NHS CHANGE MODEL Energy for Change – To Enhance Improvement in the NHS A Review of Published and Grey Literature, Initial Concept Testing and Development Final Report - Draft energy n . capacity for activity, force, vigour (Oxford English Dictionary 1984) MARTIN LAND, Director, Landmark Health Consulting NICK HEX, Associate Director, YHEC CHRIS BARTLETT, Research Consultant, YHEC DECEMBER 2012
Contents Page No. Foreword Energy for Change – The Concept in Four Pages Acknowledgements Section 1: 1 Introduction 1.1 1 Objectives of the Report 1.2 1 Review Approach Section 2: 3 Developing an Energy for Change Model for the NHS 2.1 3 Published Models 2.2 Energy for Change – A Model for the NHS 6 2.3 13 Related Concepts Section 3: 15 Physical Energy 3.1 15 Concept and Theory 3.2 16 Testing and Development 3.3 17 Potential Questions for Inclusion in the Instrument Section 4: 19 Intellectual Energy 4.1 19 Concept and Theory 4.2 21 Testing and Development 4.3 22 Potential Questions for Inclusion in the Instrument Section 5: 23 Social Energy 5.1 23 Concept and Theory 5.2 26 Testing and Development 5.3 27 Potential Questions for Inclusion in the Instrument Section 6: 28 Spiritual Energy 6.1 28 Concept and Theory 6.2 31 Testing and Development 6.3 32 Potential Questions for Inclusion in the Instrument Section 7: 33 Psychological Energy 7.1 33 Concept and Theory 7.2 36 Testing and Development 7.3 38 Potential Questions for Inclusion in the Instrument Section 8: 39 Putting the Concept into Action 8.1 39 Reflections on Practical Application of the Concept 8.2 41 Conclusions 8.3 42 Next Steps Appendices: Appendix A: Methodologies Literature Search Appendix B: Appendix C: References All reasonable precautions have been taken by YHEC to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall YHEC be liable for damages arising from its use.
Foreword Building and aligning energy for change: a powerful principle for healthcare transformation We are delighted to make this important review of literature and practice on “energy for change” available to healthcare leaders. This is the first of a series of resources that we are producing, which we hope will help leaders ignite and fan the flames of energy for change and thereby achieve their health and healthcare improvement goals more quickly, effectively and sustainably. Why do we think that building energy for change is such a powerful principle for healthcare transformation? Simply because when we look at the history of large scale change efforts, we find that the most common reason that leaders fail to achieve their goals is because their change efforts run out of energy; they simply “fizzle out” . On the other hand, leaders who tap into the positive energy for change that exists amongst their people and unleash it for the benefit of achieving organisational goals typically get better outcomes. In an era of quality and cost improvement, the ability to build and maintain energy for change for the long haul is a key requirement for leaders with transformational ambitions for their organisations, communities and patients. For the past twelve months, we have been working to develop and roll out the NHS Change Model. The change model is about improving improvement across the NHS by aligning different aspects of change. You can find out more about the NHS Change Model at www.changemodel.nhs.uk In essence, history suggests that in order to build and sustain large scale change, we need to harness intrinsic motivation for change. We need to create hope and optimism and help people feel more ready and confident to build the future. The NHS Change Model seeks to do this through connecting to shared purpose, engaging to mobilise and leading for change. At the same time, the experience of the NHS over the past ten years has demonstrated the importance of drivers of extrinsic motivation including transparent measurement, incentivising payment systems, effective performance management systems and holding leaders to account to deliver change outcomes. If we are going to deliver improvements at scale for our patients, all of these features also need to be part of our on-going approach to change. However, too often in healthcare, we haven‟t been able to achieve a balance between these intrinsic and extrinsic factors in our strategies for large scale change. We have overemphasised the extrinsic factors and sometimes unintentionally killed off the energy and creativity required to deliver improvement. i
So, we are seeking, through our work on the NHS Change Model, ways to help leaders align these intrinsic and extrinsic factors for large scale change. The extrinsic factors are typically much more tangible. We can describe payment, performance management and incentive systems and measure their progress and impact. When it comes to the intrinsic factors, things are much less clear. We have searched the evidence base about improving “culture for change”, organisational energy” and “organisational health” . There are multiple models and frameworks which can help. However, most of them are not written or framed specifically for a healthcare audience and most of them are proprietary tools that require a payment for use. We decided to produce a framework that would help healthcare leaders to improve the intrinsic conditions for change and align them with extrinsic aspects. We want to make it freely available so it can be widely used. After talking to a lot of leaders, we decided that “energy for change” resonated better for our cause than oth er concepts. The impetus behind this project is our goal to create a simple tool for measuring energy for change at a team, organisational and/or system level. The outcome is an instrument that enables teams to simply and effectively monitor their energy for change, coupled with a facilitation approach that enables them to have discussions and identify ways to manage this energy. Of course, the ultimate aim is to enable better, more sustainable improvements that spread more quickly. To unleash energy for change, we need to understand it. This evidence and practice review, which included interviews with NHS staff from a range of backgrounds, reveals the existence of five energy domains as well as real-world experiences of how they are manifested in the NHS. We draw on the work of Steve Radcliffe, Tony Schwartz, Stanton Marris, Heike Bruch and Bernd Vogel and Stephen Vogel as key contributors to the field of energy in the management literature and practitioner field. We invite you now to join us at the beginning of our journey to understand how as healthcare leaders we can become more effective in building energy for change – for the long haul. Helen Bevan and Rosanna Hunt NHS Change Model team ii
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