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#SHCR #SSHCR @HelenBevan The Scottish

The Scottish School for Health and Care Radicals

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Page 1: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

The Scottish

Page 2: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

Welcome to the School for Health and Care Radicals: a global

community of change agents

Page 4: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

The School has been formally evaluated by the Chartered Institute for Personnel & Development

#EdgeTalks WebEx

http://theedge.nhsiq.nhs.uk/expert/how-has-the-school-for-health-and-care-radicals-made-a-difference/

Or Google: #EdgeTalks School

How has the School for Health and Care Radicals made a difference?

Page 5: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

The School is being formally evaluated by the Chartered Institute for Personnel & Development

• 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

Statistically significant positive effect on EVERY dimension of impact at both individual

and organisational level

Page 6: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

The Fundamental Law of Conventional Conferences

The sum of the expertise of the

people in the audience is greater

than the sum of expertise of the people on stage

Dave Winer

““

Source of image: www.citynet.com

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#SHCR #SSHCR @HelenBevan

Joining in today and beyond

• Please tweet using the hashtags #SHCR #SSHCR and the handle @School4Radicals

• Alumni from the School for Health and Care Radicals will also be joining in

• Join our Facebook group School for Health and Care Radicals

Page 8: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

• Say hello to other people at your table

• Talk about what makes a perfect learning environment for you

• How can we as a table make today like that?

Source: http://t.co/ybkznKKHrv

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#SHCR #SSHCR @HelenBevan

Source: @NHSChangeDay

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#SHCR #SSHCR @HelenBevan

Two kinds of people at work

• Feel connected to a higher purpose

• Controlled & coordinated through shared goals & values

• Collaborate• Embrace change• Work to who they are

The contributors The compliant

• Feel disconnected from purpose• Controlled & coordinated

through performance management & standardised procedures

• Hold back• Resist change• Work to a role specification

Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/

Page 11: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

Two kinds of people at work

• Feel connected to a higher purpose

• Controlled & coordinated through shared goals & values

• Collaborate• Embrace change• Work to who they are

The contributors The compliant

• Feel disconnected from purpose• Controlled & coordinated

through performance management & standardised procedures

• Hold back• Resist change• Work to a role specification

Gallup global research:• Only 13% of the workforce are

engaged (contributors)• Contributors create six times the

value to an organisation compared to the compliant

http://www.gallup.com/poll/165269/worldwide-employees-engaged-work.aspx

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#SHCR #SSHCR @HelenBevan

People who are highly connected have twice as much power to

influence change as people with hierarchical power

Leandro Herrerohttp://t.co/Du6zCbrDBC

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#SHCR #SSHCR @HelenBevan

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

Source of image: installation by the artist Adam Katzwww.thisiscolossal.com

Via @NeilPerkin

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#SHCR #SSHCR @HelenBevan

SEISMIC SHIFTS

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#SHCR #SSHCR @HelenBevan

DIGITALCONNECTION

SEISMIC SHIFTS

Page 17: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

Work complexity

SEISMIC SHIFTS

DIGITALCONNECTION

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#SHCR #SSHCR @HelenBevan

DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity

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#SHCR #SSHCR @HelenBevan

DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexityChange from the edge

Page 21: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always

Page 22: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @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

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#SHCR #SSHCR @HelenBevan

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

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

Page 24: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan Source: Gary Hamel

Page 25: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan Source:@Alfacarlo

Page 26: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @HelenBevan

Managers know how to command obedience and diligence, but most are

clueless when it comes to galvanizing the sort of volunteerism that animates life on

the social web. Initiative, imagination and passion can’t be commanded—they’re gifts.

Gary Hamel http://www.mixmashup.org/blog/reinventing-management-mashup-architecture-ideology

Page 27: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @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

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#SHCR #SSHCR @HelenBevan

is the new normal!“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

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#SHCR #SSHCR @HelenBevan

Page 30: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

What happens to heretics/radicals/rebels/mavericks

in organisations?

