcing” and “collaborative” platforms for innovation and
improvement
The Academy of Fabulous NHS Stuff /@FabNHSStuff
Maternity Experience / #MatExp
NHS Change Day / #NHSChangeDay
The School for Health and Care Radicals / @School4Radicals

Change platforms often fly in the face of traditional change programmes- the ones that prescribe that change starts from the top of an organisation and is engineered and orchestrated in the way we might approach the building of a new housing development, where however great the intention of change, it is experienced by people who deliver care as “imposed”. History has shown us time and time again that it is very unlikely that large-scale, transformational change will be delivered in this way. Platforms signal a very different way of approaching change. Yet they offer senior leaders some of the best opportunities for enabling large scale change more quickly and sustainably.

Change platforms are open to everyone – without barriers or boundaries
Joy’s Law reminds us that, “No matter who you are, most of the smartest people work for someone else.” (Bill Joy, Sun Microsystems). You’ve got a challenge to solve, so why would you want to exclude as large, wide and as diverse a group of people from contributing their ideas and solutions as possible? Anyone with an interest and passion should be able to join the platform.

You can’t make change happen on a platform –hearts must be in it to win it
People are drawn to change platforms because they tap into intrinsic motivations for a sense of purpose, belonging and value. Maslow (1970) said that humans continually strive for the “Holy Grail” of self-actualisation to realise self-potential and continual personal growth. Change platforms thrive on creativity, spontaneity, problem-solving and belonging, all around a shared purpose for social good. The kind of change that we see emerging from change platforms could never be prescribed or imposed- change sparks and takes flight from the (often serendipitous) collisions of minds.

Old power won’t get you anywhere on a change platform- new power gets you everywhere!
The tables turn on change platforms. Relationships and respect outweigh position and permission. Those who fully embrace the ethos of change platforms will rise to top in terms of community credibility and kudos since it’s no longer about “us and them”, it’s about “us and us”

Your change platform should feel like a bazaar, not a cathedral
Many large scale NHS change programmes look like cathedrals; they are highly structured approaches to delivering change with multiple workstreams and process accountability mechanisms. In contrast, there’s vibrancy, colour, energy, hustle and bustle, trading, haggling and a real buzz about bazaars. They are the place to be, the place where the action happens and the community comes together. You can’t control a change platform in the way you can a change programme, whether that be through well-intentioned attempts to arrive at a particular outcome (some might call that match-fixing) or through overzealous facilitation and thought control. If you have the goodwill and generosity of people, throw them the ball and let them run with it. That means creating the right conditions where happy accidents are celebrated and the overriding ethos is of “test, fail, learn and evolve” (Helen Bevan, 2015).

Change is not the goal, the goal is the goal
It’s hard to get people to buy in to the concept of a change platform or any other change methodology. We have to focus on the goal we are trying to achieve and ignite the energy of people around it. The change method (platform) needs to be in the background. Too often, change platforms fail to deliver the outcomes that are sought. This typically happens because we over-focus on the technical platform and under-focus on relationships, connections and building on other peoples’ ideas. When we introduce change platforms we must always, always follow up with action. People give to change platforms on the basis of goodwill. If their expectations are not met, they won’t volunteer again. Change platforms are not a magic bullet and they require a lot of hard work. However, the results, when we are able to unleash the collective brilliance of our communities, speak for themselves.

Tough problems become everybody’s problem
The strapline of The Academy of Fabulous NHS Stuff is, “Don’t reinvent the wheel. Reinvent the way we work.” We think this sums up the spirit of the change platform perfectly. It’s all about approaching the same old problems but from a very different standpoint. In the case of The Academy of Fabulous NHS Stuff, people share their practical examples of things that make the NHS ‘fabulous’ in order to inspire and inform others to do the same, or learn from their experience. The persistent problem of silo working and slow-to-spread innovation and best practice is being tackled, head-on, with a change platform (and certainly not just a repository) where every new contribution is a celebration.

We would love to hear from you if you have an example of a change platform in action. What works well? What doesn’t work so well and needs changing? If you’re new to this idea, then tell us how you could adopt a change platform approach to a programme, project or burning passion. Tweet us using the hashtag #NHSPlatforms or email Jodi. Let’s get a discussion going around change platforms so that they become the mainstay of all our change efforts in the future NHS.

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3 thoughts on “How change platforms can help transform the NHS

  1. Helen/Jodi. Agree that so-called transformation programmes don’t always achieve transformation, and other methods can be better, but it’s not because one is good and the other is bad. It’s just because people don’t understand how to adapt methods to different situations and contexts. You need structured methods and programmes for structured technical problems – building a bridge, building a hospital, organising logistics to ship products globally, etc. They don’t work for messy, human problems, like when people disagree on anything, from who should run a country to who should get an appointment to see a doctor.

    But change platforms on their own are no panacea either. Change platforms are just the latest label for a long history of collaborative methods which engage people and release energy to get important things done. They can definitely work in certain situations, and they also have their limitations. Having a super energised bunch of people ‘in the club’ running around encouraging others to join them can be just as off putting for some people as their bosses telling them what to do.

    What both approaches miss, and the many others around, is that we are all different. We have our own personalities, styles, habits, hopes and fears. Some people love the structure of a programme and fear the chaos of anything less. Others love the energy of the crowd and some feel drained by just the idea of a bazaar. For any system to transform, particularly one as large and diverse as the NHS, the question is not which method, but how to be method agnostic, with a basket of ways to get things done. Clustering with our friends often just creates small clusters.

    The key line for me in your blog was ‘change is not the goal, the goal is the goal’. So true, and in any system, especially one as large and diverse as the NHS, the goal is for all of us to work together, with people whose preferences challenge our comfort zones, in all directions. We need structure and flexibility, reflection and action, stability and disruption, technology and humanity, appreciation and progress …. There’s a long list of things people have different biases for, and no method is immune from the simple human tendencies to avoid difficult conversations, defend our positions, promote our preferences, and wonder why only some people are as excited or grumpy as we are. Those factors constrain programmes and platforms alike in many organisations, and need as much attention as the methods themselves.

  2. Pingback: All change please, all change – Let's talk change

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