A one day school for health and care radicals: Minicourse M4 at International Forum on Safety and...

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton

A one day


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


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


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

http://www.citynet.com/


Everyone has gifts and strengthsWhat superpower do you have?


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


Source: @NHSChangeDay


People who are highly connected have twice as much power to

influence change as people with hierarchical power

Leandro Herrerohttp://t.co/Du6zCbrDBC

http://t.co/Du6zCbrDBC


“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

http://www.thisiscolossal.com/


Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always


So why do we keep reinventing the past and calling it the future?

Image used under Creative Commons licence: Kicki


Tomorrow belongs to those who can hear it coming

David Bowie

“ “


DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexityChange from the edge


Leading change in a new era

Dominant approach Emerging direction




Most healthcare transformation

efforts are driven from this side

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source: Gary Hamel

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source:@Alfacarlo


John Kotter, the most influential thought leader globally, recognises new approaches are needed

FROM


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


From “have to” to “want to”

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


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

‘

http://www.mixmashup.org/blog/reinventing-management-mashup-architecture-ideology




The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

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

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

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


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

we work as change agents?


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


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

http://t.co/6CQtA4wUv1


What happens to heretics/radicals/rebels/mavericks

in organisations?

#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


We need to be boatrockers!

• Walk the fine line between difference and fit, inside and outside, rock the boat but manage to stay in it

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

• Conform AND rebel• Capable of working with others

to create success NOT a destructive troublemaker Source: Debra Meyerson


What are the risks for a boat rocker?

1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice 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#NHSChangeDay #SHCRchatSource : Lois Kelly www.foghound.com

There’s a big difference between a rebel and a troublemaker

Rebel

http://www.foghound.com/


Reflection

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

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

• How do we protect against this?


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


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


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


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


‘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


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


Self-efficacy

“If you think you can or think you

can't, you are right.”

Henry Ford

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

Albert Bandura

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

change agent and her/his ability to facilitate change

and get good outcomes

Source of image:www.h3daily.com


What’s the difference between

self efficacyand

self esteem,self belief,

self-confidence?


Source: @NHSChangeDay

What is the issue here?“permission” ?

(externally generated)or

Self efficacy ? (internally generated)


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


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


Avedis Donabedian

“Ultimately, the secret of quality is love.…… If you have love, you can then work backward to monitor and improve the system”.


Key tactic :Out-love everyone else

Source of image: Bradley Burgess


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

http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/




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








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?


We want a welcoming Sweden. FIKA for everyone!


What is a

RCT?


Randomized Coffee Trial!


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 @jackielyntonFor more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW

http://linkis.com/www.oscarberg.net/20/QwGqW

http://linkis.com/www.oscarberg.net/20/QwGqW


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


“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


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





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


Calls to Action


Leadership is….

…the art of mobilising others to want to struggle for shared

aspirationsJim Kouzes

Source of image: environmentvictoria.org.au


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)


What’s the financial incentive?

Who is performance managing?

What’s the project plan?

Source: @RobertVarnam


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


If we want people to take action, we have to connect with their emotions through values

action

values

emotion

Source: Marshall Ganz


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



‘‘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

http://www.linkedin.com/company/activate-brand-agency


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


http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-crafting-visual-stories-with-data?sf3881865=1





Vivid details



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


Harvard researchers put a gorilla image on this lung scan


What proportion of the radiologists who reviewed this scan actually saw the gorilla?

90%

25% 17%

80%

9%

60%


How do we create a sense of “us” to build momentum for change?

Source of image: www.tannerfriedman.com

http://www.tannerfriedman.com/


Moving beyond us and them to us and us

Source of image: www.delta7.com

http://www.delta7.com/


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


strong ties (cohesive)v.

weak ties (disconnected)

Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml

http://www.forbes.com/fdc/welcome_mjx.shtml

http://www.forbes.com/fdc/welcome_mjx.shtml


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


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


The pros and cons of strong ties

Pros Cons


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


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


Sources of weak ties


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

http://www.ecommercedefense.com/


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 @jackielynton101

http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite


Source of image: http://switchandshift.com/transactional-or-transformational-which-leadership-style-is-best

http://switchandshift.com/transactional-or-transformational-which-leadership-style-is-best

http://switchandshift.com/transactional-or-transformational-which-leadership-style-is-best


“You don’t need an engine when you have wind in your sails”


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?


