@helenbevan

Rocking the boat and staying in it:

respiratory leader as organisa3onal radical

Helen Bevan Delivery team NHS Improving Quality @helenbevan @NHSIQ

@helenbevan

@helenbevan

How does it feel to be a here0c/radical/rebel/maverick in our

organisa0on?

@helenbevan

@helenbevan

What happens to here0cs/radicals/rebels/mavericks in organisa0ons?

@helenbevan

@helenbevan

Are you a boat rocker? One who challenges the status quo when they see that there could be a be@er way

Energise their organisa0on by working from their true self

Capable of working with others to create success NOT a destruc0ve troublemaker

Walk the ne line between dierence and t, inside and outside, rock the boat but manage to stay in it

@helenbevan

Troublemaker Radical Complain Create

Me-focused Mission-focused Anger Passion

Pessimist Op0mist Energy-sapping Energy-genera0ng

Alienate A@ract Problems Possibili0es Alone Together

Source : Lois Kelly www.foghound.com

Some3mes people see us radicals as troublemakers

@helenbevan

Task

Talk to others at your table about your experiences around rebels and troublemakers

Which have you been and why? What moves people from being good to bad?

How do we protect against this?

@helenbevan

First they ignore you, then they laugh at you, then they ght you, then you win

Gandhi

@helenbevan

Valuing radicals

New truths begin as heresies (Huxley, defending Darwins theory of natural selec0on)

big things only happen in organisa0ons because of here0cs and radicals

@helenbevan

@helenbevan Source: Foghound

@helenbevan

Four tac3cs for organisa3onal radicals

1. Start with myself 2. Build alliances 3. Work out what might help others to

change 4. Don't be a martyr

@helenbevan

Four tac3cs for organisa3onal radicals

1. Start with myself 2. Build alliances 3. Work out what might help others to

change 4. Don't be a martyr

@helenbevan

There is nothing more dicult to carry out, nor more doub9ul of success, nor more dangerous to handle, than to ini;ate a new order of things. For the reformer has enemies in all those who prot by the old order, and only lukewarm defenders in all those who prot by the new

Niccolo Machiavelli 15th century

@helenbevan

"Theres only one corner of the universe you can be certain of improving, and thats your own

self." Aldous Huxley

@helenbevan

@helenbevan

What are the risks for a boat rocker?

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

@helenbevan

What are the risks for a boat rocker?

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

our commitment, in order to survive

@helenbevan Source: Foghound

@helenbevan

@helenbevan

What are the risks for a boat rocker?

1. Our experiences of being dierent 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 organisa0on

@helenbevan

What are the risks for a boat rocker?

1. Our experiences of being dierent 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 organisa0on

we cannot nd a way to be true to our values and commitments and s0ll survive

@helenbevan

What are the risks for a boat rocker?

1. Our experiences of being dierent 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 organisa0on

we cannot nd a way to be true to our values and commitments and s0ll survive

3. stridently challenge the status quo in a manner which is increasingly radical and self-defea0ng

@helenbevan

What are the risks for a boat rocker?

1. Our experiences of being dierent 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 organisa0on

we cannot nd a way to be true to our values and commitments and s0ll survive

3. stridently challenge the status quo in a manner which is increasingly radical and self-defea0ng this just conrms what we already know that

we dont belong

@helenbevan

1. convic0ons and values driven 2. strong sense of self-ecacy

belief that I am personally able to create change belief in others

3. ac0on orientated ignite collec0ve ac0on mobilising others, inspiring change

4. able to join forces with others work as a collec0ve body for commonly valued changes

5. able to achieve small wins which create a sense of hope, self-ecacy and condence

6. op0mis0c in the face of challenge see opportuni0es take account of obstacles

What do we know about successful boat rockers?

@helenbevan

Three assump3ons for organisa3onal radicals

1. Assume that everyone has a noble inten0on 2. Mo0va0on and behaviour in a change

process are due to interpersonal interac;on (not just innate character trait)

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

@helenbevan

Four tac3cs for organisa3onal radicals

1. Start with myself 2. Build alliances 3. Work out what might help others to

change 4. Don't be a martyr

@helenbevan

The easiest way to thrive as an outlier ...is to avoid being one

Seth Goodin

@helenbevan

if you want to go fast, go alone. If you want to go far, go together African proverb quoted by Al Gore

@helenbevan

Framing Is the process by which leaders construct, ar3culate and put across their message in a powerful and compelling way in order to win people to their cause and call them to ac3on Snow D A and Benford R D (1992)

@helenbevan

What do we need to do? 1. Tell a story

@helenbevan

What do we need to do? 1. Tell a story 2. Make it personal

@helenbevan

What do we need to do? 1. Tell a story 2. Make it personal 3. Be authen0c

@helenbevan

What do we need to do? 1. Tell a story 2. Make it personal 3. Be authen0c 4. Create a sense of us (and be clear who the us

is)

