Day school

Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

Who we are• 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 systems.

Agenda

1. Being a health and care radical: change starts with me

2. From Me to We: Forming communities and building alliances for change

3. Rolling with resistance4. Moving beyond the edge make change

happen5. Change Challenge unconference

How we make a differenceThe School has been formally evaluated by the Chartered Institute for Personnel& DevelopmentStatistically significant positive effect on EVERY dimension 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

Twitter#SHCR

@School4Radicals

Facebook group School for Health and Care Radicals

Join in on social media

Follow us on Twitter

@School4Radicals

@KateSlater2

@OllyBenson

@JoannaHemming

@DaniG4_

My Story: Two wipes

Being a Health and Care Radical, what does this really mean?

What will the future look like? But to get here there will have to be lots of change

SEISMIC SHIFTS

Kinthi Sturtevant, IBM 13th

annual Change Management Conference

June 2015

We rarely see two, three or four year change projects anymore. Now it’s 30-60-90 day change

projects

DIGITALCONNECTION

SEISMIC SHIFTS

In 2005…• Facebook didn’t widely exist• Twitter was still a sound• The cloud was still in the sky• 4G was a parking place • LinkedIn was a prison• Applications were what you sent to college• Skype was a typo

16

Source: Thomas Friedman, World Economic Forum. Quoted by: http://aveletbaron.com

Work complexity

SEISMIC SHIFTS

DIGITALCONNECTION

Our work and our care is getting more complex

DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity

The power is changing More than 70% of all major transformation efforts fail. Why?

Because organizations do not take a

consistent, holistic approach to changing

themselves, nor do they engage their

workforces effectively. John Kotter

DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexityChange from the edge

Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always

Why go to the edge?

Adapted from 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

John Kotter, the most influential thought leader globally, recognises new approaches are needed

FROM

John Kotter: “Accelerate!”

• 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• At least 50% buy-in required• Changing our mindset

• From “have to” to “want to”

TO

People who are highly connected have twice as much power to

influence change as people with hierarchical power

Leandro Herrerohttp://t.co/Du6zCbrDBC

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

strong ties (cohesive)v.

weak ties (disconnected)

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

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

The pros and cons of strong ties

Pros Cons

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

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

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

#IQTGOLD

What happens to heretics/radicals/rebels/mavericks in

organisations?

#IQTGOLDSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

What is a rebel?•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 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: adapted from Debra E Meyerson

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 belongSource: adapted from Debra E Meyerson

Source : Lois Kelly www.foghound.com

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

Rebel

Source : Lois Kelly www.rebelsatwork.com

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

Rebel

What led you into health?

We asked via twitter the question what led you into nursing?

The responses were around the rebel values.

You can’t be a rebel alone

• Stay close to where you started • Remain focused on the goal • Understand the story • Strengthen and widen your network and ties • Believe in yourself • Be not be afraid

What is a

RCT?

Randomised Coffee Trial!

Outcomes of randomised coffee trials

Moving from me to we

Photo credit: Flickr / hugobernard

So how can we harness the power of our shared humanity to help us

accomplish positive change?

#IQTGOLD Photo credit: Flickr / mikemcsharry

“Communities are characterized by three things: common interests, frequent interaction, and identification.“Wally Block

#IQTGOLD Photo credit: Flickr / geoffandsherry

“Power used to come largely through and from big institutions. Today power can and does come from connected individuals in community.”Nilofer Merchant

“There is no power for change greater than a community discovering what it cares about.” Margaret Wheatley

Where are your communities?

#IQTGOLD Photo credit: Flickr / stjc

Learning from previous social movements

How do organisations develop activists?

#IQTGOLD Photo credit: Flickr / Angell Williams.

#IQTGOLD Photo credit: Flickr / memespring

#IQTGOLD Photo credit: Flickr / santanuvasant

“Great social movements get their energy by growing a distributed leadership”Joe Simpson

“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)

#IQTGOLD

“I have some Key Performance

Indicators for you”“I have a dream”

“I think people have begun to forget how powerful human stories are, exchanging their sense of empathy for a fetishistic fascination with data, networks, patterns and total information. Really, the data is just part of the story. The human stuff is the main stuff, and the data should enrich it.”

