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@jackielynton
Jackie LyntonCreating a contagious
commitment for change
…..
@HelenBevan #SHCR #QF15
The Horizons Group within NHS Improving Quality
Aim of the group: to stimulate new and ‘disruptive’ approaches in support of health and care transformation, operating at the edge of current thinking and practice:
1. how to create radical, system-wide change
2. working with emerging leaders, clinical trainees, students
3. open innovation, open source, digital connection, social media, change platforms, hacking
“You
can’t cross a chasm in small
steps”David
Lloyd George
@helenbevan#SHCR @School4Radicals
http://www.theedge.nhsiq.nhs.uk/school/
1. Change starts with me
2. Forming communities: Rolling with resistance
3. Building alliances for change
4. Making change happen
5. Moving beyond the edge
• Being an effective
change activist
• Transformational leadership
• Thought diversity
and disruptive
innovation
• Scale and spread of
change
• The new methods
for change
@HelenBevan @JackieLynton #mixmashup
Four ways to connect with us!
1. Follow on Twitter @Jackie Lynton
2. Subscribe to
3. The School for Health and Care Radicals: @School4Radical
4. Engage with NHS Change Daywww.ChangeDay.nhs.ukwww.usachangeday.org
TheEdge.nhsiq.nhs.uk
@HelenBevan
Five enabling themes in change and transformation www.nhsiq.nhs.uk/whitepaper
@HelenBevan @JackieLynton #mixmashup
Agenda
1. What is happening in the world of change?
2. Rocking the boat and staying in it
3. What is your story?
4. A disruptive case study: NHS Change Day
5. Twitter: @jackielynton @transformkp
The NHS is the 5th biggest employer on the globe
Source: BBC
Community
Call to attention Stay with the process
@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Activity
Introduce yourself to others at your table. Tell a quick story that demonstrates why you chose to come to this workshop today.
Time allowed: 10 minutes for the whole table
@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
What is happening in the world of change?
Source of image: from guardiansprayerwarrior.com
@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
SEISMIC SHIFTS
Change from the edge
@HelenBevan #SHCR #QF15
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
#NHSChangeDay #SHCRchat
Why is change needed and what needs to change?
#NHSChangeDay #SHCRchat
Why do we need to change and what needs to change?
Discuss in your community
ACTIVITY
@HelenBevan Source of image: Whatsthebigideascwartzy.blogspot.com
@HelenBevan
Most large scale change doesn’t fullydeliver its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey
70%
25%
5%
Gets anywhere near achieving the change and
delivering the benefits
@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
@HelenBevan
Most large scale change doesn’t fullydeliver its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey
70%
25%
5% Delivers and sustains the change
@HelenBevan
Many of the ways we go about improving health and
care were designed in a different mindset
for a different set of circumstances
We are operating with 20th century change
practice in a 21st
century world
:
Source of images : http://www.slideshare.net/dachisgroup/dave-gray-the-connected-company
@HelenBevan #SHCR #QF15
Leading change in a new era
Dominant approach Emerging direction
@HelenBevan
Most change efforts are built upon the shaky foundation of five flawed assumptions; 1. that change can be managed2. that human beings are objective 3. that there are ‘X’ steps to change4. that we have a neutral starting point for change5. and that change, itself, is the goalPeter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf
Source of image: Whatsthebigideascwartzy.blogspot.com
@HelenBevan #SHCR #QF15
Leading change in a new era
Dominant approach Emerging direction
Most policy efforts are driven from this
side
@HelenBevan #SHCR #QF15
John Kotter: “Accelerate!” most influential thought leader globally, recognises new approaches are needed
• 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
• Changing our mindsetTO
FROM
@HelenBevan #SHCR #QF15
Must do
Want to do
Kotter: From “have to” to “want to”
@HelenBevan #SHCR #QF15
“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
Embracing difference to change the conversation
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
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
strong ties (cohesive)v.
weak ties (disconnected)
Source of image:brucemacvaresh.com
#NHSChangeDay #SHCRchat
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”; Physician to Physician, nurse to nurse, gynaecologist to gynaecologist
• Influence is spread through people who are strongly connected to each other, like and trust each other
#NHSChangeDay #SHCRchat
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, nurse to nurse, gynaecologist to gynaecologist
• 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
#NHSChangeDay #SHCRchat
The pros and cons of strong ties
Pros Cons
ACTIVITY
#NHSChangeDay #SHCRchat
Strong and weak tiesWhen we seek to 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, nurse to nurse, gynaecologist to gynaecologist
• Influence is spread through people who are strongly connected to each other, like and trust each other
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
• our aim is to mobilise all the resources in our organisation, system or community that can help achieve our goals
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
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 will come when we tap into our weak ties
History suggests that weak ties will probably give us the best chance to deliver large scale improvements in a challenging
timescale
@HelenBevan #SHCR #QF15
@HelenBevan #SHCR #QF15
You get the best effort from others not by lighting a fire beneath them, but by
building a fire within
Bob Nelson
@HelenBevan #SHCR #QF15
What lights the ‘fire in your belly’ and makes you feel passionate and determined to make change happen?
