Project Workbook Getting Started with the NHS Change Model

1. Project WorkbookGetting Started with the NHS Change Model Your project name: Date workbook completed: Owner:

2. Version Control Version Note: This is a draft ‘pre-design’ version for release to a ‘test’ user community. It is intended to act as a catalyst for user input to the future versions. Within the next year the content is likely to undergo redesign and migrate to web-based functionality. An Excel 2007-10 resource workbook is also available as a parallel resource Please join our development community on the NHS Change Model Website and contribute your experience, case studies and suggestions for improvement and your own materials NHS Change Model Getting Started Workbook

3. The NHS Change Model Introduction • The model has been created to support the NHS to adopt a shared , systematic approach to building the capacity and capability for delivering service change. • Building on what we collectively know about successful change the ‘NHS Change Model’ has been developed with hundreds of our senior leaders, clinicians, commissioners, providers and improvement activists who want to get involved in building the energy for change across the NHS by adopting a systematic and sustainable approach to improving quality of care. • The model brings together collective improvement knowledge and experience from across the NHS into eight key components. Applying all eight components systematically and rigorously will improve the likelihood of successful, sustainable change. • No matter who you are or wherever you are in the NHS you can use the approach to fit your own context as a way of making sense at every level of the ‘how and why’ for delivering improvement, to consistently make a bigger difference. • Visit www.changemodel.nhs.uk for more details and resources. • Twitter - Use #nhschange to ask questions and contribute learning and reflections with a growing community Contribute to the continuing development of the NHS Change Model • The NHS Change Model will continue to develop as its use expands • There is a growing community of users who are contributing advice, case studies, experience and suggestions for improvement and additional materials. • We would encourage you to join the community through the Change Model website. NHS Change Model Getting Started Workbook

4. Why do we need to use a change model? Overview • Whether you are climbing a mountain, diving on a reef, flying a plane or just going on holiday there are a number of things we know that we should check to ensure the success, safety and comfort of the experience. • In some cases the list has been developed through understanding where the highest risks of failure are and paying attention to these carefully and thoroughly. • In many cases the list has been developed through examining the evidence of success and failure, identifying the highest risks of failure and those things most likely to ensure success and paying attention to these carefully and thoroughly. • In most cases there are a number of actions or checks which when taken together have a greater impact than the sum of the parts. Conversely leaving out one element pose a substantially greater risk because many of the elements are interdependent. • Some examples of these are illustrated on this page. You may be familiar with others in the literature of change management such as Kotter’s 8 Step Model or Lewin’s Change Management Model • The NHS Change Model is based on the evidence of the key precursors of project success and failure in both the NHS and other sectors. • The use of the term ‘Model’ is not set in stone. If you feel more comfortable using a different term to describe it which is more aligned with where you are as an individual or team or what you are trying to achieve then please do so. Some alternative terms might be: • Framework • Checklist (but not a tick-list) • Bundle • Architecture • Must-do List • As important as the Model itself is the discipline of using it systematically and collaboratively at the key stages of a change project. It is unlikely that any one person has the knowledge and expertise to adequately review each of the elements of the Change Model. Getting the right people into the room to review your project through the lens of the NHS Change Model is critical. It is part of the process of Engagement to Mobilise as well as ensuring you have a good range of perspectives and knowledge available. • Some people will have a stronger affinity for some parts of the Model than others. There may be one person responsible for ensuring that it is used but equally important is having the right people ‘in the room’ to ensure that proper attention is given to each element of the NHS Change Model and its implications for the project. We all have ‘blind spots’ in terms of personal preferences and affinities. We must not allow these to compromise the success of our intended change. NHS Change Model Getting Started Workbook

5. Case Studies – NHS Change Model in action • All these case studies can be found on the NHS Change Model website. More are being added all the time • You can access these directly either by clicking on the image in ‘Show’ mode or by right clicking and selecting ‘Open Hyperlink • Help build our learning and development community by contributing your own case studies NHS Change Model Getting Started Workbook

6. Purpose of the workbook An overview of the workbook and how it could be used NHS Change Model Getting Started Workbook

