Post on 21-Apr-2017
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
A one day
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Welcome to the School for Health and Care Radicals – a global community of change agents
• More than 5,000 change agents in health and care have taken part in The School for Health and Care Radicals
• From more than 60 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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Joining in today and beyond• Please tweet using hashtags #SHCR and #Quality2015
and the handle @School4Radicals• Alumni from the School for Health and Care Radicals will
also be joining in• We will produce summaries of the content and
discussions today using Storify and Pinterest• Join our Facebook group School for Health and Care
Radicals
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The Fundamental Law of Conventional Conferences
The sum of the expertise of the
people in the audience is greater
than the sum of expertise of the people on stage
Dave Winer
““
Source of image: www.citynet.com
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Everyone has gifts and strengthsWhat superpower do you have?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Source: @NHSChangeDay
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
People who are highly connected have twice as much power to
influence change as people with hierarchical power
Leandro Herrerohttp://t.co/Du6zCbrDBC
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Starts on the fringe (at the edge)
Starts with the activistsGary Hamel
always
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
So why do we keep reinventing the past and calling it the future?
Image used under Creative Commons licence: Kicki
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Tomorrow belongs to those who can hear it coming
David Bowie
“ “
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work complexityChange from the edge
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leading change in a new era
Dominant approach Emerging direction
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leading change in a new era
Dominant approach Emerging direction
Most healthcare transformation
efforts are driven from this side
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source: Gary Hamel
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source:@Alfacarlo
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
John Kotter, the most influential thought leader globally, recognises new approaches are needed
FROM
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
From “have to” to “want to”
Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
‘
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
DiscussionWhat are the implications of the “emerging direction” for the way
we work as change agents?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What happens to heretics/radicals/rebels/mavericks
in organisations?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton@HelenBevan
Ostracism is experienced in the brain as deeply as physical pain
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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 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 this just confirms what we already know – that
we don’t belong Source: adapted from Debra E Meyerson
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#NHSChangeDay #SHCRchatSource : Lois Kelly www.foghound.com
There’s a big difference between a rebel and a troublemaker
Rebel
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Reflection
• What are your insights around “rebels” and “troublemakers”?
• What moves people from being “rebel” to “troublemaker”?
• How do we protect against this?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Peter Fuda’s Transformational Change Agent framework
Skills and methods for creating change
Ability to make sense of, and reshape perceptions of ‘reality’
Personal characteristics and qualities
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Peter Fuda’s Transformational Change Agent framework: my perspective
“Doing”• Where most change agents
in health and care put most of their effort and emphasis
• What others typically judge us on
• What we often perceive we need to do to add value
• What most change and improvement courses focus on
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Peter Fuda’s Transformational Change Agent framework: my perspective
“Seeing ” and “Being”• We can only do effective
“doing” if we build on strong foundations of “seeing and being”
• Change begins with me• Hopeful futures, creative
opportunities and potential• Multiple lenses for change • See myself in the context of
my higher purpose
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Change starts with me
Source of image: jasonkeath.com
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
"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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
‘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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
1. able to join forces with others to create action2. able to achieve small wins which create a sense
of hope, possibility and confidence3. More likely to view obstacles as challenges to
overcome4. 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
meBEGINS WITH
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What’s the difference between
self efficacyand
self esteem,self belief,
self-confidence?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Source: @NHSChangeDay
What is the issue here?“permission” ?
(externally generated)or
Self efficacy ? (internally generated)
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Building self-efficacy: some tactics1. Create change one small step at a time2. Reframe your thinking:
• failed attempts are learning opportunities• uncertainty becomes curiousity
3. Make change routine rather than an exceptional activity4. Get social support5. Learn from the best
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Being a great change agent is about knowing, doing, living and being improvement
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Avedis Donabedian
“Ultimately, the secret of quality is love.…… If you have love, you can then work backward to monitor and improve the system”.
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Key tactic :Out-love everyone else
Source of image: Bradley Burgess
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Kinds of people at work
Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/
The Contributors
The Compliant
The Contras
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Kinds of people at work
Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/
The Contributors
The Compliant
The Contras
Gallup global research:• Only 13% of the workforce are
engaged (Contributors)• Contributors create six times the
value to an organisation compared to the Compliant
http://www.gallup.com/poll/165269/worldwide-employees-engaged-work.aspx
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
We want a welcoming Sweden. FIKA for everyone!
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What is a
RCT?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Randomized Coffee Trial!
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Outcomes of randomised coffee trials
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource of image: outskirtsbattledome.wikispaces.com
The easiest way to thrive as an outlier
...is to avoid being oneSeth Goodin
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leading change in a new era
Dominant approach Emerging direction
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonFor more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Calls to Action
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leadership is….
