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The Horizons Team

  1. PEOPLE own what they HELP CREATE
    We create spaces where people with a diversity of views and experience can come together and co-create the future so we get BETTER, QUICKER, OUTCOMES.
  2. REAL CHANGE take place in REAL WORK
    We support the front staff who do the work to share ideas, experience and operational practise to speed up… LEARNING, ACTION AND CHANGE
  3. The people who do the work do the CHANGE
    We help people, staff and patients to build their POWER to make a difference
  4. CONNECT the system to more of itself
    We connect thousands of people to each other, through social networks, virtual communities and social media

Principles taken from Myron Rogers: “Myron’s Maxims”


More FOCUS on

  • Networks
  • Communities
  • Informal POWER

Less Formal Change Management
More Choreography


Identifying and working through SUPER CONNECTORS


Less CHANGE programmes
More CHANGE platforms

Less “Top-Down Bottom-Up”
More “Inside-out Middle-Led”

LESS ONE or TWO YEAR change programmes.

10 Things Fab Leaders Do

  1. Introduce themselves:  #helloMyNameIs
  2. Less talking… more listening
  3. Empower – Help others develop as leaders. Encourage learning from mstakes mistakes.
  4. Live the values
  5. Be Accessible
  6. Give Credit and Thanks
  7. Remain Positive … even when having a bad day!  Positive pants!
  8. Welcome Challenge – I recognise I don’t have all the answers and I seek different views
  9. Balance – When to interview and when to get out of the way
  10. Learn and develop.

10 Things Fab Teams Do


  1. Create a shared vision of the Future and move towards it together
  2. Challenge the status quo together, so no-one has to face scary change alone.
  3. Sign up to… Our Common Goals.  (Change is built on a commitment to a different future, not performance management).
  4. Value and embrace difference and health conflict.
  5. Help everyone in the team to feel safe and innovate.  New Thing!
  6. Communicate -> Talk! (Don’t rely on email)
  7. Are kind to each other.  Get to know each other as people – care about the little things (like tea and cake).
  8. Think the best of each other – so when something goes wrong you don’t blame other people’s incompetence. (and we don’t punish people if they fail)
  9. Achieve win-win for all team members
  10. Are high productive – the sum is greater than its parts

10 Principles of Large-Scale Change

  1. Move towards a New Vision! Fueled by the passion and belief that there is something different and better worth striving for.
  2. Identify and communicate key themes people can relate to… and will make a BIG difference.  The New Vision! What is your aim? Why should people get involved?  How can people get involved?
  3. Multiples of Things.  It’s complex.  Try to bring groups and systems together -> collaboration.
  4. Frame issues in ways that engage and mobilise.
  5. Mutually reinforce change across multiple processes/subsystems.  Clear vision: no chaos.
  6. Keep refreshing the story -> attract new, active supporters.  Vision Latest Version!
  7. Plan… and be flexible.  Adapt and amend as you go.
  8. Many people contribute to leadership of change, beyond organisational  boundaries.
  9. Transform mindset – achieve sustainable change: New Ways of thinking
  10. Maintain and refresh leaders’ energy over the long haul.

10 Tips for Social Media Success

  1. Be authentic: genuine, human, kind.
  2. Be curious! Ask questions!  Have conversations, don’t broadcast.  Me, me, me is boring.
  3. Be a good partner.  Share, don’t just take!
  4. Be clear about your purpose.  Whom do you want to influence? Why? “I want to be known for… because…”
  5. Be credible!  Check your sources, show humility if you’re wrong
  6. Add value to conversations – don’t just RT!
  7. Set aside a small amount of time each day to engage.
  8. Respect confidentiality and other professional boundaries
  9. Never say on social media what you wouldn’t say to someone’s face. And never tweet while angry!
  10. Use your social media networks to make action happen! Connect with the super-connectors. Build your spectrum of allies – diverse voices! Social media breaks down traditional hierarchies – power and influence on social media is different to organisations.

The 5 Energies of High-Performing Teams

  • Social
    Personal Engagement, relationships and connections between people.
  • Intellectual
    Analysis, planning, thinking
  • Spiritual
    Commitment to a common vision for the future, driven by shared values and purpose.
  • Physical
    Getting things done! Making progress.
  • Psychological
    Courage, resilience, feeling safe to do things different … and take risks.

10 Ways to Build Your Resilience

  1. Celebrate your achievements (however smalll)
  2. Look after you Physical and Mental Health
  3. Self-Care: it’s how you recharge, not how you endure
  4. Have a network of supportive people to give a listening ear when things get tough.
  5. Be honest with yourself and others:  There are going to be challenges… it’s how you deal with them that counts!
  6. Maintain Perspective:L The situation might be bad now, but it won’t be forever.  Give it time.
  7. Choose your battles.  Don’t sweat the small stuff!
  8. Remember what makes you special and the unique contribution you give to the world.
  9. Remember – people who have the potential to wear me down have good intentions… talk… find out what they are.
  10. Learn from mistakes, move forward.