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#SHCR @HelenBevan @FreerMary

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#SHCR @HelenBevan @FreerMary#IQTGOLD#SCHR @HelenBevanSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

Page 33: The Scottish School for Health and Care Radicals

#SHCR #SSHCR @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

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#SHCR @HelenBevan @FreerMary

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

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#SHCR @HelenBevan @FreerMary

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

Source: adapted from Debra E Meyerson

Page 36: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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

Source: adapted from Debra E Meyerson

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#SHCR @HelenBevan @FreerMary

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#SHCR @HelenBevan @FreerMary

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#SHCR @HelenBevan @FreerMary

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 survive2. leave the organisation

Source: adapted from Debra E Meyerson

Page 40: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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 survive2. leave the organisation

we cannot find a way to be true to our values and commitments and still survive

Source: adapted from Debra E Meyerson

Page 41: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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 survive2. 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

Source: adapted from Debra E Meyerson

Page 42: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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 survive2. 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

Page 43: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary#NHSChangeDay #SHCRchatSource : Lois Kelly www.foghound.com

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

Rebel

Page 44: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Reflection

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

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

• How do we protect against this?

Page 45: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary#NHSChangeDay #SHCRchatSource : Lois Kelly www.rebelsatwork.com

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

Rebel

Page 46: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Peter Fuda’s Transformational Change Agent framework

Skills and methods for creating change

Ability to make sense of, and reshape perceptions of ‘reality’

Personal characteristics and qualities

Page 47: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Peter Fuda’s Transformational Change Agent framework: my perspective

“Doing”• Where most change agents

in health and care put most of their effort and emphasis

• What others typically judge us on

• What we often perceive we need to do to add value

• What most change and improvement courses focus on

Page 48: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Peter Fuda’s Transformational Change Agent framework: my perspective

“Seeing ” and “Being”• We can only do effective

“doing” if we build on strong foundations of “seeing and being”

• Change begins with me• Hopeful futures, creative

opportunities and potential• Multiple lenses for change • See myself in the context of

my higher purpose

Page 49: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

“Being” as a change agent

Personal characteristics and qualities

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#SHCR @HelenBevan @FreerMary

Change starts with me

Source of image: jasonkeath.com

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#SHCR @HelenBevan @FreerMary

"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

Page 52: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

‘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

Page 53: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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

Four things we know about successful boat rockers

Source: adapted from Debra E Meyerson

CHANGE

meBEGINS WITH

Page 54: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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

Page 55: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

What’s the difference between

self efficacyand

self esteem,self belief,

self-confidence?

Page 56: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Source: @NHSChangeDay

Page 57: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Source: @NHSChangeDay

What is the issue here?“permission” ?

(externally generated)or

Self efficacy ? (internally generated)

Page 58: The Scottish School for Health and Care Radicals

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton

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

• failed attempts are learning opportunities• uncertainty becomes curiousity

3. Make change routine rather than an exceptional activity4. Get social support5. Learn from the best

Page 59: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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

Page 60: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Avedis Donabedian

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

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#SHCR @HelenBevan @FreerMary

Key tactic :Out-love everyone else

Source of image: Bradley Burgess

Page 62: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Questions for reflection

1. What are the opportunities for me to build my perspectives and skills as an agent of change?

2. How can I build self efficacy as a change agent?3. How do I move beyond skills and knowledge of

change to live and be change?4. Who can help and support me as a change

agent?5. What are the implications for the way I work?

Page 63: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

Page 64: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMarySource of image: outskirtsbattledome.wikispaces.com

The easiest way to thrive as an outlier

...is to avoid being oneSeth Goodin

Page 65: The Scottish School for Health and Care Radicals

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

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#SHCR @HelenBevan @FreerMary

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

Page 67: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

“When we talk of social change, we talk of movements, a word that suggest vast

groups of people walking together, leaving behind one way and travelling towards

another”Rebecca Solnit

Page 69: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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Calls to Action

Page 71: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Leadership is….

…the art of mobilising others to want to struggle for shared

aspirationsJim Kouzes

Source of image: environmentvictoria.org.au

Page 72: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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)

Page 73: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

What’s the financial incentive?

Who is performance managing?

What’s the project plan?

