school of health care radicals
TRANSCRIPT
![Page 1: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/1.jpg)
@HelenBevan #SHCR #QF15
Supported by
![Page 2: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/2.jpg)
@HelenBevan #SHCR #QF15
So...................
What lights the “fire in your belly” and makes you determined to improve things?
![Page 3: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/3.jpg)
@HelenBevan #SHCR #QF15
The genesis of the School
2002
20142013
2010 2012
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
2015
![Page 4: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/4.jpg)
@HelenBevan #SHCR #QF15
Source: @NHSChangeDay
![Page 5: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/5.jpg)
@HelenBevan #SHCR #QF15
“New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)
Source of image: installation by the artist Adam Katzwww.thisiscolossal.com
Via @NeilPerkin
![Page 6: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/6.jpg)
@HelenBevan #SHCR #QF15
Starts on the fringe
(at the edge)
Starts with the activistsGary Hamel
always
![Page 7: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/7.jpg)
@HelenBevan #SHCR #QF15
So why do we keep reinventing the past
and calling it the future?
Image used under Creative Commons licence: Kicki
![Page 8: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/8.jpg)
@HelenBevan #SHCR #QF15
Tomorrow belongs to those who can hear it coming
David Bowie
“ “
![Page 9: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/9.jpg)
@HelenBevan #SHCR #QF15
SEISMIC SHIFTS
![Page 10: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/10.jpg)
@HelenBevan #SHCR #QF15
SEISMIC SHIFTS
![Page 11: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/11.jpg)
@HelenBevan #SHCR #QF15
SEISMIC SHIFTS
![Page 12: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/12.jpg)
@HelenBevan #SHCR #QF15
SEISMIC SHIFTS
![Page 13: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/13.jpg)
@HelenBevan #SHCR #QF15
SEISMIC SHIFTS
Change from the edge
![Page 14: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/14.jpg)
@HelenBevan #SHCR #QF15
Leading change in a new era
Dominant approach Emerging direction
![Page 15: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/15.jpg)
@HelenBevan #SHCR #QF15
Leading change in a new era
Dominant approach Emerging direction
Most healthcare transformation
efforts are driven from this side
![Page 16: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/16.jpg)
@HelenBevan #SHCR #QF15
![Page 17: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/17.jpg)
@HelenBevan #SHCR #QF15Source: Gary Hamel
![Page 18: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/18.jpg)
@HelenBevan #SHCR #QF15Source:@Alfacarlo
![Page 19: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/19.jpg)
@HelenBevan #SHCR #QF15
John Kotter, the most influential thought leader globally, recognises new approaches are needed
FROM
![Page 20: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/20.jpg)
@HelenBevan #SHCR #QF15
John Kotter: “Accelerate!”
• We won’t create big change through hierarchy on its own
• We need hierarchy AND network
• Many change agents, not just a few, with many acts of leadership
• At least 50% buy-in required
• Changing our mindset
• From “have to” to “want to”
TO
![Page 21: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/21.jpg)
@HelenBevan #SHCR #QF15
From “have to” to “want to”
Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community
![Page 22: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/22.jpg)
@HelenBevan #SHCR #QF15
Managers know how to command obedience and diligence, but most are
clueless when it comes to galvanizing the sort of volunteerism that animates life on
the social web. Initiative, imagination and passion can’t be commanded—they’re gifts.
Gary Hamel http://www.mixmashup.org/blog/reinventing-
management-mashup-architecture-ideology
‘
![Page 23: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/23.jpg)
@HelenBevan #SHCR #QF15
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
![Page 24: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/24.jpg)
@HelenBevan #SHCR #QF15
People who are highly connected have twice as much power to
influence change as people with hierarchical power
Leandro Herrero
http://t.co/Du6zCbrDBC
![Page 25: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/25.jpg)
@HelenBevan #SHCR #QF15
DiscussionWhat are the implications of the “emerging direction” for the way
change agents work?
![Page 26: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/26.jpg)
@HelenBevan #SHCR #QF15
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
![Page 27: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/27.jpg)
@HelenBevan #SHCR #QF15
![Page 28: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/28.jpg)
@HelenBevan #SHCR #QF15
We need rebels!
