module 1: being a health and care radical - change starts with me

#NHSChangeDay #SHCRchat

The School for Health and Care Radicals

www.changeday.nhs.uk/healthcareradicals Module 1:

Being a health and care radical: Change starts with me

Supported by


Welcome to the School for Health and Care Radicals – a global community of change agents

• Nearly 1000 registrants for The School for Health and Care Radicals

• Nearly 90 volunteer coach and mentor volunteers• From 22 countries, including:

Australia, Belgium, Canada, Czech Republic, Denmark, England, France, Germany, Ireland, Netherlands, New Zealand, Norway,

Northern Ireland, Philippines, Saudi Arabia, Scotland, Spain, Sweden, Ukraine, United Arab Emirates, USA, Wales


Why the School for Health & Care Radicals?It’s tough being a change agent in health and care, particularly

when other people don’t always get it or want to change.

Yet big change happens in health and care only because of heretics and radicals: passionate people who are willing to take responsibility for change. We are people who support the goals

of our health and care systems, but also want to change existing thinking and practice and improve care for patients

and people who use services.

The School for Health and Care Radicals provides tools, ideas and connections with a community of radicals to help us thrive

and survive as agents of positive change


Pledge today!http://changeday.nhs.uk

http://changeday.nhs.uk/


Joining in today and beyond

• Please use the chat box to contribute continuously during the web seminar

• Please tweet using hashtags #NHSChangeDay and #SHCRchat• We will produce summaries of the discussions on each module

using Storify.com and put on the website• The conversation continues on the live chat forum at

www.changeday.nhs.uk/healthcareradicalsforum

http://www.changeday.nhs.uk/healthcareradicalsforum


• Background to The School for Health and Care Radicals

• Learning processes• Context: emerging directions in transformation and

change• Some challenges for health and care radicals• The difference between a radical and a troublemaker• How to thrive and survive as a radical• Questions and call to action

Source of image: www.freshnessmag.com

for today


Why are we here? Why are you here?


Why did you join the school?

‘I want to:• be part of changing the NHS and to learn how to be more

effective as a change maker’• learn how to implement change effectively and encourage

others to join the vision’• help others realise they're able to make changes without

seeking permission first’• network with other healthcare radicals


Why did you join the school?

‘I want to:• learn, gain more inspiration and courage to continue what I

started’• share the joy of participating in NHS Change Day• share, be inspired and inspire others to support and coach

others to be the best they can with the aim of improving the NHS we love and cherish

• drive quality improvement, promote harm free care, make the improvement sustainable, remember patients are at the centre of everything we do

• spread change in a stealthy way!’


31st January: Being a health and care radical: change starts with me7th February: Forming communities: building alliances for change14th February: Rolling with resistance21st February: Making change happen28th February: Moving beyond the edge

Modules


The genesis of the School

2002

2014

2013

20102012

2003

NHS Change Day 2013

“A school for healthcare radicals”

Applying social movement

thinking to healthcare

improvement

“The School for Health and Care

Radicals”

“A one day school for organisational

radicals”

Applying community organising

principles to healthcare

improvement


Source: @NHSChangeDay


The school is based on two kinds of learningTransactional learning Transformational learning

A “toolkit” of ideas & approaches

Learning through motivation, practice & feedback

Seeks to transfer useful knowledge

Seeks to transform beliefs & underlying assumptions

Learning events, presentations & materials

Experiential, interactive & action-based

Generates understanding of “what to do”

Generates increased capacity in “how to do it”

Source: John Wenger https://medium.com/corporate-learning/3deb1bb2e865

https://medium.com/corporate-learning/3deb1bb2e865




What the school can offer

Five learning modules, live on Friday mornings and available 24/7

Materials, inc a weekly study guide to back up the modules changeday.nhs.uk/healthcareradicals

A weekly telephone discussion 7-8pm on Sunday evenings (if demand)