10 Ways to Build Change Agency

The Power to make a positive difference.

  1. Create small changes one step at a time
  2. Emphasis progress
  3. Reframe your thinking – failed attempts are learning opportunities / uncertainty becomes curiosity.
  4. Start a crew! (a group unified by a provocative idea)
  5. Get social support – you can’t be a great change agent on your own!
  6. Make change routine (rather than an exceptional activity)
  7. Learn from the best!
  8. Think Story!  What are we/I don? Why?  How do we/I tell our story?
  9. Build a spectrum of allies (not just people who support what you do!)
  10. Persist!  “First they ignore you, then they laugh at you, then they fight you, then – you win” Gandhi.

Boat Rockers vs Falling Out

Boat Rockers

  • Mission-focussed
  • Passionate
  • Keep perspective
  • Optimistic
  • Energy-generating
  • Attracting Others
  • See possibilities
  • Together

Falling Out

  • Complaining
  • Me-focussedAngry
  • Pessimistic
  • Energy-sapping
  • Alienate others
  • See problems
  • Alone

An Exponentially Changing World

  • Human Genome Project
    A global project to make our DNA to provide insights to treat, prevent and cure disease.
  • Massive increase in the older population
  • Dramatic increase in potential for sharing information across the world!
  • Unexpected shifts in voting
  • End of Moore’s Law

The Narrative Arc

  • The Board Rocker sets out on a journey…
  • They face a challenge..
  • And they are presented with a choice…



  • Choices
  • Challenge
  • Values
  • Work
  • Family
  • Childhood


  • Calling to…
  • Acting With..


  • The Fierce Urgency of Now

Conferences vs Unconferences



  • Career development
  • Status
  • Hierarchical control
  • Platform for expert knoweldge


  • Death by Powerpoint
  • Passive
  • Hierarchical and elitist


  • Democratic
  • Participant-led
  • No agenda
  • Active
  • Sharing collective knowledge

“The sum of the expertise of the people in the audience is greater than the sum of the expertise of the people on stage” Dave Winer

The Benefits of Virtual Collaboration

  • Build relationships, connections and trust: we can work with other teams and trusts across the country
  • Better than the phone and other traditional communication methods
  • Expand your horizons
  • Build a spectrum of allies
  • Learn different perspectives
  • Build psychological safety – the courage to try new things
  • Reduces travel time and costs – and abstraction
  • Connect 24/7
  • Collaborating virtually means that I can connect and share day or night, irrespective of my shift pattern.
  • Communicate and achieve results faster.

Tops Tips for Mentoring

Before you start:

  • Agree where and how you will meet: face-to-face, phone, skype, zoom … and how often
  • Have a conversation to agree what you would both like to gain from the mentoring relationship.
  • Mentoring is a supportive form of development that helps an individual manager their career, improve their skills

A mentor should be:

  • Compassionate
  • Inquisitive
  • PositiveAuthentic
  • Approachable
  • Encouraging
  • Kind
  • Able to listen well, ask open questions, offer non-judgemental constructive feedback.
  • Willing to share knowledge, expertise, experience, resources.

Did you know?

Mentoring is about sharing skills.  A mentor can be more senior than the person they are mentor, or more junior (reverse mentoring)

The first ‘NHS Best Place to Work’ tweet chat, 8th July 2019 #OurNHSPeople

The emerging themes

Autonomy: Having more control in my workplace, & working in ways consistent with my values.

Speech bubbles:

  • “Much more flexibility in the way I work”
  • “Personalisation for staff as well as for patients”
  • “More control over the way I work”
  • “Building my agency (power) to make a positive difference”

Belonging: Being a valued member of an NHS team

Speech bubbles:

  • “Valuing difference and diversity.”
  • “The power of the multidisciplinary team”
  • “Pride of being part of the NHS and supporting patients and families to be healthy”
  • “Applying the values (social justice) principles of the NHS to NHS employees”
  • “Connecting our roles with NHS purpose”

Competence: Growing and developing my skills and career

Speech bubbles:

  • “More development and support for leaders, particularly mid-level leaders”
  • “Being supported to make more progress in my career”
  • “Focus on strengths and things that go well”
  • “More time for learning”
  • “Improvement skills for all”
  • “Job rotation”
  • “More flexibility in careers”

Defining: Basic needs that need to be met for me to do my job

Speech bubbles: 

  • “Being and feeling cared about as an individual”
  • “Knowing what’s going on”
  • “Being appreciated”
  • “Being listened to”
  • “An environment where we feel safe to speak out”
  • “Being able/encouraged to take breaks”
  • “Healthy, nutritious food available for staff”
  • “Having somewhere to eat”

The second ‘NHS Best Place to work’ tweet chat, 12th August 2019

What can we do to improve how people in the NHS work in teams?