•The principal champion of a change initiative, cause or action
•Rebels don’t wait for permission to lead, innovate, strategise
•They are responsible; they do what is right
•They name things that others don’t see yet
•They point to new horizons
•Without rebels, the storyline never changes
Source : @PeterVan http://t.co/6CQtA4wUv1
![Page 29: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/29.jpg)
@helenbevan
What happens to heretics/radicals/rebels/mavericks
in organisations?
![Page 30: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/30.jpg)
@helenbevan
![Page 31: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/31.jpg)
@helenbevan #IQTGOLD#NHSChangeDaySource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out
![Page 32: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/32.jpg)
@HelenBevan
Ostracism is experienced in the brain as deeply as physical pain
![Page 33: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/33.jpg)
@helenbevan
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
![Page 34: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/34.jpg)
@helenbevan
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
![Page 35: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/35.jpg)
@helenbevan
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
we surrender a part of ourselves, and silence our commitment, in order to survive
Source: adapted from Debra E Meyerson
![Page 36: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/36.jpg)
@helenbevan
![Page 37: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/37.jpg)
@helenbevan
![Page 38: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/38.jpg)
@helenbevan
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
we surrender a part of ourselves, and silence our commitment, in order to survive
2. leave the organisation
Source: adapted from Debra E Meyerson
![Page 39: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/39.jpg)
@helenbevan
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
we surrender a part of ourselves, and silence our commitment, in order to survive
2. leave the organisation
we cannot find a way to be true to our values and commitments and still survive
Source: adapted from Debra E Meyerson
![Page 40: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/40.jpg)
@helenbevan
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
we surrender a part of ourselves, and silence our commitment, in order to survive
2. 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
Source: adapted from Debra E Meyerson
![Page 41: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/41.jpg)
@helenbevan
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
we surrender a part of ourselves, and silence our commitment, in order to survive
2. 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
this just confirms what we already know – that we don’t belong Source: adapted from Debra E Meyerson
![Page 42: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/42.jpg)
@helenbevan#NHSChangeDay #SHCRchatSource : Lois Kelly www.foghound.com
There’s a big difference between a rebel and a troublemaker
Rebel
![Page 43: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/43.jpg)
@helenbevan
Reflection• What are your insights around “rebels” and
“troublemakers”?
• What moves people from being “rebel” to “troublemaker”?
• How do we protect against this?
![Page 44: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/44.jpg)
@helenbevan#NHSChangeDay #SHCRchatSource : Lois Kelly www.rebelsatwork.com
There’s a big difference between a rebel and a troublemaker
Rebel
![Page 45: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/45.jpg)
@helenbevan
Change starts with me
Source of image: jasonkeath.com
![Page 46: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/46.jpg)
@helenbevan#SHCR @School4Radicals
"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
![Page 47: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/47.jpg)
@helenbevan
‘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
![Page 48: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/48.jpg)
@helenbevan
History tells us that personal transformation comes before
organisational or system transformation
If 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
![Page 49: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/49.jpg)
@helenbevan
1. able to join forces with others to create action
2. able to achieve small wins which create a sense of hope, possibility and confidence
3. More likely to view obstacles as challenges to overcome
4. strong sense of “self-efficacy” belief that I am personally able to create the change
Four things we know about successful
boat rockers
Source: adapted from Debra E Meyerson
CHANGE
me
BEGINS WITH
![Page 50: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/50.jpg)
@helenbevan
Self-efficacy
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
![Page 51: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/51.jpg)
@helenbevan
What’s the difference between
self efficacyand
self esteem,self belief,
self-confidence?
![Page 52: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/52.jpg)
@helenbevan
Source: @NHSChangeDay
![Page 53: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/53.jpg)
@helenbevan
Source: @NHSChangeDay
What is the issue here?
