How to rock the boat and stay in it: The School for Health and Care Radicals

#MEDX @HelenBevan 17th September 2016

How to the boat and stay in it: The School for Health and Care Radicals

#MEDX @HelenBevan

rock

#

What are you passionate about? What lights the fire in your belly?

Source of image: http://www.ignitepeterborough.co.uk/fire-in-your-belly/

#MEDX @HelenBevan

The Horizons team• A small team of people within the

NHS who support improvement and change.

• We tune into and engage with the best change thinking and practice in healthcare and other industries around the world and seek to translate this learning into practical approaches to change. 

• The team has emerged through years of supporting change in the NHS and wider health and care system

#MEDX @HelenBevan

Stanford Medicine X design principles

BE A REBELLead as health care

rebels. Stand up for what you believe health

care should be

#MEDX @HelenBevan

A question

What happens to heretics/radicals/rebels/mavericks in organisations?

#MEDX @HelenBevan

#MEDX @HelenBevan Source: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

#MEDX @HelenBevan

Source: @NHSChangeDay

#MEDX @HelenBevan

How do we break down the wall?

#MEDX @HelenBevan

Nearly10,000

#MEDX @HelenBevan Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

#MEDX @HelenBevan

How we make a differenceThe School was formally evaluated by the Chartered Institute for Personnel& DevelopmentStatistically significant positive effect on all dimensions of impact at both individual and organisational level• Change knowledge• Sense of purpose & motivation to improve practice• Ability to challenge the status quo• Rocking the boat & staying in it• Connecting with others to build support for change

#MEDX @HelenBevan

#MEDX @HelenBevan

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

Installation by the artist Adam Katzwww.thisiscolossal.com

Source of image via @NeilPerkin

#MEDX @HelenBevan

WHO makes change happen in healthcare?

Source: adapted by Helen Bevan from Leandro Herrera

List A• The Transformation Programme

Board• The programme sponsor• The Programme Management Office• The leads of the [insert number]

transformation work streams • The Clinical Director• The Team Leader /Unit Manager• The Change Facilitator

#MEDX @HelenBevan

WHO makes change happen in healthcare?List A

• The Transformation Programme Board

• The programme sponsor• The Programme Management Office• The leads of the [insert number]

transformation work streams • The Clinical Director• The Team Leader /Unit Manager• The Change Facilitator

List B• The mavericks and rebels• The deviants (positive). Who do things

differently and succeed• The contrarians, because they can• The nonconformists who see things

through glasses no one else has• The hyper-connected. Good or bad, they

spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on

• The hyper-trusted. Multiple reasons, doesn’t matter which ones

Source: adapted by Helen Bevan from Leandro Herrera

#MEDX @HelenBevan

WHO makes change happen in healthcare?List A

• The Transformation Programme Board

• The programme sponsor• The Programme Management Office• The leads of the [insert number]

transformation work streams • The Project Manager• The Team Leader /Unit Manager• The Change Facilitator

List B• The mavericks and rebels• The deviants (positive). Who do things

differently and succeed• The contrarians, because they can• The nonconformists who see things

through glasses no one else has• The hyper-connected. Good or bad, they

spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on

• The hyper-trusted. Multiple reasons, doesn’t matter which ones

People who live and

perform in formal

organisation land and

people with the power who

have make or break change

are two different lists

Source: adapted by Helen Bevan from Leandro Herrera

#MEDX @HelenBevan

What’s the evidence?The failure of strategic change projects is rarely due to the content or structure

of the plans put into action

It’s much more to do with the role of informal networks in the

organisations/systems affected by change

To make transformational

change happen we need to connect

networks of people who ‘want’ to

contribute

It therefore a critical ability for leaders of change to ‘craft’

informal networks of change agents to oil the wheels to

enable that change to emerge

Source: David Dinwoodie (2015) http://iedp.com/articles/vertical-leadership/

#MEDX @HelenBevan

Which kind of activists are most successful at delivering change?

Lone wolvesBuild power by expertise and information — through advocacy, oversight , contributing to committees, public comments and other forms of consultation

MobilisersBuild power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action

OrganisersBuild power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength

Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

#MEDX @HelenBevan

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”

Applying community organising

principles to healthcare

improvement

2016

“A one day school for organisational

radicals”

The genesis of the school

#MEDX @HelenBevan

Our curriculum1. Being a health and care radical:

change starts with me• How to rock the boat and stay in it• The differences between radicals and trouble

makers• Conform AND rebel

2. Forming communities: building alliances for change

• You can’t be a radical on your own• Using story and narrative to build a sense of

“us” and call others to action• Forming alliances for action

3. Rolling with resistance• Understanding that dissent, disruption and

diversity are a welcome part of change• Tactics and strategies for engaging others in

change

4. Making change happen• Working with intrinsic and extrinsic

motivators for change• Building energy for change• Creating shared purpose

5. Moving beyond the edge• What skills will the change activist of the

future need?• Helping radicals to shape how they take their

learning from the School forward• What can you do next and where else might

you get support and resources?

#MEDX @HelenBevan

Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always

#MEDX @HelenBevan http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final

#MEDX @HelenBevan

Why go to the edge?“Leading from the edge brings us into

contact with a far wider range of relationships, and in turn, this increases

our potential for diversity in terms of thought, experience and background.