People in the NHS work in multiple teams that are constantly changing and evolving. They are teaming. This is a term coined by Amy C. Edmonson. Teaming means to collaborate across boundaries, transcending specialties and professions. In the context of the NHS, this benefits patient outcomes. This graphic describes what is needed for successful teaming.

Enabling Leadership

Enabling people in the NHS to work in a way that they deem appropriate to achieve collective goals, with the ability to be comfortable with fluidity, complexity and uncertainty, as well as a high level of humility and self-awareness.

Speech bubbles:

  • “We are all working together to provide the best for our patients and staff.”
  • “Autonomy to innovate.”
  • “Health and care teams (not just NHS), with flexibility at their heart.”
  • “We need broader teams with less hierarchy, closer to patients.”
  • “Assemble ‘squads’ for a finite period of time based on the required expertise.”

Interdependence and Collaboration

Individuals having the ability to work within and beyond specialty, department, and organisational boundaries to achieve their shared purpose.

Speech bubbles:

  • “All patients are our patients no matter what part of their journey they are on.”
  • “Future teams need to be truly multidisciplinary, supported by systems that talk to each other.”
  • “Improvement doesn’t happen without collaboration”
  • “Understanding how we ALL contribute to the patient journey”
  • “Being part of a diverse team ensures the patients are offered the most appropriate treatment.”
  • “By working collaboratively you achieve more than you can ever achieve alone”

Individual and Collective Development

In teaming situations, individuals require a ‘home’ team, to foster a sense of belonging and ‘us’-ness.

Speech bubbles

  • “Time for interdisciplinary team development, understanding each others’ roles, building trust.”
  • “Access to appropriate technology.”
  • “Operate in a learning environment”
  • “Diverse teams that respect and value difference.”

The third ‘NHS Best Place to work’ tweet chat, 9 September 2019

What do people who work in the NHS need from their leaders?

When the Horizons team analysed the tweets from the tweet chat, we concluded that the best match was Brene Brown’s BRAVING leadership model. This graphic details what each of the elements means for the NHS.


Our leaders must create boundaries that protect people’s wellbeing. This includes offering flexible working and allowing us to be human beings rather than ‘resources’.: balancing work with other important aspects of our lives. Our leaders need to be positive role models of looking after their own health and wellbeing.rk’ tweet chat, 9 September 2019


Our leaders must do what they say they will do. This means staying aware of their capacity and limitations so they don’t overpromise. Leaders must deliver on commitments and balance competing priorities. They need to be strong in a crisis.


Our leaders need to make roles and expectations clear. They must give us the responsibility to solve problems and make decisions, leading to fewer meetings and more delegation. Our leaders need to be accountable for their own actions, owning their own mistakes, saying sorry, learning, and following up actions.


We need to be able to trust our leaders to work in ways that value our confidentiality as well as that of our patients. Our leaders should not share information or experiences that are not theirs to share or which mean that they get kudos and we get nothing.


Our leaders must have the courage to do what’s right and create the climate for us to thrive. They need to stand up for their teams and ‘walk the walk’, visibly demonstrating their values to NHS staff, and patients.


Our leaders must value us as people and think the best of us. They should assume we have a positive intent. They must listen to us and spread positive feedback about us.


Our leaders go the extra mile for us, so we feel supported and challenged and we can develop. They should show us that they appreciate us more than they criticise us.

– moderators

As a i systems thinker I am graphic


  • Moving to the net base and reappraising
  • Reading to amend my thinking


  • Being authentic
  • Acting in accordance with and embodying my values
  • Deepening my awareness


  • Patterns
  • Feedbacks
  • Boundaries
  • Relationships
  • Connections


  • Trying to clarify my assumptions and beliefs
  • Perhaps use others to help with this
  • Questioning and testing these


  • Appreciating
  • Aware of the sytle and quality of relationships, conversations, body language


  • Checking in
  • Checking out
  • Sharing frames


  • Especially framing
  • Being curious
  • Asking “I wonder…”


  • To achieve results
  • To create a better, fairer world


  • How do I, or you, or we, know this?


  • Comfortable with uncertainity
  • Ready to flex


  • Holding lightly
  • Not having to be righht
  • Letting go of the outcome


  • Noticing
  • From myself
  • Not being afraid to fail
  • Wanting to learn all the time
  • Continuously reflecting, experimenting, learning
  • Coming form a place of positive intention
  • Playing, imaging, innovating