How to triple the success rate of health and care transformation

I recently came across an article published in May from McKinsey’s on how the public sector could triple the success rate of transformational service change through the adoption of five critical disciplines. These resonate with characteristics which I describe in the following publications;

• Health and Care; how to deliver sustainable transformation using systems thinking. For Senior Executives and STP Leaders preparing for complex system changes on a large scale, March 2018.
• What is the ask of health and care system leaders today, Oct 2017.
• Your STP/ICS needs a Chief Transformation Officer, Mar & Jun 2018. 

The report entitled; Delivering for citizens: How to triple the success rate of government transformations. Describes how 80 percent of public sector efforts to transform performance don’t fully meet their objectives. This key finding came from of a survey of nearly 3,000 public officials across 18 countries as part of a study by the McKinsey Center for Government. The study also included insights from 80 case studies, as well as 30 in-depth interviews with leaders who had personally led transformations in government.

The article then focussed upon the learning from the 20 percent of transformations that did achieve their goals. McKinsey’s identified the five disciplines that, together, could more than triple the success rate of public sector transformations. Their research showed although they appear nothing more than common sense they are extremely difficult to get right. They call them the five Cs

1. Committed leadership.

Transformation leaders must go beyond standard public-sector management routines, committing extraordinary energy to the effort, taking personal responsibility for success or failure, leading by example to facilitate change, and challenging long-established conventions. To inspire the transformation, they must spend substantial time communicating face-to-face with the people affected, listening as much as they talk.

2. Clear purpose and priorities.

Successful transformations paint a compelling picture of their destination and make it crystal clear, to public servants and citizens alike, why change is necessary. In setting objectives, less is more: successful efforts keep targets few, specific, and outcome based.

In the publication, “What is the ask of health and care system leaders today” I describe how as a system leader you need to reach out, listen and inspire others with a simple message which shows your commitment to the belief that things can be better.  

“A belief that everything should better for patients, for staff and taxpayers but more importantly that it can be better, there is always an answer. A belief which gives individuals the confidence to reach out beyond their borders, to put their head above the parapet to find and talk to peers, to seniors, to whole groups about that belief. To be able to articulate their message simply, to listen to the response (word, body language, tone) and to ask questions, to gain an understanding of a shared belief or not and if not why not.”

“A successful system leader needs to be able to observe the events and patterns that surround them; to gain insight into the aims, aspirations, common interests, common values and the needs of peers and leaders who are outside the sphere of their positional or organisational boundaries. This enables them to engage with those colleagues, share those common interests, exchange information and offer support. This builds confidence and trust with each other and helps to build relationships which facilitate co-operation and co-production. A system leader works with and through other people. They distribute their leadership; delegating their responsibility, empowering leaders across the system at organisational (meso) and microsystem level. They take a performance facilitation role; allowing individuals to operate within the boundaries of their defined framework of operating.”

In “Health and Care_How to deliver sustainable transformation using systems thinking”, I and my fellow author, Steve Boam describe the role of the engagement and communication unit, a critical tool for change leadership.

“The primary action of the Engagement and Communications Unit is the continual massive and active engagement of all stakeholders, system users and staff. To connect with, motivate and engage with each stakeholder so they can make a personal connection with the story of now, but more importantly the story of tomorrow. In making that connection leaders, front line teams, patients and carers will be engaged, motivated and committed to the new tomorrow, they will be mobilised to deliver the new future.”

3. Cadence and coordination in delivery.

Transformations differ markedly from traditional public-sector policy-development and implementation efforts. They require a fast yet steady pace; a flatter hierarchy, with close collaboration among different agencies and functions; and flexibility, so problems are solved as they arise. They also require an empowered, focused transformation team to drive and track progress.

In “Health and Care_How to deliver sustainable transformation using systems thinking”, We describe how System Engineers and front-line staff form transformation teams to work across different organisations and microsystem to integrate pathways.

“Technical experts such as System Engineers, use their expertise in improvement science to strengthen the operations of healthcare systems. System Engineers don’t need to be clinical experts but they do need to be good at visualisation, problem solving and system design. The required capacity of the resource will vary dependent upon the size and complexity of the system change, in many local health and care economies improvement resource may already exist. But there is often no alignment of how the whole system approaches improvement, transformation and change. In-house disparate improvement capability and capacity needs to be brought together in a central shared service function. They must adopt a common approach for systems integration and quality, with focus on problem solving, process and system understanding, stakeholder engagement, patient and staff participation and system design. A right sized centre of expertise; resourced with System Engineers will support front-line teams to redesign pathways and microsystems that cut across multiple organisations.”