ACTIVITY
@HelenBevan #SHCR #QF15
Connecting to other people values and emotions
@HelenBevan #SHCR #QF15
If we want people to take action, we have to connect with their emotions through values
action
values
emotion
Source: Marshall Ganz
@HelenBevan #SHCR #QF15
What is strategy?
Strategy is the process of turning the you have into the you need to win
the you wantSource: Marshall Ganz
@HelenBevan #SHCR #QF15
Here have some of mine!
MyPower
Power
Shifting positional power to relational
@HelenBevan #SHCR #QF15
Unleashing the energy
The more you do what you love the more energy you have. Leadership Freak
Vs
@HelenBevan #SHCR #QF15
Resources to improve health and care
Economic resourcesdiminish with use• money• materials• technology
Natural resourcesgrow with use• relationships• commitment• community
Based on principles from Albert Hirschman, Against Parsimony
@HelenBevan #SHCR #QF15#NHSChangeDay #SHCRchat
“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
@HelenBevan #SHCR #QF15 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? 3 Mins
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
@HelenBevan
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)
@HelenBevan
Three components of framing
• 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 the audience?
Source: Benford and Snow
@HelenBevan
What’s the financial incentive?
Who is performance managing?
What’s the project plan?
Source: @RobertVarnam
@HelenBevan
“I have some Key
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam
@HelenBevan
Call to Action
• A call to action assumes that we can end an intolerable condition by creating a burning platform from which to organise our resources and seek commitment
• A call to action finds and builds new sources of power and so enables change through
• collaboration and mobilisation• developing leadership
• A call to action unites us around a collective vision and focuses our energy towards a specific and real change and a measureable goal
@HelenBevan
Starts on the fringe
(at the edge)
Starts with the activistsGary Hamel
always
@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Why am I a radical, rebel, maverick?
@HelenBevan
@HelenBevan
Source : Lois Kelly www.rebelsatwork.com
Sometimes other people see radicals/rebels as troublemakers
Rebel
@HelenBevan
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
@HelenBevan #SHCR #QF15#NHSChangeDay #SHCRchat
If your horse dies, get off itCherokee proverb
Source of image: fenwickgallery.co.uk
@HelenBevan
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 survive
2. 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
@HelenBevan #SHCR #QF15
We need rebels!
•They are 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
•Without rebels, the storyline never changes
Source : @PeterVan http://t.co/6CQtA4wUv1
@HelenBevan #SHCR #QF15 Source: Rebelsatwork.com
Rebels learn to tell their story
What’s your story?
#NHSChangeDay #SHCRchat
"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
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
It starts
with me….
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Effective framing: what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us” is)
5. Build in a call for urgent action
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Creating our narrative
• Challenge: What was the challenge? Why was it a challenge?
• Choice: What were the choices? Why did you make the choice you did? Where did you get the courage or hope? How did it feel?
• Outcome: How did the outcome feel? Why did it feel that way? What do you want us to feel?
Source: Marshall Ganz
#NHSChangeDay #SHCRchat
Vivid details
Source: Marshall Ganz
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Me at 22 years old
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5Image from: @TheWorldStories
MY GOAL
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
• Creating a space for getting ready for change
• Invitation to thinking differently about change
• Share the collective wisdom of people in the room – 5 minutes of wisdom
OverviewMY
GOAL
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Strong sense public service and community
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
1986
1. I did not feel heard, supported
2. Let down by my profession
3. I was part of a hierarchical
system that didn’t protect vulnerable people
#NHSChangeDay #SHCRchat
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Always fighting for change an speaking out
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Being open to creating
alliances with others,
and not build silos…..
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
This picture was taken fromthe window of my hotelroom in Scotland when I asked myself one of the mostimportant questions
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Connecting to What’s important to me?
Alone/Me
Together/We
Building connections and relationships for change
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Knowing your purpose
#NHSChangeDay #SHCRchat
[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
@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
30 years on
1. Staff didn’t feel heard –
‘checked out’
2. Compliance over
commitment
3. Staff not feeling
‘permission’ to make to
make changes
#NHSChangeDay #SHCRchat
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
‘Can I really make the change?’
Will ‘the system’ really ALLOW me?
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
When you hit up against this wall, how do you feel and how do staff feel?