A weekly tweetchat, 4-5pm on Wednesdays #SCHRchat

A chat forum www.changeday.nhs.uk/healthcareradicalsforum

Potential to link you and/or your group with a mentor

What you might do Take part in the programme at

whatever level of engagement you want

Encourage others in your organisation or locality to join the school

Create your own local learning set or group

Join the Change Day movement and mobilise others

Keep a learning log, complete all modules and action your Change Day pledges to gain certification

http://www.changeday.nhs.uk/healthcareradicalsforum


Emerging themes in change and transformation

Organisation CommunityPower through hierarchy Power through connectionMission and vision Shared purposeMaking sense through rational argument

Making sense through emotional connection

Leadership-driven (top down) innovation

Viral (grass-roots driven) creativity

Tried and tested, based on experience

“ Open” approaches , sharing ideas & data, co-creating

change

Transactions Relationships

Dominantapproach

Emerging direction

Source: @HelenBevan


John Kotter: “Accelerate!”

• We won’t create big change through hierarchy on its own

• We need hierarchy AND network• Many change agents, not just the usual few • Changing our mindset

• From “have to” to “want to”• Head and heart, not just head

Source of image:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community


The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy

2. If you want to create small scale change, work through a cohesive network

If you want to create big change, create bridge networks between disconnected groups


DiscussionWhat are the implications of the “emerging direction” for the way

change agents work?Organisation Community

Power through hierarchy Power through connection

Mission and vision Shared purpose

Making sense through rational argument

Making sense through emotional connection

Leadership-driven (top down) innovation

Viral (grass-roots driven) creativity

Tried and tested, based on experience

“ Open” approaches , sharing ideas & data, co-creating change

Transactions Relationships

Dominant approach Emerging direction


is the new normal!

“By questioning existing ideas, by opening new fields for action, change

agents actually help organisations survive and adapt to the 21st Century.”

Céline SchillingerImage by neilperkin.typepad.com


@rebelsatwork rebelsatwork.com

Across the world, the change agent movement is exploding!

@chagwwChangeagentsworldwide.com

@corprebelsCorporaterebelsunited.com

@helenbevan #1000LivesPlusImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

@helenbevan#NHSChangeDay #SHCRchat

What happens to heretics/radicals/rebels/mavericks

in organisations?


“There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who profit by the new.”

Niccolo Machiavelli 15th century


We need to be boatrockers!• Walk the fine line between

difference and fit, inside and outside, rock the boat but manage to stay in it

• Able to challenge the status quo when we see that there could be a better way

• Conform AND rebel• Capable of working with others

to create success NOT a destructive troublemaker Source: Debra Meyerson


What are the risks for a boat rocker?

1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice

Source: adapted from Debra E Meyerson



1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice we surrender a part of ourselves, and silence

our commitment, in order to survive


@helenbevan#NHSChangeDay #SHCRchat Source: Foghound

@helenbevan#NHSChangeDay #SHCRchat Source of image: quote.lifehack.org




our commitment, in order to survive2. leave the organisation






we cannot find a way to be true to our values and commitments and still survive







3. stridently challenge the status quo in a manner which is increasingly radical and self-defeating







3. stridently challenge the status quo in a manner which is increasingly radical and self-defeating this just confirms what we already know – that

we don’t belong Source: adapted from Debra E Meyerson

@helenbevan#NHSChangeDay #SHCRchatSource : Lois Kelly www.foghound.com

Sometimes people see us radicals as troublemakers

Rebel

http://www.foghound.com/


Discussion

• What are your insights around “radicals” and “troublemakers”?

• What moves people from being “radical” to “troublemaker”?

• How do we protect against this?


Valuing radicals

• “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)

• Big things only happen in organisations because of heretics and radicals.

GALILEO DESCRIBES HIS DISCOVERIES TO THE CHURCH ESTABLISHMENT

@helenbevan@HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents

"There’s only one corner of the

universe you can be certain of

improving, and that’s your own

self." Aldous Huxley

Source of image: timcoffeyart.wordpress.com


‘I do not think you can really deal with change without a person asking real

questions about who they are and how they belong in the world’

David Whyte, The Heart Aroused 1994

Source of image: fistfuloftalent.com


History tells us that personal transformation comes before

organisational or system transformationIf we want to play our role, we have to focus deeply on our own perspective and the ways

http://blogs.bmj.com/quality/2013/08/19/a-call-to-action-helen-bevans-blog-2/

we interact with and influence others. The more that we can unleash that powerful reservoir of energy for change, the more our influence and impact will grow.