We also describe how a programme office enables effective tracking of progress and how co-developed plans are critical to deliver system wide change involving various sovereign organisations.

“The role of the Portfolio Management Office (PMO) is to bring a structured approach to the design and delivery of the transformation. It enables the effective monitoring and performance management, progress tracking of each change initiative and holds people to account for delivery. The structure of the governance needs to place accountability for the transformation at the Executive and Senior Clinicians. A good PMO ensures all participants have a single version of the truth, a transparent view of information flow through the management structure and a central record of the progress of delivery for each initiative. Creating a sustainable transformation plan is as an evolving journey, new information and knowledge becomes known and new ideas are discovered, as a consequence the end of the journey will undoubtedly change.”

“Co-developed and co-ordinated strategic plans are a critical component of delivering successful change; a single strategic plan is fundamental when transforming a system.”

4. Compelling communication.

Few governments communicate effectively enough to win hearts and minds. Nearly 90 percent of the participants in our survey said that the transformation would have been more successful if there had been more engagement with frontline employees. Transformations need well-planned, in-depth, and genuine two-way communication with all the groups affected by change—especially the employees of the organization undergoing the transformation.

The ability to actively engage each and every person about the transformation is the primary objective of the Engagement and Communication unit, one of the seven critical infrastructure components described in “Health and Care_How to deliver sustainable transformation using systems thinking”.

“What the leader cares about – and typically bases at least 80% of his or her message to others on – does not tap into roughly 80% of the workforces’ primary motivators for putting extra energy into the change programme. (Keller, et al., 2009).”

“The design and set-up of the Engagement and Communication Unit needs to be one of the first-wave efforts when developing the supporting infrastructure. The unit must develop new visual, auditory and written systems for listening and broadcasting. In spending more time upfront in building the readiness for change, we reduce the risk of disengagement and failure when we reach the stages of implementation."

"The foundations of a highly effective communications strategy must be built on the theory of large scale change (LSC). One of the goals of an LSC effort must be to create a sufficient mindset shift in stakeholders to create a movement towards a new vision that is better and fundamentally different from the status quo. LSC is fuelled by the passion that comes from the fundamental belief that there is something very different and better that is worth striving for. (Bevan et al., 2011)."

5. Capability for change.

Although many highly skilled people work for government, they rarely have deep expertise and experience in change management. Reliance on business-as-usual capabilities is a major contributor to the high failure rate of government transformations. Three sets of skills are particularly important: the ability to run complex, large-scale service-delivery organizations; project and program-management; smart and digital and analytics capabilities.

In a recent Linkedin post I made reference to the belief that commissioning, operational and programme management alone can succeed in connecting horizontal pathways of health and care across multiple interdependent vertical sovereign organisations was flawed. That systems thinkers or system engineers were essential to shift this paradigm. And in “Your STP/ICS needs a Chief Transformation Officer” I describe how geographical health and care systems need a Chief Transformation Officer, a specialist in large scale service change.

“An STP, ICS needs a Chief Transformation Officer, a system engineer, architect and driver, a specialist in large scale complex change and crucially a ‘disruptor’. They don’t have to be an expert in all services, all pathways and commissioning. A working knowledge of the system - yes, but the skill of the Chief Transformation Officer is to facilitate, coordinate, engage and bring all of the elements together. The required skill is leadership, energy and enthusiasm and not time served.”

“An individual who is orientated to new ideas, possibilities, improvement. Their motto must be; everything could be improved: process, systems, information, system technology, organisations, self and others. An improvement scientist who bridges the gap between the classic professions of organisational development (OD) and service improvement. A thought leader who thinks about the big questions and who’s view point is not shaped by the boundaries of fear created by public sector institutional bureaucracy.” 

To deliver transformational change across health and care or wider public sector requires a cadre of system leaders, with a clear and concise purpose, to be able to tell their compelling story. Supported by a Chief Transformation Officer, a team of system engineers and ability to co-ordinate their collective priorities.

The report entitled; delivering for citizens: How to triple the success rate of government transformations and written by Tera Allas, Martin Checinski, Roland Dillon, Richard Dobbs, Solveigh Hieronimus, and Navjot Singh. Report May 2018, McKinsey’s.

If you would like to say hello or grab a coffee (real or virtual) to discuss the role of a Chief Transformation Officer or my take on system transformation infrastructure and the critical role they both play in health and care integration email me at [email protected] or give me a call; 07739 687907.

Michael Shaw