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Change starts with me
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
When you start with ‘me’ - you can see ‘we and us’
1. Cut on the dotted line2. Rotate 180 degrees
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Creating change through connections and building relationships
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Reconnecting with my values
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Innovation/ideas is not reserved for someone sitting at
the top of a hierarchy, but driven down to unleash new
levels of engagement
Nurse
Doctor ManagerSocial worker
Patient
Carer maker Cleaner
Pharmacist
#NHSChangeDay #SHCRchat
Now I don’t!Now I bring my authentic self to work
I had to be someone else
to fit in
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Talk to the person next to you ACTIVITY
• 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
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Talk to the person next to you
Have a further discussion
• In terms of the people you want to get on board with your change project, what will create a sense of “us” rather than “us and them”?
• How could telling your story help create the “us”?
You have three minutes for further discussion as a pair
Key messages• Create a “burning ambition” and imperative
for action around quality, improvement and cost
• Make a relevant case that makes both a rational case for change and a connection to emotions, through values
• Frame to connect with hearts and minds and identify levers for commitment rather than compliance
• Build a strategy for both strong and weak ties
• Ask people to commit to specific actions
NHS Change Day
Making a change for
better together.
Disruptive Case Study
Do something better together….
Audacity to imagine we could mobilise
the 1.3m people in the NHS
Must do
Want to do
Shared purposeGoal – 65,000 (500k)
pledgesCore leadership team
Personal pledgeSet a dateWebsite
Social media Took risks
Courage & belief Kept it simple!
Holding each other to account rather than performance management
Change Day pledges and stories
‘…the floodgates of change open’from front line to senior leaders
@HelenBevan @JackieLynton #mixmashup
Change starts with me..
Maker
...Making a
difference
Anyone can pledge – it’s personal to you!
Change Activist
@HelenBevan @JackieLynton #mixmashup
Volunteers – leaders everywhere
98% of activity via volunteers
My pledge/action…..Not let hierarchy get in the way of patient care
What I didWorked with the hierarchy at an early stage. Seeking their support with an explicit understanding that they respected the grassroots nature of Change Day.
Bottom up approach with top down support
I urge as many people as possible to give their support“
"NHS Change Day is a fantastic opportunity to join a movement of young leaders who want to make a
difference in the NHS
Jeremy Hunt Health Secretary
Chief Nursing Officer - England
Professor Sir Bruce Keogh National Medical Director
It's especially an opportunity for the next generation of junior doctors to effect change
in a practical and sustainable way"
Fun day for children Support group with a stomas
NHS CEO personal National pledge campaign
30% shift in staff survey:‘Would you feel confident your hospital
would address your concern?’
Ashley Brooks Patient Champion
‘Change Day gave me the permission to use my energy in the direction I wanted to use it’
Students swap places with patients in mock ward
Change in University nursing curriculum
Louise Trowse – Second year student
Tasting common medicine for children
Discussing pharmacy methods of improving the taste
Dr Damian Roland
“The single most important skill I learned from improvement leaders was narrative. It connects us to the reasons we were called to work forthe NHS. It will stay with me the rest of my career.”
Jeharna sings forchildren’s ward tosay thank you
‘I wanted to say thank you to NHS staff for the way my brother was looked after when he got knocked over,’
Staff feel appreciated
Smile Feedback Wednesday
Ellie Milner
@HelenBevan @JackieLynton #mixmashup
2013 2014 2015
Google Searches Twitter
Google Searches and Twitter posts tell the same story: 50% bigger than last year at peakOnline mentions: 4x bigger than last year (Source — OLR) 9,274 vs1,869 in 2014
Changeathon:
Changeathon peaked on Twitter around 09:00 and 11:00
46 Million Twitter Impressions14 Thousand Tweets9 Thousand online mentions4,859 individuals tweeting200 events flagged on Twitter60 events notified to team
Biggest ever
Events acrossEngland
Twitter:
50% bigger than 2014(tweets & searches — online is 400% bigger)
CHANGEATHON
Chloe at 24
Quote from ChloeI was inspired by the caring,
creative and committed individuals I met in the NHS and realised I need to fulfil a sense of
purpose in using my skills and passion in helping others.
I want ……
#NHSChangeDay #SHCRchat
@HelenBevan @JackieLynton #mixmashup
A global movement was born
https://www.youtube.com/watch?v=inHc1NgohuA
OCTOBER 2015 www.usachangeday.org
@helenbevan #IQTGOLD#SHCR @School4Radicals
“You don’t need an engine when you have
wind in your sails”
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
• We must activate the mavericks, radicals, rebels and heretics
• There is a massive untapped reservoir of energy and talent out there and the
potential is outstanding
SO GO OUT AND CAUSE TROUBLE!
SUMMARY
@HelenBevan @JackieLynton #mixmashup
Four ways to connect with us!
1. Follow on Twitter @Jackie Lynton [email protected]
2. Subscribe to
3. The School for Health and Care Radicals: @School4Radical
4. Engage with NHS Change Daywww.ChangeDay.nhs.ukwww.usachangeday.org
TheEdge.nhsiq.nhs.uk