Image from novamagazine.com




1. Driven by conviction and values2. strong sense of “self-efficacy”

belief that I am personally able to create the change3. able to join forces with others to create action4. able to achieve small wins which create a sense

of hope, self-efficacy and confidence5. More likely to view obstacles as challenges to

overcome

Five things we know about successful boat rockers


CHANGE

meBEGINS WITH


Self-efficacy

“If you think you can or think you

can't, you are right.”

Henry Ford

“The ability to act is tied to a belief that it is possible to do so”

Albert Bandura

There is a positive, significant relationship between the self-efficacy beliefs of a

change agent and her/his ability to facilitate change

and get good outcomes

Source of image:www.h3daily.com


What’s the difference between

self efficacyand

self esteem,self belief,

self-confidence?



What is the issue here?“permission” ?

(externally generated)or

Self efficacy ? (internally generated)


Brainstorm

What are some ways that health and care radicals can build self-efficacy?


Building self-efficacy: some tactics1. Invest in your own change agent development (modules 2-5)

• create the conditions where success is more likely to happen

2. Create change one small step at a time3. Reframe your thinking:

• failed attempts are learning opportunities• uncertainty becomes curiousity

4. Make change (and learning cycles from change) routine rather than an exceptional activity5. Get social support6. Learn from the best7. Get people whose opinions you value to encourage you (mentor?)


1. Driven by conviction and values2. strong sense of “self-efficacy”

belief that I am personally able to create the change3. able to join forces with others to create action4. able to achieve small wins which create a sense

of hope, self-efficacy and confidence5. More likely to view obstacles as challenges to

overcome

Five things we know about successful boat rockers


CHANGE

meBEGINS WITH


The most effective change agents:• don’t waste their time and energy

blaming and complaining• take calculated risks to achieve the

outcomes they soughtNow is the time to plan steps to keep moving myself forward, with positive momentum, as a health and care radical


Three assumptions for health and care radicals

1. Assume that everyone has a noble intention.2. When people “resist” change is it more likely

to be a result of their interpersonal interaction with the change process than their innate character traits (“a bad change process not a difficult person”).

3. My role as a change agent is about alignment, not judgement.

Source of image:help.adobe.com


Being a great change agent is about knowing, doing, living and being improvement


Being a great change agent is about knowing, doing, living and being improvement

Don’t boost self esteem

without boosting personal

knowledge and skills


We have a choice“This is the true joy of life, the being used up for a

purpose recognised by yourself as a mighty one, being a force of nature instead of a feverish, selfish little clot of ailments and grievances, complaining that the world will not devote itself to making you

happy.”

George Bernard Shaw


Outwitted

He drew a circle that shut me out -Heretic, rebel, a thing to flout.But Love and I had the wit to win:We drew a circle that took him in.

Edward Markham


Calls to action campaigns for this weekPost these or similar actions as a pledge on the NHS Change Day pledge wall http://changeday.nhs.uk/wall• Reflect on your own role/knowledge/skills as a

health and care radical and create an action plan to “start with me”

• Discuss tactics for rocking the boat and staying in it with other radicals

• Identify and support others who are at risk of crossing the line from “radical” to “troublemaker”

http://changeday.nhs.uk/wall

http://changeday.nhs.uk/wall


Next opportunities for learning

• Sunday 2nd February 19:00-20:00 conference call discussion of

module one• Wednesday 5th February

16:00-17:00 Tweet chat #SHCRchat• Next Friday morning module 2:

Building alliances: forming communities for change


Questions for reflection

1. What are the opportunities for me to build my perspectives and skills as an agent of change?

2. How can I build self efficacy as a change agent?3. How do I move beyond skills and knowledge of

change to live and be change?4. Who can help and support me as a change

agent?5. What are the implications for the way I work?

module 1: being a health and care radical - change starts with me

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