“permission” ? (externally generated)
or
Self efficacy ? (internally generated)
![Page 54: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/54.jpg)
@HelenBevan
Building self-efficacy: some tactics
1. Create change one small step at a time
2. Reframe your thinking:
• failed attempts are learning opportunities
• uncertainty becomes curiousity
3. Make change routine rather than an exceptional
activity
4. Get social support
5. Learn from the best
![Page 55: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/55.jpg)
@helenbevan
The most effective change agents:
• don’t waste their time and energy blaming and complaining
• take calculated risks to achieve the outcomes they sought
Now is the time to plan steps to keep moving myself forward, with positive momentum, as a health and care radical
![Page 56: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/56.jpg)
@helenbevan
Being a great change agent is about knowing, doing,
living and being improvement
![Page 57: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/57.jpg)
@helenbevan
Avedis Donabedian
“Ultimately, the secret of quality is love.
…… If you have love, you can then work backward to monitor and improve the system”.
![Page 58: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/58.jpg)
@helenbevan
Tactic for radicals:Out-love everyone else
Source of image: Bradley Burgess
![Page 59: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/59.jpg)
@helenbevan
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?
![Page 60: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/60.jpg)
@helenbevan
What is a
RCT?
![Page 61: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/61.jpg)
@helenbevan
Randomized Coffee Trial!
![Page 62: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/62.jpg)
@helenbevan
Outcomes of randomised coffee trials
![Page 63: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/63.jpg)
@helenbevan
Randomized Coffee Trial!• Instructions in News from Jo later today• Send an email to say you want to take part in the RCT to
[email protected]• We will randomly match you with another participant in the
School for Health and Care Radicals from anywhere in the world• At some time in the next four weeks, arrange to have a
conversation over Skype (or other communication system) with a cup of coffee!
![Page 64: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/64.jpg)
@helenbevan
Learning from the first section
YOU can make a differenceAND
You can’t do it ALONE
Source: TED talk by Barry Posner http://workplacepsychology.net/2014/02/01/the-truth-about-leadership-you-make-a-difference-and-you-cant-do-it-alone/
Source of image: jamessamy.com
![Page 65: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/65.jpg)
@helenbevan
Often as radicals, we feel different to other people
![Page 66: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/66.jpg)
@helenbevan
Often as radicals, we feel different to other people
![Page 67: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/67.jpg)
@helenbevanSource of image: outskirtsbattledome.wikispaces.com
The easiest way to thrive as an outlier
...is to avoid being one
Seth Goodin
![Page 68: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/68.jpg)
@helenbevan
Leading change in a new era
Dominant approach Emerging direction
From module one
![Page 69: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/69.jpg)
@helenbevan#SHCR @School4Radicals
![Page 70: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/70.jpg)
@helenbevan
What is community?1. Locality
2. Interest or shared purpose
3. Sense of belonging: “community spirit”
“There is no power for change greater than a community discovering what it cares about.”~ Margaret Wheatley
Source of image: rootedincommunity.org
![Page 71: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/71.jpg)
@helenbevan
Power in community“Power used to come largely through and from big institutions.
Today power can and does come from connected individuals in community.
When community invests in an idea, it co-owns its success.
Source of image: orton.org
Instead of trying to achieve scale all by ourselves, we have a new way to have scale. Scale can be in, with and through community.”
Nilofer Merchant
![Page 72: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/72.jpg)
@helenbevan
Who are your communities?
Source: Celine Schillinger http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite
• In your role: through relationships and social networks
• Through external social networks such as Twitter and LinkedIn
• Through communities of practice and learning groups
![Page 73: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/73.jpg)
@helenbevan
“When we talk of social change, we talk of movements, a word that suggest vast
groups of people walking together, leaving behind one way and travelling towards
another”
Rebecca Solnit
![Page 74: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/74.jpg)
@helenbevan
Learning from social movement leaders
http://www.slideshare.net/NHSIQ/the-power-of-one-the-power-of-many?qid=97bb3464-07c2-4883-9531-c3d436a66aa1&v=qf1&b=&from_search=2
![Page 75: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/75.jpg)
@helenbevan
![Page 76: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/76.jpg)
@helenbevan
Six characteristics of people or groups within effective social movements
1. They share a sense of PURPOSE: There is purposefulness about
collaborations, discussions, actions, decisions and a sense of forward momentum
2. They are UNITED: They have learned to manage their differences well enough
that they can unite to accomplish their purpose. Differences are openly debated, discussed, and resolved.