7. Using the workbook Introduction • You can use the NHS Change Model: • Before you begin a project or change programme to help you improve the likelihood of success • At key stages during a project or change programme especially if key participants and stakeholders are changing to review progress , refresh the plan and to re-engage participants • After completion of a project or change programme as part of an After Action Review to draw out learning for future changes. • It can be used for any level of change from a small local project in a GP surgery, clinic, team or ward to major system and network transformations. • The NHS Change Model provides a common framework for engaging and mobilising project participants and key stakeholders and for aligning language, ambition and action. • You ‘drive’ the NHS Change Model is does not ‘drive’ you. You can customise it with your language and examples. But it is essential that you keep all the elements of the Model. Starting out • We suggest that if this is the first time you have used the NHS Change Model – for example you are exploring it before trying it out with a project you are involved in - that you set aside a couple of uninterrupted hours in your diary to work through the individual exercises and to explore the resources available. Make an ‘appointment’ with yourself . • Some of the resources are provided as online videos – you may need to talk to your organisation’s IT department about allowing you access to streaming media if they are still trying to find their way into the 21st century. • There is also an active community working with the NHS Change Model who use Twitter to stay connected and provide support under the #nhschangehashtag. If you have not already set up a Twitter account we suggest you do so. You can post questions, thoughts and suggestions there and get feedback from a rapidly growing community of practice. Again you may need to discuss with your IT department your organisations policy on the use of Social Media. Using the workbook • The workbook can be completed in paper or electronic versions. • If you print the workbook you should use A3 size paper so that you have plenty of space to work with. • A number of the pages contain templates that you can complete individually or as teams. When working with a team in a workshop environment we suggest that you print these to a poster size so they can be worked on by groups. • When working with a project team we suggest that the workbook is best completed in a workshop environment involving key stakeholders. Complete a stakeholder analysis before hand to identify who should be engaged (Engage to Mobilise) • For a team coming together at the start of a project you should set aside at least half a day to work through your project using the NHS Change Model as the framework. • The workbook is supported by a range of online materials and resources. • There is no substitute for talking to others about their experience of working with the NHS Change Model and what has worked for them in introducing it to their teams, organisations or networks. A word of caution – Optimism bias in projects • There is evidence that as many as 70% of projects fail to some degree to achieve their objectives. They may overrun on time or cost, not achieve all the outcomes that were expected, have unexpected side-effects, be unduly affected by personnel turnover or just be complete disasters. • Any yet how often do we start out on a project with no external systematic reference to what has gone wrong with similar projects to inform realistic planning ? How often do we feel that to be overtly and unduly negative about a project’s chances of success is not good for our careers? • Optimism bias is a major issue in project planning. Even the most diligent and rigorous use of the NHS Change Model cannot overcome this bias if the environment is not supportive of realistic and honest debate and there are no external reference points for similar projects. You should have the option open to you to at least delay the start of the project or re-scope the intended outcomes in order to address the issues that you identify in using the NHS Change Model if they are of such significant concern. • Using the ‘Premortem’ method with the NHS Change Model can help although it can be quite challenging to some organisational mind-sets. We would be interested to work with teams who want to try it out. NHS Change Model Getting Started Workbook

8. Getting started with the nhs change model as an individual How to start thinking about the NHS Change Model and what it might mean to you NHS Change Model Getting Started Workbook

