{"id":197,"date":"2021-02-01T19:23:11","date_gmt":"2021-02-01T19:23:11","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=197"},"modified":"2021-06-14T14:41:18","modified_gmt":"2021-06-14T14:41:18","slug":"creating-tomorrow-today-seven-simple-rules-for-leaders-by-helen-bevan-and-goran-henriks","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2021\/02\/01\/creating-tomorrow-today-seven-simple-rules-for-leaders-by-helen-bevan-and-goran-henriks\/","title":{"rendered":"Creating tomorrow today: seven simple rules for leaders by Helen Bevan and Goran Henriks"},"content":{"rendered":"

This is the first of eight blogs that we will be posting on BMJ Leader over the coming weeks.<\/em><\/p>\n

We both lead change inside our respective health and care systems; Helen in the National Health Service in England and Goran in Region J\u00f6nk\u00f6ping County in Sweden. Together we have 70 years\u2019 experience in leading change in health and care. As well as working on our own countries, we have supported leaders across six continents seeking to make large scale change happen. The two of us have been working together for several years to combine our knowledge and experience. The COVID-19 pandemic and the desire to create different, better systems for the future has been an added motivation for us to share our perspectives. As a result, we have created a set of \u201cseven simple rules\u201d for leaders who are ambitious for transformation, based on our joint learning.<\/p>\n

\"\"<\/p>\n

In this first blog, we will describe the motivation behind our simple rules. Over the next seven blogs, we will describe each of the rules in turn.<\/p>\n

Rules for transformation in the context of the pandemic<\/strong><\/p>\n

Across the globe, we have seen more change occurring in the ways we deliver health and care as a response to the pandemic than we have ever seen before. Methods of delivery that we took for granted as the norm have been swept away in the COVID-19 response as people have responded in extraordinary ways.<\/p>\n

Yet looking back over the last 30 years, the speed and complexity of change has been increasing all that time. To a large extent, COVID-19 has amplified what was happening already. To quote John Kotter<\/a>: \u201cThe speed and complexity of change over the last 30 or 40 years have continued to go up with occasional spikes, like in March of 2020. There’s no evidence whatsoever that there’s going to be a post-COVID slowdown”<\/em><\/p>\n

So, when we think about transforming the health and care system, we need to learn greatly from what has happened in the past year AND we need to think beyond that.\u00a0 This is not about a pre or post-COVID world; it\u2019s about a world that was already moving fast, got faster as a result of COVID-19 and will continue at speed. The more we mobilise people around the potential for a radically different future, the better we prepare for the future.<\/p>\n

Why \u201cSimple rules\u201d?<\/strong><\/p>\n

\u201cSimple rules\u201d is a principle<\/a> from complexity science for transforming mindsets that drive behaviours and actions in large complex systems.<\/p>\n

If we want to get a very large group of people, in a complex adaptive system<\/a> to behave differently, with everyone moving in a coherent direction, there are at least two approaches<\/a> we can follow.<\/p>\n

\"\"\"\"<\/p>\n

Our thinking behind the simple rules is that rather than, or as well as, identifying sets of standards and policies that those in the system should comply to (approach #1), we seek to identify a few simple rules so that everyone understands why and what we are doing (approach #2). One of our simple rules, which we will discuss in blog 6, is \u201cembrace contradictions and tensions\u201d. There is a paradox between approach #1 and approach #2 and neither is likely to be the full answer. History<\/a> shows that it is very difficult to create large scale, sustainable change through approach #1 on its own. On the other hand, we need formal leaders of the system to embrace different ways of working, such as approach #2, so we have to get senior leaders behind our simple rules. We have to work with both approaches, often in contradiction to each other, at the same time.<\/p>\n

People often think that \u201crules\u201d are about stopping people doing things. However, in our approach #2 context, changing the rules means rethinking and reshaping the conditions that characterise the dominant patterns of our system.<\/p>\n

Where we have effective simple rules, everyone in the system understands them and delivers them in their own way. We are NOT saying: \u201cthis is how you should do it\u201d or \u201cdo whatever you like\u201d. We ARE saying: \u201cthese are the ways we want to work\u2013 express yourself using those elements\u201d. Our goal with the simple rules is not to exercise control but to establish the high-level principles within which we all operate.<\/p>\n

Here is an example set of simple rules to demonstrate this principle. Don Berwick<\/a> published a collection of his speeches in the book Escape Fire: designs for the future of healthcare<\/em><\/a>. <\/em>In the foreword, Frank Davidoff synthesised the content into a set of eight simple rules that people who are improving health and care should follow. He is saying that if you want change to happen, rather than imposing top-down policies and asking people to comply with methods or procedures, get everyone following these basic principles:<\/p>\n\n\n\n
An example of simple rules<\/strong><\/p>\n