3. They share UNDERSTANDING: There is a widely shared understanding of what's going on, what the challenges are and why what is being done has to be done
4. People PARTICIPATE: Lots of people and organisations in the system are
active - not just in discussions and meetings, but getting the work done.
5. They take INITIATIVE: Rather than reacting to whatever happens in their
environment, they are proactive, and act upon their environment.
6. They ACT: People do the work they must do to
make the things happen that need to happen
Source: adapted from Wellstone Action
![Page 77: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/77.jpg)
@helenbevan
Calls to Action
![Page 78: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/78.jpg)
@helenbevan
Leadership is….
…the art of mobilising others to want to struggle for shared
aspirationsJim Kouzes
Source of image: environmentvictoria.org.au
![Page 79: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/79.jpg)
@helenbevan
What is strategy?
Strategy is the process of turning the you have into the you need to win
the you wantSource: Marshall Ganz
![Page 80: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/80.jpg)
@helenbevan
Resources to improve health and care
Economic resourcesdiminish with use• money• materials• technology
Natural resourcesgrow with use• relationships• commitment• community
Based on principles from Albert Hirschman, Against Parsimony
![Page 81: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/81.jpg)
@helenbevan
Framing… is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action.
Snow D A and Benford R D (1992)
![Page 82: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/82.jpg)
@helenbevan
What’s the financial incentive?
Who is performance managing?
What’s theproject plan?
Source: @RobertVarnam
![Page 83: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/83.jpg)
@helenbevan
The reality“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 workforce’s primary motivators for putting extra energy into the change
programme”Scott Keller and Carolyn Aiken (2009)
The Inconvenient Truth about Change Management
Source of image: swedenbourg-openlearning.org.uk
![Page 84: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/84.jpg)
@helenbevan #IQTGOLD#NHSChangeDay
“I have some Key
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam
![Page 85: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/85.jpg)
@helenbevan
Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........
Sensemaking is not done via marketing...or slogans but by emotional connection with employees
Ron Weil
![Page 86: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/86.jpg)
@helenbevan#NHSChangeDay #SHCRchat
If we want people to take action, we have to connect with their emotions through values
action
values
emotion
Source: Marshall Ganz
![Page 87: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/87.jpg)
@helenbevan
![Page 88: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/88.jpg)
@helenbevan #IQTGOLD#NHSChangeDay
But not all emotions are equal.........
inertiaurgency
anger apathy
solidarity isolation
you can make a difference
Self-doubt
hope fear
Overc
om
es
Action motivators Action inhibitors
Source: Marshall Ganz
![Page 89: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/89.jpg)
@helenbevan#SHCR @School4Radicals
‘‘Leaders must wake people out of inertia. They must get people excited about something they’ve never seen before, something that does not yet
exist”
Rosa Beth Moss Kanter
Source of image: www.linkedin.com/company/activate-brand-agency
![Page 90: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/90.jpg)
@helenbevan
Effective framing: what do we need to do?
1. Tell a story
Source of image: woccdoc.org
![Page 91: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/91.jpg)
@helenbevan
http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-crafting-visual-stories-with-data?sf3881865=1
![Page 92: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/92.jpg)
@helenbevan
Effective framing: what do we need to do?
1. Tell a story
2. Make it personal
Source of image: woccdoc.org
![Page 93: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/93.jpg)
@helenbevan
Effective framing: what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
Source of image: woccdoc.org
![Page 94: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/94.jpg)
@helenbevan
Effective framing: what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us” is)
Source of image: woccdoc.org
![Page 95: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/95.jpg)
@helenbevan
Effective framing: what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us” is)
5. Build in a call for urgent action
Source of image: woccdoc.org
![Page 96: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/96.jpg)
@helenbevan #IQTGOLD#NHSChangeDay
Vivid details
Source: Marshall Ganz
![Page 97: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/97.jpg)
@helenbevan #IQTGOLD#NHSChangeDay
![Page 98: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/98.jpg)
@helenbevan #IQTGOLD#NHSChangeDay
![Page 99: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/99.jpg)
@helenbevan#SHCR @School4Radicals
How do we create a sense of “us” to build momentum for
change?