Source: @RobertVarnam

Page 74: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

The reality“What the leader cares about (and typically bases at

least 80% of his or her message to others on) does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into the change

programme”Scott Keller and Carolyn Aiken (2009)

The Inconvenient Truth about Change Management

Source of image: swedenbourg-openlearning.org.uk

Page 75: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

1. People speak intellectually but engage emotionally

2. Facts are hard to remember and easy to challenge

3. If we only talk about our success people won’t believe us

4. People don’t want more communication; they want meaningful communication

http://www.peterfuda.com/2014/10/30/traditional-comms-fail-engage/

Four gaps betweenhow we

communicate change

how people engage with that communication

Page 76: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary#IQTGOLD#SCHR @HelenBevan

“I have some Key Performance

Indicatorsfor you”

or

“I have a dream”

Source: @RobertVarnam

Page 77: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

If we want people to take action, we have to connect with their emotions through values

action

values

emotion

Source: Marshall Ganz

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#SHCR @HelenBevan @FreerMary

Page 79: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary#IQTGOLD#SCHR @HelenBevan

But not all emotions are equal.........

inertiaurgency

anger apathy

solidarity isolation

you can make a difference

Self-doubt

hope fear

Ove

rcom

es

Action motivatorsAction inhibitors

Source: Marshall Ganz

Page 80: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

‘‘Leaders must wake people out of inertia. They must get people excited about something they’ve never seen before, something that does not yet exist”

Rosa Beth Moss Kanter

Source of image: www.linkedin.com/company/activate-brand-agency

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Effective framing: what do we need to do?

1. Tell a story

Source of image: woccdoc.org

Page 83: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Effective framing: what do we need to do?

1. Tell a story2. Make it personal

Source of image: woccdoc.org

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#SHCR @HelenBevan @FreerMary

Effective framing: what do we need to do?

1. Tell a story2. Make it personal3. Be authentic

Source of image: woccdoc.org

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#SHCR @HelenBevan @FreerMary

Effective framing: what do we need to do?

1. Tell a story2. Make it personal3. Be authentic4. Create a sense of “us” (and be clear who the “us”

is)

Source of image: woccdoc.org

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#SHCR @HelenBevan @FreerMary

Effective framing: what do we need to do?

1. Tell a 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

Source of image: woccdoc.org

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#SHCR @HelenBevan @FreerMary#IQTGOLD#SCHR @HelenBevan

Vivid details

Source: Marshall Ganz

Page 88: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

Talk to the person next to you

• 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

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#SHCR @HelenBevan @FreerMary

How do we create a sense of “us” to build momentum for change?

Source of image: www.tannerfriedman.com

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Moving beyond us and them to us and us

Source of image: www.delta7.com

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The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy

2. If you want to create small scale change, work through a cohesive network

If you want to create big change, create bridge networks between disconnected groups

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#SHCR @HelenBevan @FreerMary

strong ties (cohesive)v.

weak ties (disconnected)

Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml

Page 93: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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, social worker to social worker, nurse to nurse, community leader to community leader

• Influence is spread through people who are strongly connected to each other, like and trust each other

Page 94: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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, social worker to social worker, nurse to nurse, community leader to community leader

• 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

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#SHCR @HelenBevan @FreerMary

The pros and cons of strong ties

Pros Cons

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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

• We can mobilise all the resources in our organisation, system or community to help achieve our goals

Page 97: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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

More on weak ties: https://www.youtube.com/watch?v=w7AzRVxhEXA#t=45

Page 98: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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

Page 99: The Scottish School for Health and Care Radicals

#SHCR @HelenBevan @FreerMary

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 and most radical change will come when we tap into our weak ties

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#SHCR @HelenBevan @FreerMary

Sources of weak ties

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Three components of a great narrative• 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 our audience?

Source: Benford and SnowSource of image: www.ecommercedefense.com

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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

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#SHCR @HelenBevan @FreerMary

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#SHCR @HelenBevan @FreerMary

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

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http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite

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Source of image: http://switchandshift.com/transactional-or-transformational-which-leadership-style-is-best

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

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Questions for reflection

1. What learning and inspiration can you take from social movement leaders to help you in your role as an agent of change in health and care?

2. How will you attract the attention of the people you want to call to action?

3. Who are the people who are currently disconnected that you want to unite in order to achieve your goal for change? How can you build a sense of “us” with them?

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Employee resistance is the most common reason executives cite for the

failure of big organizational-change

effortsScott Keller and Colin Price

(2011), Beyond Performance: How Great Organizations Build Ultimate

Competitive Advantage Source of image: Businessconjunctions.com

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“Thousands of patients have died needlessly because of

a damaging reluctance amongst doctors and the

public to accept changes in the NHS, according to the country’s top emergency

doctor

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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

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Resistant behaviour is a good indicator of missing relevance

Harald Schirmerhttp://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-role-of-hr-driving-social-adoption-and-change-in-the-enterprise

Source of image: driverlayer.com

‘‘

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Cultural change is a million

subversive acts of resistance

Brene Brown

Source of image: zazzle.com

‘‘

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#SHCR @HelenBevan @FreerMaryImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

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C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

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

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

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

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Make it a personal PERFORMANCE target.