…the art of mobilising others to want to struggle for shared
aspirationsJim Kouzes
Source of image: environmentvictoria.org.au
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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)
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What’s the financial incentive?
Who is performance managing?
What’s the project plan?
Source: @RobertVarnam
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“I have some Key Performance
Indicatorsfor you”
or
“I have a dream”
Source: @RobertVarnam
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
If we want people to take action, we have to connect with their emotions through values
action
values
emotion
Source: Marshall Ganz
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
But not all emotions are equal.........
inertiaurgency
anger apathy
solidarity isolation
you can make a difference
Self-doubt
hope fear
Ove
rcom
es
Action motivatorsAction inhibitors
Source: Marshall Ganz
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
‘‘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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Effective framing: what do we need to do?
1. Tell a story2. Make it personal3. Be authentic4. 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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-crafting-visual-stories-with-data?sf3881865=1
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Vivid details
Source: Marshall Ganz
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Talk to the person next to you
• Tell your story about why the change you are involved in now is so important to you
• Relate it to a personal experience
You have:• 2 minutes to prepare your story• 3 minutes each to tell your story
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Harvard researchers put a gorilla image on this lung scan
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Harvard researchers put a gorilla image on this lung scan
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What proportion of the radiologists who reviewed this scan actually saw the gorilla?
90%
25% 17%
80%
9%
60%
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
How do we create a sense of “us” to build momentum for change?
Source of image: www.tannerfriedman.com
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Moving beyond us and them to us and us
Source of image: www.delta7.com
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
strong ties (cohesive)v.
weak ties (disconnected)
Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The pros and cons of strong ties
Pros Cons
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Sources of weak ties
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton101
http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Source of image: http://switchandshift.com/transactional-or-transformational-which-leadership-style-is-best
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“You don’t need an engine when you have wind in your sails”
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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 Advantage Source of image: Businessconjunctions.com
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“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
“
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
‘‘
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Cultural change is a million
subversive acts of resistance
Brene Brown
Source of image: zazzle.com
‘‘
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal PERFORMANCE target.
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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 twelfth
contact
Source: http://www.slideshare.net/bryandaly/go-for-no
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“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.
—
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• 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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• 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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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)
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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)
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Prochaska, DiClemente & Norcross (1992)
“Stages of change” Transtheoretical model of behaviour change
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• Which stage do most change activities in health and care focus on?
• Which stage are most people actually at?
Some questions
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• 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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• 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?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The single biggest problem in communication is the illusion that it has taken
place
George Bernard Shaw
‘‘
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• 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?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• 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
Example from the worksheet
• 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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
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If your horse dies, get off itCherokee proverb
Source of image: fenwickgallery.co.uk
‘‘
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source: Helen Bevan
Compliance
States a minimum performance standard that everyone must achieve
Uses hierarchy, systems and standard procedures for co-ordination and control
Threat of penalties/ sanctions/ shame creates momentum for delivery
What is our approach to change?Commitment
States a collective goal that everyone can aspire to
Based on shared goals, values and sense of purpose for co-ordination and control
Commitment to a common purpose creates energy for delivery
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leaders who focus on meaning also
get compliance, without focusing on it
@JeremyScrivens
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
We know that ...
• Shared purpose is a common thread in successful change programmes*
• Organisations and change initiatives with strong shared purpose consistently outperform those without it.**
*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)
**Management Agenda 2013 Boury et al (Roffey Park Institute)
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#NHSChangeDay #SHCRchat
A 3-word concept
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
[Shared] purpose goes way deeper than vision and mission; it goes right into your gut
and taps some part of your primal self. I believe that if you can bring people with similar primal-purposes together and get them all marching in the same direction,
amazing things can be achieved.Seth Carguilo
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The power of shared purpose:
Perhaps the single most important influence on program response by individual units—either in promoting or resisting change—was the extent of consensus and
coalition among the senior medical and nursing staff on individual ICUs….
Transforming or boosting of efforts was most likely to occur when those locally charged with implementation were sincere in their beliefs about the value of the
program, were able to create transdisciplinary alliances, had local credibility among peers, were prepared to tolerate debate but exercise firmness, and used
multiple tactics including role modelling, persuasion, sanctioning, reminders, and constant feedback….