Source of image: www.tannerfriedman.com
![Page 100: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/100.jpg)
@helenbevan
Moving beyond us and them to us and us
Source of image: www.delta7.com
![Page 101: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/101.jpg)
@helenbevan
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
From Module 1
![Page 102: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/102.jpg)
@helenbevan
strong ties (cohesive)v.
weak ties (disconnected)
Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml
![Page 103: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/103.jpg)
@helenbevan#NHSChangeDay #SHCRchat
When we spread change through strong ties:
• we interact with “people like us”, with the same life experiences, beliefs and values
• Change is “peer to peer”; GP to GP, social worker to social worker, nurse to nurse, community leader to community leader
• Influence is spread through people who are strongly connected to each other, like and trust each other
![Page 104: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/104.jpg)
@helenbevan#NHSChangeDay #SHCRchat
When we spread change through strong ties:
• we interact with “people like us”, with the same life experiences, beliefs and values
• Change is “peer to peer”; GP to GP, social worker to social worker, nurse to nurse, community leader to community leader
• Influence is spread through people who are strongly connected to each other, like and trust each other
IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied
![Page 105: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/105.jpg)
@helenbevan#NHSChangeDay #SHCRchat
The pros and cons of strong ties
Pros Cons
![Page 106: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/106.jpg)
@helenbevan
When we seek to spread change through weak ties
• we build bridges between groups and individuals who were previously different and separate
• we create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action
• We can mobilise all the resources in our organisation, system or community to help achieve our goals
![Page 107: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/107.jpg)
@helenbevan
Why we need to build weak ties AS WELL AS strong ties
• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers
More on weak ties: https://www.youtube.com/watch?v=w7AzRVxhEXA#t=45
![Page 108: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/108.jpg)
@helenbevan
Why we need to build weak ties AS WELL AS strong ties
• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers
• In situations of uncertainty, we have a tendency to revert to our strong tie relationships
yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity
![Page 109: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/109.jpg)
@helenbevan
Why we need to build weak ties AS WELL AS strong ties
• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers
• In situations of uncertainty, we have a tendency to revert to our strong tie relationships
yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity
• The most breakthrough innovations and most radical change will come when we tap into our weak ties
![Page 110: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/110.jpg)
@helenbevan
Sources of weak ties
![Page 111: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/111.jpg)
@helenbevan
Three components of a great narrative
• Diagnostic – what is the problem that we are addressing? What is the extent of the problem? What is the specific source or sources?
• Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan?
• Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of our audience?
Source: Benford and SnowSource of image: www.ecommercedefense.com
![Page 112: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/112.jpg)
@helenbevan
Four keys to collaboration
• Lean into your discomfort
• Listen as an ally
• State your intent
• Share your “street corner”Source: Judith Katz and Fred Miller
![Page 113: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/113.jpg)
@helenbevan
![Page 114: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/114.jpg)
@helenbevan
Four keys to collaboration
• Lean into your discomfort
• Listen as an ally
• State your intent
• Share your “street corner”Source: Judith Katz and Fred Miller
![Page 115: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/115.jpg)
@helenbevan 115
http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite
![Page 116: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/116.jpg)
@helenbevan
Source of image: http://switchandshift.com/transactional-or-transformational-which-leadership-style-is-best
![Page 117: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/117.jpg)
@helenbevan #IQTGOLD#NHSChangeDay
“You don’t need an engine when you have
wind in your sails”
![Page 118: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/118.jpg)
@helenbevan
Questions for reflection
1. What learning and inspiration can you take from social movement leaders to help you in your role as an agent of change in health and care?
2. How will you attract the attention of the people you want to call to action?
3. Who are the people who are currently disconnected that you want to unite in order to achieve your goal for change? How can you build a sense of “us” with them?
