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Building contagious commitment to change: what healthcare improvement and reform can learn from social
movements
Helen Bevanhttp://twitter.com/helenbevan @helenbevan
Our agenda
1. Why these principles are important to healthcare: some British context
2. Comparing traditions of change3. How movement leaders changed the
world4. Learning from movement leaders:
what we need to do
The English NHS: facts and figures
• Provides comprehensive healthcare to 54 million people
• Funded by direct tax• It’s free• Virtually EVERYONE uses it• There is lots of patient choice
Average spending on health per person
Source: Commonwealth Fund 2010
What Britain loves
How Britons rank their “national treasures”
Source: Demos/Sunday Times, 27th November 2011
71%
72%
68%
55%
51%
47%
Shakespeare
How Britons rank their “national treasures”
Source: Demos/Sunday Times, 27th November 2011
71%
72%
68%
55%
51%
47%
Shakespeare
The British Armed forces
How Britons rank their “national treasures”
Source: Demos/Sunday Times, 27th November 2011
71%
72%
68%
55%
51%
47%
Shakespeare
The British Armed forces
The Union Jack flag
How Britons rank their “national treasures”
Source: Demos/Sunday Times, 27th November 2011
71%
72%
68%
55%
51%
47%
Shakespeare
The British Armed forces
The Union Jack flag
The National Health Service
How Britons rank their “national treasures”
Source: Demos/Sunday Times, 27th November 2011
71%
72%
68%
55%
51%
47%
Shakespeare
The British Armed forces
The Union Jack flag
The National Health Service
The Royal Family
How Britons rank their “national treasures”
Source: Demos/Sunday Times, 27th November 2011
71%
72%
68%
55%
51%
47%
Shakespeare
The British Armed forces
The Union Jack flag
The National Health Service
The Royal Family
The BBC (British Broadcasting Corporation)
How Britons rank their “national treasures”
Source: Demos/Sunday Times, 27th November 2011
71%
72%
68%
55%
51%
47%
Shakespeare
The British Armed forces
The Union Jack flag
The National Health Service
The Royal Family
The BBC (British Broadcasting Corporation)
The Beatles
How Britons rank their “national treasures”
Source: Demos/Sunday Times, 27th November 2011
71%
72%
68%
55%
51%
47%
Shakespeare
The British Armed forces
The Union Jack flag
The National Health Service
The Royal Family
The BBC (British Broadcasting Corporation)
The Beatles
The British legal system
How Britons rank their “national treasures”
Source: Demos/Sunday Times, 27th November 2011
71%
72%
68%
55%
51%
47%
Shakespeare
The British Armed forces
The Union Jack flag
The National Health Service
The Royal Family
The BBC (British Broadcasting Corporation)
The Beatles
The British legal system
Parliament
If there was one thing that the British people took from the [World War II] experience, it was a health service free at the point of use......
And no government of any stripe has dared to try to take it away from us since..... Andrew Marr
History of Modern Britain
The NHS belongs to the people
It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most
The NHS is facing its biggest challenge ever
• Impact of economic recession• Rising demand and expectation• 4% compound reduction, four years
running• Securing the future of the NHS system• Delivering higher value through quality
improvement
“Revolution begins with transformation of consciousness”
Paul Bate
We possess power
“Our problem is to hitch it up for action on the broadest, daring
and most gigantic scale”
Which tradition of change?
Management of
change
organizing and
mobilizing
• Organisational behaviour• Leadership and management studies• Clinical/medical audit• Improvement “science”• Academic tradition(s) – 100 years
Which tradition of change?
Management of change
• Community organizing, campaigns and social movements
• Learning from popular, civic and faith-based mobilisation efforts
• Academic tradition– 100 years
Which tradition of change?
organizing and mobilizing
Which tradition of change?
• Organisational behaviour
• Leadership and management studies
• Clinical/medical audit
• Improvement “science”
• Academic tradition(s) – 100 years
• Community organizing, campaigns and social movements
• Learning from popular, civic and faith-based mobilisation efforts
• Academic tradition – 100 years
Management of change
organizing and mobilizing
Source: Bernard Crump/Helen Bevan
Anatomy of change Physiology of change
Defined as
The shape and structure of the system; detailed analysis; how the system fits together
The vitality and life-giving forces that enable the system and its people to develop, grow and change.
Focus Processes and structures to deliver health & healthcare
Energy/fuel for change
What leaders do
• measurement and evidence
• improving clinical systems
• reducing waste and variation
• redesigning pathways
• creating a higher purpose and deeper meaning
• building commitment to change
• connecting with values• creating hope and optimism
about the future• calling to action
“You can’t impose anything on anyone and expect them
to be committed to it”Edgar Schein, Professor Emeritus
MIT Sloan School
Source: Helen Bevan
From
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
From the old world to the new worldTo
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
“Large scale change is fuelled by the passion that comes from the fundamental belief that there is
something very different and better that is worth striving for”
Leading Large Scale Change (2011)
NHS Institute for Innovation and Improvement
Source: Marshall Ganz
Shared understanding leads to Action
How did the great transformational
leaders change the world?
StrategyWhat?
Narrative
Why?
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
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)
If we want people to take action, we have to connect with their emotions through
values
actionaction
valuesvalues
emotionemotion
Source: Marshall Ganz
But not all emotions are equal.........
inertiainertiaurgencyurgency
angeranger apathyapathy
solidaritysolidarity isolationisolation
you can make a difference
you can make a difference
Self-doubt Self-doubt
hopehope fearfear
Action motivators Action inhibitors
Source: Marshall Ganz
“A cynic, after all, is a passionate person who does not want to be disappointed again”
Zander R and Zander B (2000) The art of possibility. Harvard Business School Press. As quoted by Steve Onyett
Leaders are “signal generators”
“As a leader, think of yourself
as a “signal generator” whose words and actions are
constantly being scrutinised and interpreted by others”
Our words and actions as leaders are massively amplified
“Signal generators reduce uncertainty and ambiguity about
what is important and how to act”
Charles O’Reilly, Leaders in Difficult Times, 2009
Do not be dismayed in these terrible
times.......
Learning from movement leaders: what do we need to do?
1. Tell our story
1. Tell our story2. Make it personal
Learning from movement leaders: what do we need to do?
1. Tell our story2. Make it personal3. Be authentic
Learning from movement leaders: what do we need to do?
1. Tell our story2. Make it personal3. Be authentic4. Create a sense of “us” (and be
clear who the “us” is)
Learning from movement leaders: what do we need to do?
1. Tell our 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
Learning from movement leaders: what do we need to do?
What the framing literature tells us
“‘a new idea must be at the least couched in the language of past ideas; often, it must be, at first, diluted with vestiges of the past”
Saul Alinsky Rules for Radicals (1971)
What the framing literature tells us
“‘a new idea must be at the least couched in the language of past ideas; often, it must be, at first, diluted with vestiges of the past”
Saul Alinsky Rules for Radicals (1971) In other words: People are much more likely to embrace
change if it is framed as something that builds positively on what they are familiar with than as something that seems far away and unachievable
“When you have gone so far that you can’t manage one more step, then you have gone just half the distance that you are capable of”
Proverb of the Inuit people of the Arctic Circle