[Consultant says] ‘I think it’s been successful because it’s a unifying program, it’s one of the few things that we’ve done that hasn’t been just a doctor thing, or
just a nurse thing, it’s involved the doctors and the nurses together.’ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
As leaders, we are “signal generators”“As a leader, think of yourself as a “signal generator”
whose words and actions are constantly being scrutinised and interpreted, especially by those below you” [in the hierarchy]
“Signal generators reduce uncertainty and ambiguity about what is important and how to act”
Charles O’Reilly, Leaders in Difficult Times
Source of image: vintage-radio.com
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Avoiding “de facto” purpose• What leaders pay attention to matters to staff, and consequently
staff pay attention to that too• Shared purpose can easily be displaced by a “de facto” purpose:
hitting a target reducing costs reducing length of stay eliminating waste completing activities within a timescale complying with an inspection regime
• If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce
Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Purpose
Obfuscation O-
meter
@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Police
@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Education
@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Healthcare
@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
....the last era of management was about how much performance we could extract from people .....the next is all about how much humanity we can inspireDov Seidman
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“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
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The Fundamental Law of Conventional Conferences
The sum of the expertise of the
people in the audience is greater
than the sum of expertise of the people on stage
Dave Winer
““
Source of image: www.citynet.com
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Traditional conferenceThe agenda is pre-set
One way learning style with Questions & AnswersPeople sit in rows or round tables as prescribedNetworking between sessions
Hard to leave the session once it starts
Absorbing information
Unconference
People set the agenda
Based on discussion
People sit where they want
Networking the whole time
Encouraged to find the right session
Connecting to action
Source: adapted from @BCPSQC
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The unconference: 4 principles and a law
Principles:1. Whoever comes are the right people2. Whatever happens is the only thing that could
have happened.3. When it starts is the right time4. When it's over it's over
The Law is known as the Law of Two Feet:"If you find yourself in a situation where you are not contributing or learning, move somewhere where you can."
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Our process
• Think about a topic that you would like to explore with other people based on what you have heard today
• It should be a topic that you want to take action on over the next twelve months
• Suggest your idea to the big group
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The task
• Discuss your topic and identify key actions that should be taken
• Summarise your discussion on one sheet of flip chart
• On a separate sheet of A4 paper write one “big idea”
• Identify one person from your group to explain your discussion and conclusions in a “gallery” session
Time available: 50 minutes
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What’s our approach to change?
Deficit based
• what is wrong?• solve problems• identify what we
need to improve• fill gaps and
deficiencies
Strength based
• what is strong?• work with our
existing assets and resources
• amplify what works• “positive deviants”
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“Dotocracy”
• One person from each group to stand by their place in the “gallery”
• Each person has four dots• We are voting for the idea that offers the best potential
for radical/transformational change• You can give all your dots to one idea or one dot each
to four ideas• Switch the “standing” person half way so they can vote• Time allowed 12 minutes
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
1. Follow on Twitter @HelenBevan @BoelGare
2. Subscribe to 3. Get materials from The School for Health and Care
Radicals: www.theedge.nhsiq.nhs.uk/school4. Sign up to our MOOC (Massive Open Online Course)
on “Improvement Fundamentals”)5. Come to the #Folkslab on Wednesday, Thursday or
Friday
TheEdge.nhsiq.nhs.uk
Five ways to connect!
@JackieLynton@School4Radicals@TheEdgeNHS
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonwww.nhsiq.nhs.uk/ImprovementFundamentals
• Delivered entirely online to study at your own time and pace
• Features live knowledge exchange events with experts and other participants
• Gives you the tools to put improvement ideas into practice
• Connect with a global improvement community
• Free to ANYONE interested in improving health and care
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Come join us at #Folkslab2015A new approach to learning and sharing. An informal guided
creative process to discuss, share and design solutions to these common issues:• Improvements in Primary Care• The revolution in care for older people• Spreading change• Person-centred care• Clinical Innovation
Learn more about Human Centred Design
Wednesday or Thursday 11-12:30 or Friday 12-13:00Or try a taster session Wednesday or Thursday 13-13:30
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
References and linksBaron A (2014) Preparing for a changing world: the power of relationships Battilano J, Casciaro T (2013) The network secrets of the great change agents Harvard Business Review, July-August Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Bevan H, Fairman S (2014) The new era of thinking and practice in change and transformation, NHS Improving Quality Change Agents Worldwide (2013) Moving forward with social collaboration SlideShareDiaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontierFuda P (2012) 15 qualities of a transformational change agentGrant, M (2014) Humanize: How people centric organisations succeed in a social world http://prezi.com/usju20i0nzhd/humanize-how-people-centric-organizations-succeed-in-a-social-world/ Hamel G (2014)Why bureaucracy must dieJarche, H (2013) Rebels on the edges
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Jarche H (2014) Moving to the edges
Kotter J (2014) Accelerate! Harvard Business Review Press
Merchant N (2013) eleven rules for creating value in the social era
Llopis G (2014) Every leader must be a change agent or face extinction
Meyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard
Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BP
Perkins N (2014) Bats and pizzas (agility and organisational change)
Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated
School for health and Care radicals (2014) www.changeday.nhs.uk/healthcareradicalsShinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadershipWilliams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activismVerjans S (2013) How social media changes the way we work together
References and links