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#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
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“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