![Page 119: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/119.jpg)
@helenbevan
Employee resistance is the most common reason executives cite for the
failure of big organizational-change
effortsScott Keller and Colin Price
(2011), Beyond Performance: How Great Organizations Build Ultimate
Competitive AdvantageSource of image: Businessconjunctions.com
![Page 120: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/120.jpg)
@helenbevan
“Thousands of patients have died
needlessly because of a damaging reluctance amongst
doctors and the public to accept changes in the NHS, according to
the country’s top emergency doctor
“
![Page 121: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/121.jpg)
@helenbevan#SHCR @School4Radicals
What do we mean by
?
![Page 122: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/122.jpg)
@helenbevan Source of image: sport-fitness-advisor.com
Any force that stops or slows movement
Resistance
![Page 123: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/123.jpg)
@helenbevan
In module 1, we talked about:
![Page 124: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/124.jpg)
@helenbevan
Let’s think about this in the context of “resistance”
![Page 125: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/125.jpg)
@helenbevan#NHSChangeDay #SHCRchat
Leading change in a new eraDominant approach Emerging direction
• Change can be planned and managed through a rigorous process
• Resistance is a force to overcome
• Resistance prevents change
• Change agents mustdiagnose, manage and/or overcome resistance
• Resisters can otherwise be known as “laggards”, “blockers”, “in denial”
![Page 126: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/126.jpg)
@helenbevan
Resistance to change: the dominant approach
![Page 127: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/127.jpg)
@helenbevan
An example “dominant approach” transformation programme
![Page 128: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/128.jpg)
@helenbevan
“The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to
implement successfully and may not succeed at all”
David StonehouseThe change agent: the manager’s role in change
British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445
Dominant approach: the role of the change agent
![Page 129: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/129.jpg)
@helenbevan#NHSChangeDay #SHCRchat
Leading change in a new era
• Change in human systems is often emergent and hard to predict
• Change results from connections/interactions stimulating different perspectives, shaping how people think about things
• Resistance is an inevitable consequence of a complex change process
• Resistance should be embracedand rolled with
Dominant approach Emerging direction
• Change can be planned and managed through a rigorous process
• Resistance is a force to overcome
• Resistance prevents change
• Change agents mustdiagnose, manage and/or overcome resistance
• Resisters can otherwise be known as “laggards”, “blockers”, “in denial”
![Page 130: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/130.jpg)
@helenbevan#SHCR @School4Radicals
“Change doesn’t rain down on us from on high. Rather, its stories are co-
created and co-owned by the community. Or, at least they are if you want
the change to stick”Julian Stodd
https://julianstodd.wordpress.com/2013/11/29/the-co-creation-and-co-ownership-of-organisational-change/
![Page 131: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/131.jpg)
@helenbevan
Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........
Sensemaking is not done via marketing...or slogans but by emotional connection with employees
Ron Weil
![Page 132: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/132.jpg)
@helenbevan
Resistant behaviour is a good indicator of missing relevance
Harald Schirmerhttp://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-role-of-hr-driving-social-adoption-and-change-in-the-enterprise
Source of image: driverlayer.com
‘‘
![Page 133: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/133.jpg)
@helenbevan
Cultural change is a million
subversive acts of resistance
Brene Brown
Source of image: zazzle.com
‘‘
![Page 134: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/134.jpg)
@helenbevan#SHCR @School4Radicals
Language constructs our world(s) rather than reports the objective facts about the world. Therefore changing when, where, how and which people
talk about things – changing the conversation – will lead to
organisational changeRobert J Marshak
Source of image: createbusiness.net.au
‘‘
![Page 135: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/135.jpg)
@helenbevan
1. Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system and by being welcoming
2. Create opportunities for everyone to express their views, spot opportunities and build on each other’s ideas
3. Create ways for people to reflect together to find meaning, understanding and shared purpose in the change
Source: Peggy Holman
Emerging direction: the role of the change agent
Source of image: rachtalks.pressprestige.com
![Page 136: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/136.jpg)
@helenbevan
“Having care wrapped around the person rather than the person pushed through the system”
Lesley Young-MurphyNorth Tyneside Clinical Care Group
![Page 137: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/137.jpg)
@helenbevan
“The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities. Do this before you start hiring consultants and rethinking your innovation process, there is no process that works without true diversity.”
