IS4 Review: Improvement is a contact sport

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Professor Maxine Power wraps up a week of improvement

Professor Maxine Power, Chief Executive, Haelo reviews lessons learnt as workshop one, hosted for the second cohort of Improvement Science 4 (IS4) Leaders delegates, comes to it’s conclusion.

As a team based, 12 month, training programme in improvement science, IS4L includes a blend of web-based learning, improvement coaching and site visits. Prior to this week (3-5th May 2016), delegates have been preparing for their first of three workshops, as part of a Breakthrough Series Collaborative.

Improvement is a contact sport

I have spent the last three days with our new cohort of leaders on the IS4 programme and our faculty including Lloyd Provost MS, Improvement Advisor, Associates in Process Improvement.

Every time Lloyd and I meet a group of committed, passionate and skilled healthcare leaders we are reminded what talent we have in the NHS. Over the course of the first three days we work together to shape their improvement aims, build their case for change, describe the potential solution (using driver diagrams), understand the system (process mapping) and start to build measures of success (using run and control charts). It’s a real baptism of fire for most participants.

Team photo at Improvement Science 4 Leaders

We often find that teams are wrangling with the challenges of ‘fitting in’ their improvement work with their ‘day job’. From the outset we are clear – improvement is the day job! We believe that the adoption of improvement methods and an understanding of the science which underpins it helps people to work ‘smarter’ rather than ‘harder’. Impacting on way more than their project.

The leaders we work with are often predisposed to ‘getting things done’ under their own steam – an approach which has served them well during their clinical training. We encourage a fundamental switch in mindset and approach. We support participants to discover skills to lead through influence and persuasion – a far cry from the prevailing leadership models of positional power and authority which many of us have experienced first hand and are pervasive in the NHS.

We know that this new leadership requires a compelling personal narrative; the story of me, the story of now, the story of us’ is a method developed and tested by social movement leaders such as Marshall Ganz. For me this means sharing why I work in healthcare, my passion for change, my relentless pursuit of change and the challenges I (like many others) face every day.

The day to day challenges of an improvement advisor are manifold but today I was reminded of how important it is that we build resilience as leaders. Why is that? Well, we all assume that improvement is ‘good’ and therefore it will be welcomed! Not true. We know from the ‘Diffusion of Innovation’, work of Everett Rogers  that more people are likely to be agnostic or resistant to change than positive advocates. These characteristics of the ‘late majority’ and ‘laggards’ are some of the most difficult to deal with as a novice improvement leader. These are the people who, when faced with change respond with ‘we are already doing this’ or ‘that will never work here, our patients are different’ or ‘we are simply too busy to contemplate change right now’.

For the aspiring improver

The aspiring improver needs a toolkit to respond and mobilise these groups. Here are my top tips:

  1. Expect resistance from the outset and design the response into your plans. Ask yourself why (and how) people might object. Be prepared. Build a standard set of responses to common objections and use them with your team to build a single shared narrative.
  2. Don’t take it personally – the challenge is predictable and speaks to concerns about the change not your personal integrity. The natural response is to defend your improvement. I often refer to this as the ‘ugly baby’ – this visceral response to your improvement project engenders the same emotional response as someone telling you that your beautiful baby is actually quite ordinary (or even ugly). The best response here is to acknowledge that you have listened and heard. Take on board suggestions and use them to positively influence the programme wherever possible. Resist your instincts to respond and silently count to 10. Remember – one converted laggard is worth 20 innovators!
  3. Use peers to describe how they have adopted the improvement. Don’t fall into the trap of using innovators to convince the late majority or laggards, they simply will not identify with them. Remember for this group – people like me will convince people like me…stories trump data every time!
  4. Don’t let objections and challenge sap energy from the change. Positivity is the fuel for improvement it produces light and heat charging the project forward. Focus on the people who are actively engaged and spend at least 80% of your effort with this group. Build a system of ground rules for engagement which allows you to park’ contentious issues.
  5. Perfection is the enemy of the good. You can’t wait to have everyone completely on side before you get going. Acknowledge the challenge respectfully and sincerely but set up a system for testing with the willing whilst working on a solution to challenges. Remember no one has the power of veto unless you give it to them.

It’s time to challenge change

There is no doubt in my mind that improvement is a contact sport for individuals who operate in teams, more akin to rugby or American football than running or high jump. The natural response to change is challenge (or run away) and the natural response to challenge is defence (or silence).  For successful improvement we must develop as resilient and balanced leaders informed by social science working in a seamless union with our environments and teams. This team based activity, informed by science, allows us to see more clearly and act more impact fully. Something we all need to do to build our NHS for the future.

You can follow Prof. Maxine on twitter @powerNHS

To find out more about Haelo’s Improvement Science programmes and our team of experts on offer here at Haelo HQ, explore our website or email info.haelo@nhs.net

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