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


“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

“


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


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

‘‘

http://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-role-of-hr-driving-social-adoption-and-change-in-the-enterprise




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/


C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

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.



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

http://www.slideshare.net/bryandaly/go-for-no

http://www.slideshare.net/bryandaly/go-for-no


“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.

—


“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)


• 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


• 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


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




“Stages of change” Transtheoretical model of behaviour change


• Which stage do most change activities in health and care focus on?

• Which stage are most people actually at?

Some questions


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


• 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


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


• 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?


The single biggest problem in communication is the illusion that it has taken

place

George Bernard Shaw

‘‘


• 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?


• 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


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


If your horse dies, get off itCherokee proverb

Source of image: fenwickgallery.co.uk

‘‘

#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


Leaders who focus on meaning also

get compliance, without focusing on it

@JeremyScrivens


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


[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


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/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/




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


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

https://twitter.com/SimonJGuilfoyle



Purpose

Obfuscation O-

meter

@SimonJGuilfoyle Police Inspector and systems thinker




Police





Education





Healthcare





....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


“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


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

http://www.citynet.com/


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


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."


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


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


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”


“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


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

http://www.theedge.nhsiq.nhs.uk/school

#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


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


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

http://www.slideshare.net/fullscreen/ayeletb/preparing-for-the-future-the-power-of-relationships/1

http://www.slideshare.net/fullscreen/ayeletb/preparing-for-the-future-the-power-of-relationships/1

http://cci-catalyst.s3-us-west-1.amazonaws.com/uploads/1384364389642-ybp7cg76g1rzr529-33ce7d6c1677a906fea8a88cd3b37a0a/The+Network+Secrets+of+Great+Change+Agents.pdf

http://changeday.nhs.uk/files/Leading%20Large%20Scale%20Change%20Part%201.pdf

http://changeday.nhs.uk/files/Leading%20Large%20Scale%20Change%20Part%202.pdf

http://www.nhsiq.nhs.uk/resource-search/publications/white-paper.aspx

http://www.slideshare.net/chagww/moving-forward-with-social-collaboration

http://dupress.com/articles/diversitys-new-frontier/

http://www.peterfuda.com/category/the-transformational-change-agent/

http://www.peterfuda.com/category/the-transformational-change-agent/

http://prezi.com/usju20i0nzhd/humanize-how-people-centric-organizations-succeed-in-a-social-world/



http://management.fortune.cnn.com/2014/03/26/bureaucracy/

http://www.jarche.com/2013/11/rebels-on-the-edges/


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

http://www.jarche.com/2014/01/moving-to-the-edges/

http://www.jarche.com/2014/01/moving-to-the-edges/

http://www.amazon.co.uk/Accelerate-John-P-Kotter/dp/1625271743

http://www.slideshare.net/missrogue/11-rules-for-the-social-era-book-by-nilofer-merchant

http://www.forbes.com/sites/glennllopis/2014/03/24/every-leader-must-be-a-change-agent-or-face-extinction/

http://hbr.org/2001/10/radical-change-the-quiet-way/ar/1

http://hbr.org/product/rocking-the-boat-how-to-inspire-change-from-within/an/2138-PBK-ENG

http://www.slideshare.net/neilperkin/google-squared-online-0114

http://www.slideshare.net/neilperkin/google-squared-online-0114

http://www.changeagentsworldwide.com/assets/doc/caww_ebook_11.pdf

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


http://www.slideshare.net/JulianStodd/the-future-of-leadership-by-julian-stodd


http://www.webershandwick.com/uploads/news/files/employees-rising-seizing-the-opportunity-in-employee-activism.pdf

http://www.slideshare.net/sverjans/how-social-media-changes-the-way-we-work-together

http://www.slideshare.net/sverjans/how-social-media-changes-the-way-we-work-together

A one day school for health and care radicals: Minicourse M4 at International Forum on Safety and...

Healthcare

Transcript of A one day school for health and care radicals: Minicourse M4 at International Forum on Safety and...