Idris Moore
Source of image: idsgn.org
Diversity is critical to innovation and change
![Page 138: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/138.jpg)
@helenbevan
“Leaders and organisations must let go of the idea that there is “one right way” and instead focus on creating a learning culture where people feel accepted, are comfortable contributing ideas, and actively seek to learn from each other”
Diaz_Uda, Medina and Schill (2013)
Source of image:fineartamerica.com
As health and care radicals, we should be champions of diversity for change
![Page 139: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/139.jpg)
@helenbevan
In the context of “rolling with resistance”
• What are the implications of embracing diversity of thought, experience and background in our change efforts?
• What skills and perspectives do health and care radicals need to work effectively with diverse teams for change?
Source of image:fineartamerica.com
Discussion
![Page 140: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/140.jpg)
@helenbevan
Our effectiveness as change agents is not a matter of intention; it’s a matter of impact
![Page 141: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/141.jpg)
@helenbevan
• Helen’s intent was to give people quick solutions, help them do their work faster and get on to the next problem at hand
• However, her impact was that people did not know how to solve their own problems so that Helen’s style was impeding their development
Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee
Source of image: thedigitalawards.com
![Page 142: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/142.jpg)
@helenbevan
Stop talkingAT ME
Start talkingTO ME
Source of image: prepbeijing.com
![Page 143: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/143.jpg)
@helenbevan
• Build a trusting and supportive work environment
• Listen like an ally • Be open with my intent
• Fully commit to the change• Seek common purpose and common
interests• Take time to build relationships• Take responsibility for my own actions
What can I do?
![Page 144: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/144.jpg)
@helenbevan
![Page 145: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/145.jpg)
@helenbevan
If your horse dies, get off it
Cherokee proverb
Source of image: fenwickgallery.co.uk
‘‘
![Page 146: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/146.jpg)
@helenbevan#SHCR @School4RadicalsImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
![Page 147: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/147.jpg)
@helenbevan
C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
![Page 148: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/148.jpg)
@helenbevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
![Page 149: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/149.jpg)
@helenbevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
![Page 150: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/150.jpg)
@helenbevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
![Page 151: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/151.jpg)
@helenbevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
![Page 152: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/152.jpg)
@helenbevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal PERFORMANCE target.
![Page 153: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/153.jpg)
@helenbevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
![Page 154: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/154.jpg)
@helenbevan
Research from the sales industry:How many NOs should we be seeking to get?
• 2% of sales are made on the first contact
• 3% of sales are made on the second contact
• 5% of sales are made on the third contact
• 10% of sales are made on the fourth contact
• 80% of sales are made on the fifth to twelfthcontact
Source: http://www.slideshare.net/bryandaly/go-for-no
![Page 155: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/155.jpg)
@helenbevan
“Papers that are more likely to contend against the status quo are more likely to find an
opponent in the review system—and thus be rejected —but those papers are also more
likely to have an impact on people across the system, earning them more citations when
finally published”
V. Calcagno et al., “Flows of research manuscripts among scientific journals reveal hidden submission patterns,”
Science, doi:10.1126/science.1227833, 2012.
—
![Page 156: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/156.jpg)
@helenbevan
![Page 157: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/157.jpg)
@helenbevan
“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
![Page 158: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/158.jpg)
@helenbevan
• smoking cessation
• exercise adoption
• alcohol and drug use
• weight control
• fruit and vegetable intake
• domestic violence
• HIV prevention
• use of sunscreens to prevent skin cancer
• medication compliance
• mammography screening
The model is mostly used around health-related behaviours
![Page 159: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/159.jpg)
@helenbevan
• smoking cessation
• exercise adoption
• alcohol and drug use
• weight control
• fruit and vegetable intake
• domestic violence
• HIV prevention
• use of sunscreens to prevent skin cancer
• medication compliance
• mammography screening
It works for organisational and service change too!
The model is mostly used around health-related behaviours
![Page 160: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/160.jpg)
@helenbevan
“Stages of change” Smoking
I am not aware my smoking is a
problem – I have no intention to quit
Prochaska, DiClemente & Norcross (1992)
![Page 161: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/161.jpg)
@helenbevan
“Stages of change” Smoking
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
Prochaska, DiClemente & Norcross (1992)
![Page 162: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/162.jpg)
@helenbevan
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
![Page 163: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/163.jpg)
@helenbevan
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped smoking!