Jonathan Harris

#IQTGOLD

inertiaurgency

anger apathy

solidarity isolation

you can make a difference

Self-doubt

hope fear

Ove

rcom

esAction motivatorsAction inhibitors

Using stories to connect and prompt action

“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.”

Rosabeth Moss Kanter

Tell a story Make it personal.

Be authentic.Create a sense of ‘us’ (and be clear

who ‘us’ is) Build in a call for urgent action.

Challenges and choices

• In the first sentence, make a connection with your audience.

• In the second sentence, give us the context of your story.

• In the third sentence, tell us about the challenge or crisis in your story.

• In the final sentence, provide closure to your story – tell us the outcome of your choices.

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton

Rolling with resistance

Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

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

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

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Make it a personal PERFORMANCE target.

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton

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

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton

“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.

—

Seeing with new eyes

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

Key tactic :Out-love everyone else

Source of image: Bradley Burgess

“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

• 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

• 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

“Stages of change” Smoking

I am not aware my smoking is a

problem – I have no intention to quit

Prochaska, DiClemente & Norcross (1992)

“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)

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)

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)

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)

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)

Prochaska, DiClemente & Norcross (1992)

“Stages of change” Transtheoretical model of behaviour change

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

• 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

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

• 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?

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

place

George Bernard Shaw

• 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?

• The biggest-ever digital campaign for EMAP (Health Service Journal and Nursing Times)

• 14,000 contributors to the joint campaign to “challenge top down change”

• Ground-breaking: the first-ever crowd-sourced theory of change in the NHS

14,000 contributions identified 10 barriers to change:

Confusing strategies

Over controlling leadership

Perverse incentivesStifling innovation

Poor workforce planning

One way communication

Inhibiting environment

Undervaluing staff

Poor project management

Playing it safe

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

14,000 contributions identified 11 building blocks for change:

Inspiring & supportive leadershipCollaborative working

Thought diversityAutonomy & trust

Smart use of resources

Flexibility & adaptability

Long term thinking

Nurturing our people

Fostering an open culture

A call to action

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

Challenging the status quo

If your horse dies, get off itCherokee proverb

Source of image: fenwickgallery.co.uk

‘‘

Five stages of grief Kubler Ross

Making change that sticks

of change fails

Dr Peter Fuda

70%

Extrinsic vs Intrinsic

#IQTGOLD

#IQTGOLD

#IQTGOLD

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

#IQTGOLD

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

Doing. Seeing. Being.

Doing. Seeing. Being.

• What has been some of the key learning from the School for Health and Care Radicals under each category?

• How is your own current balance between doing, seeing and being in your practice as a change agent?

• What might you want to do differently, or additionally in future?

Traditional conferenceThe agenda is pre-set

One way learning style with Questions & AnswersPeople sit in rows or round tables as prescribedNetworking between sessions

Hard to leave the session once it starts

Absorbing information

Unconference

People set the agenda

Based on discussion

People sit where they want

Networking the whole time

Encouraged to find the right session

Connecting to action

Source: adapted from @BCPSQC

The unconference: 4 principles

Principles:1. Whoever comes are the right people2. Whatever happens is the only thing that could

have happened.3. When it starts is the right time4. When it's over it's over

The Law of Two Feet:"If you find yourself in a situation where you are not contributing or learning, move somewhere where you can."

Our process

• Think about a topic that you would like to explore with other people based on what you have heard today

• It should be a topic that you want to take action on over the next twelve months

• Suggest your idea to the big group

The task

• Discuss your topic and identify key actions that should be taken

• Summarise your discussion on one sheet of flip chart

• On a separate sheet of A4 paper write one “big idea” for an action you can take within a week, a month and a year

Time available: 50 minutes

Topics

• Digital communities• Preventive health• Mental health in physical health• Macmillan change• Student funding• Leading change between community and

acute

Follow us on Twitter

@School4Radicals

@KateSlater2

@OllyBenson

@JoannaHemming

@DaniG4_

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