9. Exploring our mental model of change • The way we approach the NHS Change Model is highly symbolic of the way we think about change. That will be based on our experiences and inherent preferences for ‘getting things done’. • This ‘Mental Model’ of change will be different for different people in the team. Each person brings to the project a wealth of experience and learning which has been synthesised according to a set of very personal preferences. • Taking time to understand your own preferences and experience and how that influences the way you see and use the NHS Change Model is an important first step. • Before you work your way around the NHS Change Model for the first time in detail you might want to do some personal reflection. Here are some suggestions: • If you have ever done a psychometric profile such as MBTI, PRISM, Insights Discovery or Belbin then you might want to review the results and think about how they might influence the way you see the Model. Does your profile mean that you will be attracted to some parts of the Model more than others? In which case how will you ‘guard’ against paying less attention to parts of the Model than others? • Consider your own mental model of how change happens – look at the diagrams opposite and think about your experience and how best to strike the balance in your approach between • Deficit based and asset based • Compliance and commitment • Extrinsic and Intrinsic motivators • There are some great thought provoking videos on the web which can act as a catalyst and more are being shared all the time by the #nhschange Twitter community. • RSA Animate Series – The Divided Brain • Peter Fuda – Lighting the Fire Within • Notts City Partnership - The Story of Ada and Maureen • Derek Sivers – Leadership Lessons from the Dancing Guy • TaliSharot – The Optimism Bias • Dan Pink – The Puzzle of Motivation • Mitchell and Webb – Bronze Age Orientation Day • Designing a local process of discovery and experimentation with the NHS Change Model can either reflect the way we have always worked or be used as an opportunity to challenge and test the way we have always worked. NHS Change Model Getting Started Workbook

10. The NHS Change Model – the elements Use the following section to explore what each part of the NHS Change Model means to you. By thinking of powerful examples from our experience we bring the different parts of the Model alive and begin to root our understanding in previous learning If necessary talk to friends and colleagues to share examples. • Organisationsdeemed as ‘successful’ whose communities are strong, passionate and committed to delivering improvement and outcomes, create shared purpose as a common thread. • Shared purpose connects us with our commitment and contribution to our core NHS values that bring people into the NHS to deliver outcomes that matter to local communities, beyond just what we do as individuals, teams or organisations. • We can manage for innovation, but it starts with knowing what drives creativity in our leaders, clinicians and staff who generate and develop new ideas which, when implemented, will become tomorrow’s innovation. We need to know what problems we are trying to solve, and why it matters, the meaning, and a clear direction towards a worthwhile purpose. • Leading change means something when it is connected to purpose, connecting people to the change in a very open way. Think of a powerful example of this element from your experience Think of a powerful example of this element from your experience • The evidence suggests that the leadership style and philosophy that is most likely to deliver large scale change is one that generates a commitment to a shared purpose through collaboration. Leaders of successful large scale change are more likely to have built their efforts on a platform of commitment to change, setting the conditions, creating a shared purpose and deeper meaning for the change. They role-model leadership behaviours, skills and attributes and set a high ambition for performance. They connect to values and engage and empower others to commit to action. By doing these things they ensure that the scale and pace of improvement is maximised NHS Change Model Getting Started Workbook

11. The NHS Change Model – the elements • Evidence and learning from social movements and community organising tells us that to affect large scale change it is essential that large numbers of people and resources must be engaged and mobilised in an effective, collaborative and strategic way. Change needs to be implemented at every level: Nationally through senior leaders, regionally through existing channels, locally through commitment groups. • Engagement is founded on intentional relationships based around exploring shared and values, harnessing new resources, actively seeking ‘weak ties’ as well as established ‘strong ties’ and these are skills that must be developed at every level in the system. • Engagement and mobilisation is about building scale and pace – enhancing work that is often already underway, working through existing hierarchies and securing a broad constituency of support including the voluntary sector and other stakeholders. It should enable all stakeholders to build relationships quickly – through developing their own ‘commitments’ to each other and to the common goal. Think of a powerful example of this element from your experience • When we want to change something, whether it’s just something small, or the way a whole health care system works, we know that we need conditions to be right if what we change is going to both work as we wanted it to, and also stay changed for the future. Key to both of these is whether the broad conditions for change - the system drivers -, can be lined up to support what we are trying to do. These drivers might take the form of incentives for change, or specific standards to be achieved if penalties are to be avoided. Aligning these drivers with the quality improvement intent and thereby making best use of them is the crucial focus of this component of the NHS Change Model. • It is important to recognise that not all system drivers impact in the same way across all parts of the system, and they can range from personal incentives, through organisational or regional scope, up to national level. It is vital to ensure that skilful alignment of drivers prevents conflicting incentives that can conspire to undermine the quality improvement we are seeking to achieve. • Poor alignment of system drivers can lead to a clash of incentives and penalties which might stand in the way of positive quality improvement. The individual incentives to change, wider standards to be achieved to avoid penalties, and payment systems must be supportive of a single direction of travel to continuously improve the quality of care patients receive for the resources available. To do this, the drivers also need to be able to evolve and respond and change appropriately against the prevailing economic and operational backdrop. Think of a powerful example of this element from your experience NHS Change Model Getting Started Workbook