Diversity leads to more disruptive thinking, faster change and better outcomes”

Aylet Baron

Why go to the edge?

#MEDX @HelenBevan

Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA

old power new powerCurrency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

#MEDX @HelenBevan

The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

“As a change agent, my centrality in the informal network is more important than my position in the

formal hierarchy”

#MEDX @HelenBevan

People who are highly connected have twice as much power to influence change as people with hierarchical

powerLeandro Herrero

http://t.co/Du6zCbrDBC

#MEDX @HelenBevan For more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW

#MEDX @HelenBevan

Power in community“Power used to come largely through and from big institutions.Today power can and does come from connected individuals in community.When community invests in an idea, it co-owns its success.

Source of image: orton.org

Instead of trying to achieve scale all by ourselves, we have a new way to have scale. Scale can be in, with and through community.”

Nilofer Merchant

#MEDX @HelenBevan

“I have some Key Performance

Indicators for you”

or

“I have a dream”

Source: @RobertVarnam

#MEDX @HelenBevan

Leaders who focus on meaning also get

compliance, without focusing on it

@JeremyScrivens

#MEDX @HelenBevan

“Tomorrow’s management systems will need to value diversity, dissent and

divergence as highly as conformance, consensus and cohesion.”

Gary Hamel

Image by neilperkin.typepad.com

is the new normal!

#MEDX @HelenBevan

“Tomorrow’s management systems will need to value diversity, dissent and

divergence as highly as conformance, consensus and cohesion.”

Gary Hamel

Image by neilperkin.typepad.com

“The single biggest mistake to avoid? Creating disruption at work. Focus on developing relationships, not disrupting and alienating people. Peter Vander Awera on learning from setbacks and failures

is the new normal!

#MEDX @HelenBevan

#MEDX @HelenBevan

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

We need rebels!

#MEDX @HelenBevan

“If you put fences around people, you get sheep. Give people the

room they need”William L McKnight

#MEDX @HelenBevan

We need to create more boat rockers!• Rock the boat but manage to stay

in it• Walk the fine line between

difference and fit, inside and outside

• Conform AND rebel• Capable of working with others to

create success NOT a destructive troublemaker Source: Debra Meyerson

We need more boat rockers!

#MEDX @HelenBevan

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

Rebel

Source : Lois Kelly www.rebelsatwork.com

#MEDX @HelenBevan

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

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

• How do we protect against this?

Reflection

#MEDX @HelenBevan Source : Lois Kelly www.rebelsatwork.com

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

Rebel

#MEDX @HelenBevan

Change starts with me

Source of image: jasonkeath.com

#MEDX @HelenBevan

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

they are and how they belong in the world’ David Whyte, The Heart Aroused 1994

Source of image: fistfuloftalent.com

#MEDX @HelenBevan

Four things we know about successful boat rockers

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

Source: adapted from Debra E Meyerson

CHANGEme

BEGINS WITH

#MEDX @HelenBevan

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

#MEDX @HelenBevan

Source: @NHSChangeDay

#MEDX @HelenBevan

Source: @NHSChangeDay

What is the issue here?“permission” ? (externally generated)

orSelf efficacy ?

(internally generated)

#MEDX @HelenBevan

Building self-efficacy: some tactics1. Create change one small step at a time2. Reframe your thinking:

• failed attempts are learning opportunities

• uncertainty becomes curiousity3. Make change routine rather than an

exceptional activity4. Get social support5. Learn from the best

Building self efficacy: some tactics

#MEDX @HelenBevan Image credit: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

#MEDX @HelenBevan

#MEDX @HelenBevan http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#MEDX @HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#MEDX @HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#MEDX @HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#MEDX @HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#MEDX @HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Make it a personal PERFORMANCE target.

#MEDX @HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#MEDX @HelenBevan

Research from the sales industry:How many NOs should we be seeking to get?

• 2% of sales are made on the first contact• 3% of sales are made on the second contact• 5% of sales are made on the third contact• 10% of sales are made on the fourth contact• 80% of sales are made on the fifth to twelfth contact

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

#MEDX @HelenBevan

“Papers that are more likely to contend against the status quo are more likely to find an opponent in the review system—and thus be rejected —but those papers are also more likely to have an impact on people across the system, earning them more citations when finally published”V. Calcagno et al., “Flows of research manuscripts among scientific journals reveal hidden submission patterns,” Science, doi:10.1126/science.1227833, 2012.

—

#MEDX @HelenBevan

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

#MEDX @HelenBevan

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

#MEDX @HelenBevan

After years of intensive analysis, Google discovers that the key to high performing, innovative teams is being nice

Project Aristotle: http://qz.com/625870/after-years-of-intensive-analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/

#MEDX @HelenBevan

Key tactic : Out-love everyone else

Source of image: Bradley Burgess

Key tactic: out-love everyone else

#MEDX @HelenBevan

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

Paul Bate

#MEDX @HelenBevan

Four ways to connect!

1. Follow us on Twitter

@HelenBevan@School4Radicals

2. Subscribe to

theedge.nhsiq.nhs.uk3. Get materials from

theedge.nhsiq.nhs.uk/school …and sign up for our monthly #EdgeTalks

theedge.nhsiq.nhs.uk/edgetalks