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

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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

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“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.

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“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

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• smoking cessation • exercise adoption• alcohol and drug use• weight control • fruit and vegetable intake• domestic violence• HIV prevention• use of sunscreens to prevent skin cancer • medication compliance • mammography screening

The model is mostly used around health-related behaviours

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• smoking cessation • exercise adoption• alcohol and drug use• weight control • fruit and vegetable intake• domestic violence• HIV prevention• use of sunscreens to prevent skin cancer • medication compliance • mammography screening

It works for organisational and service change too!

The model is mostly used around health-related behaviours

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“Stages of change” Smoking

I am not aware my smoking is a

problem – I have no intention to quit

Prochaska, DiClemente & Norcross (1992)

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“Stages of change” Smoking

I am not aware my smoking is a

problem – I have no intention to quit

I know my smoking is a problem – I

want to stop but no plans yet

Prochaska, DiClemente & Norcross (1992)

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I am not aware my smoking is a

problem – I have no intention 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 preparation.

“Stages of change” Smoking

Prochaska, DiClemente & Norcross (1992)

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I am not aware my smoking is a

problem – I have no intention 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 preparation.

I have stopped

smoking!

“Stages of change” Smoking

Prochaska, DiClemente & Norcross (1992)

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I am not aware my smoking is a

problem – I have no intention 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 preparation.

I have stopped

smoking!

I am continuing to not smoke.

I sometimes miss it – but I am still not

smoking

“Stages of change” Smoking

Prochaska, DiClemente & Norcross (1992)

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I am not aware my smoking is a

problem – I have no intention 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 preparation.

I have stopped

smoking!

I am continuing to not smoke.

I sometimes miss it – but I am still not

smoking

“Stages of change” Smoking

Prochaska, DiClemente & Norcross (1992)

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Prochaska, DiClemente & Norcross (1992)

“Stages of change” Transtheoretical model of behaviour change

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• Which stage do most change activities in health and care focus on?

• Which stage are most people actually at?

Some questions

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The reality of our change situation• Our tools are often not effective at the stage of change

that most people we work with are at• It’s hard to engage people in change• It’s hard to get people to make the changes we want

them to make• People get irritated, defensive, irrational• We feel powerless in our ability to lead or facilitate the

change

90% of the tools available for health and care change agents are designed for the “action” stage

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• Designed for Stage 4 – ACTION!

• Mandated it through targets

• Despite compelling case for change – people resisted it – no values connection

• People did the task and missed the point

Example – WHO Surgical Safety Checklist

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IN A NUTSHELL• Evidence from observational studies that the use of surgical safety

checklists results in striking improvements in outcomes• Led to rapid adoption of such checklists worldwide• Researchers studied effect of mandatory adoption of checklists in

Ontario, Canada• Use of checklists not associated with significant reductions in

operative mortality or complications

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• Lower our ambitions for improvement• Focus our energies on those who are

already in the “action” stage• Put negative labels on those who are

not yet at the action stage such as “blocker” or “resister” or “laggard”

• Blame “the management” for not enforcing change

So what do we TEND to do when people resist?

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The single biggest problem in communication is the illusion that it has taken

place

George Bernard Shaw

‘‘

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• Listen and understand• appreciate the starting point• elaborate interests

• Roll with resistance (Singh) • Don’t argue against it• Encourage elaboration of resistance

• What makes it so hard?• What would help?

• Build meaning and conviction in the change

So what SHOULD we do?

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• The focus should be on creating awareness for me of the need to change

• Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation

Example from the worksheet

• I am not thinking about changing my behaviours, actions or work processes

• The problem or issue is outside my frame of awareness or my perceived need

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Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model: • What stage of change are some of the key

people that you need to influence for your change initiative at?

• What actions can you take to help them move to the next stage?

Thinking about your own situation

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If your horse dies, get off itCherokee proverb

Source of image: fenwickgallery.co.uk

‘‘

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What happens to large scale change efforts in reality?