12. The NHS Change Model – the elements • Evidence and learning from social movements and community organising tells us that to affect large scale change it is essential that large numbers of people and resources must be engaged and mobilised in an effective, collaborative and strategic way. Change needs to be implemented at every level: Nationally through senior leaders, regionally through existing channels, locally through commitment groups. • Engagement is founded on intentional relationships based around exploring shared and values, harnessing new resources, actively seeking ‘weak ties’ as well as established ‘strong ties’ and these are skills that must be developed at every level in the system. • Engagement and mobilisation is about building scale and pace – enhancing work that is often already underway, working through existing hierarchies and securing a broad constituency of support including the voluntary sector and other stakeholders. It should enable all stakeholders to build relationships quickly – through developing their own ‘commitments’ to each other and to the common goal. Think of a powerful example of this element from your experience Think of a powerful example of this element from your experience • The evidence suggests that an effective approach for the delivery of change and the monitoring of progress towards planned objectives are essential to making that change a reality. A proven portfolio programme, or project management approach will increase the likelihood that changes will deliver the planned benefits, because accountabilities are shared and clear, and the scale and pace of improvement are enhanced. A rigorous approach requires discipline and focus and is not optional. It provides greater financial and quality control of the change to deliver benefits of strategic importance. Without rigorous delivery other elements of the change model will fail. NHS Change Model Getting Started Workbook

13. The NHS Change Model – the elements • Using an evidence-based improvement methodology ensures that the change will be delivered in a planned, proven way that follows established methods. The improvement methodology is the game plan. There is a range of proven methodologies available to support different kinds of change, with a particular emphasis on large scale change across systems, not just process improvement. • Improvement methodologies underpin the other components of the NHS Change Model and provide an underlying coherence for change efforts. • With the use of effective evidence-based improvement methodologies the adoption and systematic spread of change is supported more effectively; delivery of leadership goals and the overall success of a change effort are more likely to be assured. Think of a powerful example of this element from your experience Think of a powerful example of this element from your experience • We need to accelerate the speed and extent of the spread and adoption of innovation in order to deliver the cost savings required while improving the quality of care we deliver. This will mean more active sharing of successful innovations with others across the NHS and more being prepared to learn from others and adopt innovations from elsewhere into our own practice. • The spread and adoption of innovation does not just happen but needs to be planned for so that the benefit of the innovation is maximised. Factors that help or hinder the spread and adoption of innovation in healthcare are known. These factors interact in a dynamic and complex way for each innovation in each unique context / setting. We need to use the existing evidence to inform our plans by identifying factors that are weak and strengthening them using existing knowledge, tools and approaches. • Successful spread and adoption links directly with all other NHS change model components. NHS Change Model Getting Started Workbook

14. Personal Affinity Discovery Exercise • Use this tool to surface and make explicit your own personal affinities to the different parts of the NHS Change Model • The tool enables you to identify those parts of the Model that you might need to pay more attention to –ensure that you have a Personal Development Plan for those parts or ensure that you work with someone who has a stronger affinity to them. • A tool for consolidating personal affinities from a team or group is available within the Excel resource which comes with this workbook. Instructions Select and double click on the table to activate the embedded spreadsheet (PowerPoint 2007 and 2010) Select your preferences from the paired choices and review your affinity scores. Click outside the table to deactivate it. Save the file to preserve the changes NHS Change Model Getting Started Workbook