8 principles for designing the future of health care<\/strong><\/p>\n

1.\u00a0\u00a0\u00a0 Name the problem<\/p>\n

2.\u00a0\u00a0\u00a0 Build on successes<\/p>\n

3.\u00a0\u00a0\u00a0 Take leaps of faith<\/p>\n

4.\u00a0\u00a0\u00a0 Look outside medicine<\/p>\n

5.\u00a0\u00a0\u00a0 Set aims and show constancy of purpose<\/p>\n

6.\u00a0\u00a0\u00a0 Understand systems<\/p>\n

7.\u00a0\u00a0\u00a0 Make action lists<\/p>\n

8.\u00a0\u00a0\u00a0 Never, ever lose sight of the patient as the central figure<\/p>\n

Source: Frank Davidoff: summarising the underlying in principles in the book Escape Fire by Don Berwick, 1992-2002<\/em><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

We have created our own set of simple rules for leaders of health and care who seek transformation that will result in improvements for large numbers of people.<\/p>\n\n\n\n
Creating tomorrow today: seven simple rules for leaders<\/strong><\/p>\n

1.\u00a0\u00a0\u00a0 Define our shared purpose<\/p>\n

2.\u00a0\u00a0\u00a0 Root our transformation in a sense of belonging<\/p>\n

3.\u00a0\u00a0\u00a0 Predict and prevent<\/p>\n

4.\u00a0\u00a0\u00a0 Support people to build their agency (power) at every level of the system<\/p>\n

5.\u00a0\u00a0\u00a0 Embrace contradictions and tensions<\/p>\n

6.\u00a0\u00a0\u00a0 Unleash learning as a transformational power<\/p>\n

7.\u00a0\u00a0\u00a0 Action small-scale change in a large scale framework<\/p>\n

Source: Helen Bevan and Goran Henriks<\/em><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Our rules are different (but complementary) to the Berwick rules. The Berwick rules apply to everyone who is working to make improvements at any level. Our rules are principles for leaders of large-scale system change who want to bring together people from across the system to build collective power and co-produce improvements.<\/p>\n

Hundreds of people have worked with us to identify and develop these principles since we started this quest to create some simple rules in 2013. In the past few months, we have tested the relevance of our simple rules for a post-COVID world with system leaders from several countries.<\/p>\n

The simple rules take us back to the very essence of health and care services.\u00a0 They remind us of what we are aiming to achieve in all our interactions with the care system. By operating through new leadership rules, we can create tomorrow today. Over the next seven blogs, we will outline each of the seven rules and make connections between the rules. We invite fellow leaders to dig into, reflect or apply these rules into their daily work.<\/p>\n

At the end of every blog, we will add three questions for reflection. You may want to think about these yourself or ask other people in your team or network to read the blog and discuss the questions together.<\/p>\n

Key questions to reflect on in blog one:<\/strong><\/p>\n

    \n
  1. Which of the seven simple rules \u201cspeak\u201d to you the most at this early stage?<\/li>\n
  2. How can the principle of simple rules support you in your wider transformation efforts?<\/li>\n
  3. To what extent are you thinking about learning from the period before the pandemic (as well as the pandemic itself) in planning your transformation efforts post-pandemic?<\/li>\n<\/ol>\n

    Please join in the conversation on Twitter, adding #CreatingTomorrowToday and @BMJLeader to your tweets.<\/p>\n

    \"\"<\/p>\n

    Helen Bevan<\/a> @HelenBevan is Chief Transformation Officer with the NHS Horizons team, England.<\/p>\n

    \"\"<\/p>\n

    G\u00f6ran Henriks<\/a> @GoranHenriks is Chief Executive of Learning and Innovation with Region J\u00f6nk\u00f6ping County, Sweden.<\/p>\n

    Declaration of interests<\/strong><\/p>\n

    We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.<\/p>\n","protected":false},"excerpt":{"rendered":"

    This is the first of eight blogs that we will be posting on BMJ Leader over the coming weeks. We both lead change inside our respective health and care systems; Helen in the National Health Service in England and Goran in Region J\u00f6nk\u00f6ping County in Sweden. Together we have 70 years\u2019 experience in leading change […]<\/p>\n

    Read More…<\/a><\/p>\n","protected":false},"author":395,"featured_media":198,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,12],"tags":[],"class_list":["post-197","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-covid-19-pandemic","category-creating-tomorrow-today-seven-simple-rules-for-leaders-by-helen-bevan-and-goran-henriks"],"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts\/197","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/users\/395"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/comments?post=197"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts\/197\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/media\/198"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/media?parent=197"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/categories?post=197"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/tags?post=197"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}