In order of frequency:1. the effort effectively “runs out of energy” and

simply fades away2. the change hits a plateau at some level and no

longer attracts new supporters3. the change becomes reasonably well established;

several levels across the system have changed to accommodate or support it in a sustainable way

Source: http://www.nhsiq.nhs.uk/8530.aspx

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Research shows that more than almost any other factor affecting an

organisation, energy can lead to either a wellspring of corporate vitality or the

destruction of its very core

Source: Bruch and Vogel

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Bruch and Vogel researchOrganisations with HIGH productive energy scored higher on:• overall performance - 14% higher• productivity – 17%• efficiency – 14%• customer satisfaction – 6%• customer loyalty – 12%

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Persistent application of power and authority drains energy

from those in its wakeDan Rockwell

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Energy for change

The capacity and drive of a team, organisation or system to act and make the difference necessary to

achieve its goals

http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html

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Psychological

Physical

Spiritual

Social Intellectual

Energy for change

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Social energy

Energy of personal engagement, relationships and

connections between people

It’s where people feel a sense of “us and us” rather than “us and them”

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Spiritual energy

Energy of commitment to a common vision for the future, driven by shared

values and a higher purposeGives people the confidence to move towards a

different future that is more compelling than the status quo

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Psychological energy

Energy of courage, resilience and feeling safe to do things differently

Involves feeling supported to make a change and trust in leadership and direction

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Physical energy

Energy of action, getting things done and making progress

The flexible, responsive drive to make things happen

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Intellectual energy

Energy of analysis, planning and thinking

Involves gaining insight as well as planning and supporting processes, evaluation, and arguing a

case on the basis of logic/ evidence

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High and low ends of each energy domain

Low High

Social isolated solidarity

Spiritual uncommitted higher purpose

Psychological risky safe

Physical fatigue vitality

Intellectual Illogical reason

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Some questions

• Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)

• Nearer to CEO, higher or lower energy scores?

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• Are particular energy domains more dominant than others for our team at the moment?

• Is this the optimal energy profile to help us achieve our improvement goals?

Energy for change profileSocial

Spiritual

PsychologicalPhysical

Intellectual

1

2

3

4

5

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Social

Spiritual

PsychologicalPhysical

Intellectual

1

2

3

4

5

Team 1: what’s your assessment of their energy for change?

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Social

Spiritual

PsychologicalPhysical

Intellectual

1

2

3

4

5

Team 2: what’s your assessment of their energy for change?

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Where is your team?

Social

Spiritual

PsychologicalPhysical

Intellectual

1

2

3

4

5

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There has never been a time in the history of healthcare when this advice has been

more pertinent

“Leadership is not about making clever decisions and doing bigger deals. It is about

helping release the positive energy that exists naturally within people”

Henry Mintzberg

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Four ways to connect!

1. Follow us on Twitter@HelenBevan @TheEdgeNHS @School4Radicals

2. Subscribe to theedge.nhsiq.nhs.uk

3. Get materials from theedge.nhsiq.nhs.uk/school

…and sign up for our monthly #EdgeTalkstheedge.nhsiq.nhs.uk/edgetalks

4. Save the date for theedge.nhsiq.nhs.uk/transformathon

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#SHCR @HelenBevan @FreerMary #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

4pm - 4pm, 27-28th January 2016

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References and linksBaron A (2014) Preparing for a changing world: the power of relationships Battilano J, Casciaro T (2013) The network secrets of the great change agents Harvard Business Review, July-August Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Bevan H, Fairman S (2014) The new era of thinking and practice in change and transformation, NHS Improving Quality Change Agents Worldwide (2013) Moving forward with social collaboration SlideShareDiaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontierFuda P (2012) 15 qualities of a transformational change agentGrant, M (2014) Humanize: How people centric organisations succeed in a social world http://prezi.com/usju20i0nzhd/humanize-how-people-centric-organizations-succeed-in-a-social-world/ Hamel G (2014)Why bureaucracy must dieJarche, H (2013) Rebels on the edges

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Jarche H (2014) Moving to the edges

Kotter J (2014) Accelerate! Harvard Business Review Press

Merchant N (2013) eleven rules for creating value in the social era

Llopis G (2014) Every leader must be a change agent or face extinction

Meyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard

Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BP

Perkins N (2014) Bats and pizzas (agility and organisational change)

Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated

School for health and Care radicals (2014) www.changeday.nhs.uk/healthcareradicalsShinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadershipWilliams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activismVerjans S (2013) How social media changes the way we work together

References and links