15. Personal affinity exercise – Personal Development Plan • Use this sheet to think about the personal development needs that have emerged from the Personal Affinity Discovery Exercise • Write down your rankings and then think about what you could do to increase your confidence and attention to the lower ranked affinities. One thing to do is look at your highest ranked affinities and think about how they could make best use of your lower ranked affinities. So if you are high on Leadership for Change and low on System Drivers ask yourself what Leadership for Change needs from System Drivers to be even better and also what it can contribute to System Drivers to make System Drivers even better. NHS Change Model Getting Started Workbook

16. Your notes NHS Change Model Getting Started Workbook

17. Getting started with the NHS change model as a team Moving from individual grounding in the use of the Model to actually applying it to a project NHS Change Model Getting Started Workbook

18. Preparing for and running the team planning exercise Introduction • The NHS Change Model provides a strong systematic framework which a project team and its stakeholders can use both to aid planning and preparation for a project and as a developmental and mobilisation activity. • You can run versions of this exercise: • When a project is in planning stage • At key milestone stages in the lifecycle of a project • After the completion of a project as part of the learning and review process. Framing the powerful question • The NHS Change Model is not an end in itself, it is simply a lens through which a project is viewed. We are using the NHS Change Model to help us better frame and plan the project, not using the project to demonstrate the NHS Change Model. • To start with sufficient attention must be given to framing the question that using the NHS Change Model will help you answer. In most cases there will be a set of project objectives or ambitions and it may be sufficient to simply use the Model to help you answer the question ‘What is the capability and capacity we need to give the project the best chance of a successful outcome?’ Preparation and Planning • We strongly recommend that you plan well ahead to take at least a half-day to run this workshop. An intensive 4 hour workshop session can achieve a considerable amount both in terms of planning and in terms of mobilising and engaging the project team and its key stakeholders. • Start by undertaking a stakeholder analysis – who needs to be in the room with you to be part of the planning and engagement? What do you know from the personal affinity mapping exercise that suggests the expertise you might need in the session with you? Tools and guidance can be found through this link http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/stakeholder_analysis.html • The impact of the choice of venue cannot be underestimated. The nature and configuration of the space that you choose to work in has a considerable impact on the energy, dynamics and productivity of the session. Boardroom layout encourages ‘boardroom’ behaviours and hierarchical responses A more flexible open layout with no tables, or cabaret style with plenty of space for movement and group work focused around different parts of the space creates a richer environment more conducive to imagination. If you are trying to engage and mobilise people then you need to design a workshop space where people can be engaged and mobilised. How engaged and mobilised do you feel sitting in a Boardroom layout? • In advance have poster sized versions of the NHS Change Model templates and Radar Plot in this workbook (or in the Excel Resource Pack) printed and ensure you have a supply of pens and post-its available. • Split attendees into groups in advance of the session. 8 groups is ideal as this means you can have a group working on each part of the Model. If you have fewer groups then some groups may be working on more than one part of the model. NHS Change Model Getting Started Workbook