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
![Page 164: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/164.jpg)
@helenbevan
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped smoking!
I am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
![Page 165: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/165.jpg)
@helenbevan
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped smoking!
I am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
![Page 166: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/166.jpg)
@helenbevan
Prochaska, DiClemente & Norcross (1992)
“Stages of change” Transtheoretical model of behaviour change
![Page 167: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/167.jpg)
@helenbevan
• Which stage do most change activities in health and care focus on?
• Which stage are most people actually at?
Some questions
![Page 168: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/168.jpg)
@helenbevan
The reality of our change situation
• Our tools are often not effective at the stage of change that most people we work with are at
• It’s hard to engage people in change
• It’s hard to get people to make the changes we want them to make
• People get irritated, defensive, irrational
• We feel powerless in our ability to lead or facilitate the change
90% of the tools available for health and care change agents are designed for the “action” stage
![Page 169: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/169.jpg)
@helenbevan#NHSChangeDay #SHCRchat
• Designed for Stage 4 –ACTION!
• Mandated it through targets
• Despite compelling case for change –people resisted it – no values connection
• People did the task and missed the point
Example – WHO Surgical Safety Checklist
![Page 170: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/170.jpg)
@helenbevan
IN A NUTSHELL
• Evidence from observational studies that the use of surgical safety checklists results in striking improvements in outcomes
• Led to rapid adoption of such checklists worldwide
• Researchers studied effect of mandatory adoption of checklists in Ontario, Canada
• Use of checklists not associated with significant reductions in operative mortality or complications
![Page 171: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/171.jpg)
@helenbevan
• Lower our ambitions for improvement• Focus our energies on those who are
already in the “action” stage• Put negative labels on those who are
not yet at the action stage such as “blocker” or “resister” or “laggard”
• Blame “the management” for not enforcing change
So what do we TEND to do when people resist?
![Page 172: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/172.jpg)
@helenbevan
The single biggest problem in communication is the illusion that it has taken
place
George Bernard Shaw
‘‘
![Page 173: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/173.jpg)
@helenbevan
• Listen and understand• appreciate the starting point
• elaborate interests
• Roll with resistance (Singh)
• Don’t argue against it• Encourage elaboration of resistance
• What makes it so hard?• What would help?
• Build meaning and conviction in the change
So what SHOULD we do?
![Page 174: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/174.jpg)
@helenbevan
• The focus should be on creating awareness for me of the need to change
• Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation
• I am not thinking about changing my behaviours, actions or work processes
• The problem or issue is outside my frame of awareness or my perceived need
![Page 175: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/175.jpg)
@helenbevan
Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model:
• What stage of change are some of the key people that you need to influence for your change initiative at?
• What actions can you take to help them move to the next stage?
Thinking about your own situation
![Page 176: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/176.jpg)
@helenbevan
“Tomorrow’s management systems
will need to value diversity, dissent and
divergence as highly as conformance, consensus
and cohesion.”
Gary Hamel
Source of image: www.fastcompany.com
![Page 177: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/177.jpg)
@helenbevan
1. What does resistance means to you?
think about the things you resist as well as your responses to others’ resistance
2. How do you work with resistance as a change leader?
3. How can you make sure that the changes you make achieve the impact you desire and also
are sustainable?
do not create dependency?
generate self-efficacy in others?
4. Who you are interacting with and where they are on the Stages of Change model?
Questions for reflection
![Page 178: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/178.jpg)
@helenbevan #IQTGOLD#NHSChangeDay
![Page 179: School of Health Care Radicals](https://reader030.vdocument.in/reader030/viewer/2022020208/55a629f71a28abda138b472f/html5/thumbnails/179.jpg)
@helenbevan
The “two levels down” rule
What can I achieve in:
a year?
a month?
a week?
a day?
an hour?
If you think your improvement initiative will take a year to test and implement, consider what you could achieve in a week
If you think it will take a week, what you could achieve in an hour?
Source: Paul Plsek