@helenbevan

What do we need to do? 1. Tell a story 2. Make it personal 3. Be authen0c 4. Create a sense of us (and be clear who the us

is) 5. Build in a call for urgent ac0on

@helenbevan

@helenbevan

@helenbevan

@helenbevan

@helenbevan

Four tac3cs for organisa3onal radicals

1. Start with myself 2. Build alliances 3. Work out what might help others to

change 4. Don't be a martyr

@helenbevan

@helenbevan

Stages of change Transtheore0cal model of behaviour change

Prochaska, DiClemente & Norcross (1992)

@helenbevan

The model is mostly used around health-related behaviours

smoking cessa0on exercise adop0on alcohol and drug use weight control fruit and vegetable intake domes0c violence HIV preven0on use of sunscreens to prevent skin cancer medica0on compliance mammography screening

@helenbevan

The model is mostly used around health-related behaviours

smoking cessa0on exercise adop0on alcohol and drug use weight control fruit and vegetable intake domes0c violence HIV preven0on use of sunscreens to prevent skin cancer medica0on compliance mammography screening

It works for organisa3onal and service change too!

@helenbevan

Stages of change Smoking

Prochaska, DiClemente & Norcross (1992)

I am not aware my smoking is a

problem I have no inten0on to quit

@helenbevan

Stages of change Smoking

Prochaska, DiClemente & Norcross (1992)

I am not aware my smoking is a

problem I have no inten0on to quit

I know my smoking is a problem I

want to stop but no plans yet

@helenbevan

Stages of change Smoking

Prochaska, DiClemente & Norcross (1992)

I am not aware my smoking is a

problem I have no inten0on 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 prepara0on.

@helenbevan

Stages of change Smoking

Prochaska, DiClemente & Norcross (1992)

I am not aware my smoking is a

problem I have no inten0on 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 prepara0on.

I have stopped smoking!

@helenbevan

Stages of change Smoking

Prochaska, DiClemente & Norcross (1992)

I am not aware my smoking is a

problem I have no inten0on 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 prepara0on.

I have stopped smoking!

I am con0nuing to not smoke.

I some0mes miss it but I am s0ll not

smoking

@helenbevan

Stages of change Smoking

Prochaska, DiClemente & Norcross (1992)

I am not aware my smoking is a

problem I have no inten0on 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 prepara0on.

I have stopped smoking!

I am con0nuing to not smoke.

I some0mes miss it but I am s0ll not

smoking

@helenbevan

Stages of change Transtheore0cal model of behaviour change

Prochaska, DiClemente & Norcross (1992)

@helenbevan

90% of the tools available for healthcare change agents are designed for the ac3on stage

The reality of our change situa3on Our tools are oken not eec0ve at the stage of change that most people we work with are at

Its hard to engage people in change Its hard to get people to make the changes we want them to make

People get irritated, defensive, irra0onal We feel powerless in our ability to lead or facilitate the change

@helenbevan

Example - Surgical Checklist

Designed for Stage 4 ACTION!

Mandated it through targets

Despite compelling case for change people resisted it no values connec0on

People did the task and missed the point

@helenbevan

One key issue is that many doctors already feel that they are delivering pa;ent centred care unfortunately that is not what pa;ents report. Dr Nigel Mathers, Vice Chair, Royal College of General Prac0ce

@helenbevan

So what do we TEND to do? Lower our ambi0ons for improvement Focus our energies on those who are already in the ac0on stage

Put nega0ve labels on those who are not yet at the ac0on stage such as blocker or resister or laggard

Blame the leadership for not enforcing change Overes0mate the mo0va0on of those who say theyre ready to change and underes0mate the mo0va0on of those who indicate no interest in change (Lundberg)

@helenbevan

So what SHOULD we do

Listen and understand appreciate the star0ng point elaborate interests

Build meaning and convic0on in the change Roll with resistance (Singh)

Dont argue against it Encourage elabora0on of resistance

What makes it so hard? What would help?

Build shared purpose

@helenbevan

OutwiPed

He drew a circle that shut me out - Here0c, rebel, a thing to out. But Love and I had the wit to win: We drew a circle that took him in.

Edward Markham

@helenbevan

Discussion

What might you do to: enhance your own role as a respiratory maverick, radical or here0c?

Support other mavericks, radicals or rebels in your organisa0on or system?

@helenbevan

....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 inspire Dov Seidman

@helenbevan

We have a choice

This is the true joy of life, the being used up for a purpose recognised by yourself as a mighty one,

being a force of nature instead of a feverish, selsh li@le clot of ailments and grievances, complaining that the world will not devote itself to making you

happy

George Bernard Shaw