19. A typical workshop outline The NHS Institute for Innovation and Improvement has a very useful set of Facilitation Guides on its website. If you are not an experienced facilitator then it is recommended that you familiarise yourself with them. Facilitation Guides Design • Space: • Open room with cabaret or horseshoe seating. The 8 NHS Change Model posters and the Radar Plot Poster positioned around the room. Chairs clustered around posters but no table • Resources: • Pens, post-its and flip chart paper, blue tack etc • Projector and laptop • Coffee, tea and fruit on ‘tap’ as there are no formal breaks Agenda • Housekeeping (5 mins) • Challenge (10 mins) • A senior leader or stakeholder describes the challenge and the question that needs to be answered today. • This element needs careful thought as the style sets the tone for the rest of the workshop. We do not recommend slides unless they powerfully illustrate the challenge. • A fresh eyes exercise (optional) 30 mins) • acts as a catalyst for imagination and new thinking, as an energiser and sets the tone for the rest of the session. The link to the resource is here. • Can be used to also introduce self-facilitation methodology • An introduction to the NHS Change Model (see slide pack resources) (20 mins) • Why do we use a Model • The 8 parts of the Model • Mental Models of change in balance • Team Affinity Exercise (20 minutes) • all participants in one group • Planning Exercise (2 hours) • in groups focused around posters. If enough people then a group to each poster or if smaller numbers each group has two posters to work on in timed intervals. Use the Parking Lot for things that the group cannot agree on or which are out of scope but still relevant. • Law of two feet • groups nominate one person to remain with the poster(s) • The others are then free to visit any of the other posters, are briefed by the host, make their own contributions and then move on. • Groups then return to original poster are updated by the host and then complete the task • Groups plot their scores on the Radar Plot template • Feedback (30 mins) • Groups feedback with an example www and action , an example ebi and action and a newspaper headline that encapsulates their ambition (what would a journalist have written as a headline if they had been working with the group). • Review the Radar Plot template and ask for reflections and thoughts • Ask participants to write a ‘commitment to contribute’ on a post-it (with their email address) and stick it to the relevant area of the Radar Plot poster. Tips • Groups working around the posters and moving between them is an important part of creating the energy for learning and engagement. • Try and keep it all in one room – the buzz and cross fertilisation is very important. • If you have a technologically ‘savvy’ group you can get them to type up the posters themselves direct onto electronic versions of the templates to cut down on the burden of follow-up admin and speed the consolidation of the outputs. We suggest using something like DropBox to hold and distribute the templates if your IT systems policies permit it. But always use the paper posters as well as they provide the key visual input and group working space. • Create a Twitter hashtag for your project and encourage people to twitter before, during and after the event - it gets them started and will help keep them connected. • Always have a follow-up meeting of the key project group members within a week after the event to review the outputs, look for common themes, to agree how to integrate the output into your programme and project plans and to agree the feedback messages from the workshop to participants and key stakeholders. NHS Change Model Getting Started Workbook

20. Exploring group affinities to elements of the Model Introduction • When using the Model for a project it is important to explore and understand the impact of the personal preferences of individuals for parts of the Model on the functioning and performance of the team itself. • A preponderance of strong preferences for a small number of parts of the NHS Change Model can lead to teams paying insufficient attention to those parts of the Model to which they feel less affinity. This example of group-think may be expressed by questions such as: • ‘why can’t we just focus on these four elements ?’ • ‘there are too many parts of the model to cope with’ • The resources available with this Workbook include: • An affinity discovery activity for a team or group to undertake which introduces the concepts around the implications of personal and group affinities • An Excel affinity discovery tool to allow an individual to surface their preference profile • An Excel tool to allow a project manager to produce a consolidated profile of the individual affinities of their team • Online versions of all resources will be developed in the next phase. Things to be thinking about • Personality types (as described by MBTI, PRISM, Belbinetc) will have an impact on how people view the model. You could work with the team exploring the linkages between personality types and preferences and its implications • The language used to describe the different parts of the Model can create a set of immediate reactions. You could explore with the group how the different parts of the model could be reframed in different languages to appeal more effectively to different perspectives and personality types. • Ask people to think about the possible linkages between their most preferred part of the Model and their least preferred part of the Model. For example if the most preferred is Leadership for Change and least preferred is Transparent Measurement then ask what Leadership for Change will need from Transparent Measurement to be most effective and vice versa. • Surface and explore stereotypes that people associate with different parts of the Model and the implications of those stereotypes. • If the team has undertaken the personal affinity discovery exercise then consolidate the responses using the Excel Tool and use the outputs to discuss with the team where the strengths and the gaps lie. Discuss how you avoid over doing the focus on areas of high team preference and how you will pay proper attention to those areas where the overall preferences are lower. Questions you might want to ask: • How do we bring in the expertise we need in areas of low preference? • Do we have ‘lone voices’ who have a strong preference that is not typical in the team and how do we ensure that this voice is heard and not ‘stereotyped’? • How as a team do we manage our agendas and meetings to achieve a balanced approach to the Model? NHS Change Model Getting Started Workbook

21. Team affinity exercise facilitator instructions This exercise is designed to help your team and stakeholders explore the implications of individual and group preferences for the different parts of the Model at the same time as exploring what the Model might mean for your project. This exercise is a vehicle for prompting discussion and insights into the use of the Model. A more comprehensive and graded picture can be achieved by everyone completing the individual affinity discovery exercise and combining the results using the Excel Resources Workbook or the online survey tool. NHS Change Model Getting Started Workbook

22. Team affinity exercise template NHS Change Model Getting Started Workbook

23. Our actions based on outcome of Affinity Mapping NHS Change Model Getting Started Workbook

24. Team capability and capacity planningUsing the templates 1 5 4 8 2 6 3 7 NHS Change Model Getting Started Workbook

25. Our Shared Purpose NHS Change Model Getting Started Workbook

26. Leadership for change NHS Change Model Getting Started Workbook

27. Engagement to mobilise NHS Change Model Getting Started Workbook

28. System drivers NHS Change Model Getting Started Workbook

29. Transparent measurement NHS Change Model Getting Started Workbook

30. Rigorous delivery NHS Change Model Getting Started Workbook

31. Improvement methodology NHS Change Model Getting Started Workbook

32. Spread of innovation NHS Change Model Getting Started Workbook

33. Radar Priority Plot NHS Change Model Getting Started Workbook

34. Dependency Mapping exercise - instructions Why a Dependency Mapping exercise? • When planning a project using the NHS Change Model it is important to keep checking the linkages and dependencies between the different parts of the Model. Otherwise it is possible that work to develop the different parts may become disconnected and start to pull in different directions. • The dependency mapping exercise also provides a framework for assessing the key interdependencies of the project. Which parts of the Model are most important because they have the greatest impact on the other parts of the Model? • As in all of these exercises undertaking the activity as a project team with key stakeholders also uncovers a richer level of meaning and perspective amongst the participants and allows different views and understanding to be surfaced and shared. Instructions • An example Dependency Map is shown on the next page. • Nominate someone to facilitate the first stage and to hold the pen. • Starting with Shared Purpose work clockwise around the chart identifying the dependency and the reason for the dependency. • Use the sentence choice clearly articulated by the facilitator ‘Shared Purpose depends on Spread of Innovation’ or ‘Spread of Innovation depends Shared Purpose’ for example • Ask the group to discuss and come up with a decision. You may need to repeat the question several times. • If there is no consensus then vote and go with the majority • Note the reason for the dependency on the connecting line (and the voting figures if relevant) • Continue working clock wise until you have reached the final connection between Shared Purpose and Leadership for Change. • Now repeat starting with Spread of Innovation and Improvement Methodology. • It helps to use a post it with an arrow to point to the part of the Model you are working from – it is easy to lose track. • Hand over the pen several times to different people – it can get quite tiring repeating the dependency choice and it is easy to start becoming confused. • At each move around clockwise there are fewer dependencies to map • When you have completed the exercise count the number of arrow heads arriving at each part of the Model. Put the count next to each part of the Model. • The parts of the Model with the highest count are the ones which are more critical to success. These are the ones upon which more of the other parts are dependent. • Add the dependency scores to the Radar Priority Plot and compare the outputs from each. High priority and high dependency score would indicate a critical development requirement. • You might want to add into the mix the outcomes of a group affinity discovery activity to give a richer set of insights for discussion. High dependency, high priority and a low Affinity Score might indicate an area of very significant risk. • The Excel workbook resource includes a Dependency Mapping Tool which you can use to capture the outputs of the poster exercise. You can also use it projected onto a large screen rather than use the poster – although again the dynamics of working around a poster as a group are more effective. • If you are working with a dispersed group then you could use something like WebEx or GoTo Meeting bring the group together virtually to work with the Excel tool. NHS Change Model Getting Started Workbook

35. Dependency Mapping – an Example NHS Change Model Getting Started Workbook

36. Dependency Mapping Template Depends on X Y Arrow cannot be double ended – you must decide which way the dependency runs Write the nature of the dependency on the link Reason for dependency added to link NHS Change Model Getting Started Workbook Ambition Statement Ambition Statement

37. Dependency Mapping Tool • Select and double click on the table below to activate the embedded spreadsheet (PowerPoint 2007 and 2010) • Select the direction of the dependency from the drop-down selection. The Dependency Statement is automatically created so you can confirm • The dependency score and ranking helps you identify those parts of the Model on which there is a high level of dependency and are thus a priority for attention • Click outside the table to deactivate it. Save the file to preserve the changes NHS Change Model Getting Started Workbook

38. Spreading the use of the model Advice and thoughts on the experience of working with the NHS Change Model so far NHS Change Model Getting Started Workbook

39. Spreading use of the Model – things to think about Introduction • Using the NHS Change Model as a common language and framework as part of project and programme planning and delivery within organisations, networks and systems provides a strong foundation for collaborative working. • In an increasingly complex and fast moving environment the simplicity of the 8 parts of the Model helps groups make sense of complexity and focus on what really matters for success. • Spreading the use of the Model will need careful preparation and planning. The imposition of top-down initiatives, ‘not invented here syndrome’ or ‘not another management fad’ weariness can all create anti-bodies to the adoption of and embedding of the Model. • The NHS Change Model is not an end in itself – it is only a lens to help you prepare systematically for a project. • Our suggestion is that you plan the spread and adoption of the Model in your organisation, network or system using the Model – be the change you want to see in others. Some thoughts • Shared purpose • How do you create a core team of champions acting as the ‘cell’ that works together to use and test the Model in their own respective areas? • How do you ensure they remain connected, engaged and share a simple narrative when describing the use of the Model? • Leadership • How do you identify and equip key leaders with the powerful questions that create the incentive and interest to find out more about the NHS Change Model? Do they articulate and use the 8 parts of the Model when reviewing a project or programme? • How do Leaders encouraging ‘positive deviancy’ – celebrating experimentation and learning from using the Model. • Mobilise and Engage • Who are the key stakeholders? If this was an infection you were trying to spread rather than contain who would be the best carriers/vectors? • How do you spark curiosity and experimentation rather than mandating? • How do you use identify and use existing informal and formal networks • How do you use social media and other communications tools to engage, mobilise and stay connected? • How do you build communities of practice that span organisational silos? • System Drivers • Remember the Mental Models of change described earlier in the workbook. What is the balance you are trying to strike? • What intrinsic Incentives can you provide – celebrating success, building the sense of community, providing mentoring and coaching and appreciative feedback. • How can you get to a point where projects that have used the NHS Change Model as part of the preparation phase get fast tracked to approval? • Transparent Measurement • How do you track and measure the spread and adoption of the NHS Change Model? • What are your simple measures and how do you visualise and promote these? • Rigorous delivery • How could you embed the Model into your existing programme and project management processes? • How will you methodically tackle the spread and adoption of the Model? • Improvement methodologies • How will you equip early adopters with the tools to promote spread and adoption? • Narrative techniques for engaging others • Providing your community with facilitation skills • Spread of innovation • Think about how to ‘socialise’ the NHS Change Model in an organisation • Case studies of projects that have sued the Model • Use of different communications channels • Shadowing, mentoring and coaching • Resource packs NHS Change Model Getting Started Workbook

40. Resource slides for use in your own presentations Some slides for inclusion in your own local presentations NHS Change Model Getting Started Workbook

41. The Change Model

42. Shared Purpose What can we do locally to build the shared purpose that draws us together to deliver our ambitions for ..........?

43. Leadership for change What can we do locally to build the leadership at all levels to deliver our ambitions for ..........?

44. Engagement to mobilise What can we do locally to engage and mobilise staff, users and carers and other key stakeholders to deliver our ambitions for ..........?

45. System drivers What can we do locally to get the incentives and processes aligned to deliver our ambitions for ..........?

46. Transparent measurement What can we do locally to ensure we can measure our outcomes so we know how we are doing and do so transparently, to deliver our ambitions for ..........?

47. Rigorous delivery What can we do locally to ensure we have the disciplines and rigour of planning and monitoring to deliver our ambitions for ..........?

48. Improvement methodology What can we do locally to ensure staff at all levels are equipped with the tools and skills to redesign and deliver our ambitions for ..........?

49. Spread of innovation What can we do locally to ensure that we are able spread what works in a systematic and sustainable way to ensure our ambitions for .......... are available to all?