Slides for 19th July

1. #OUSR
19th July 2016
School for Radicals

2. #OUSR
WHO makes change happen in your organisation?
Source: adapted by Helen Bevan
from Leandro Herrera
List A
• The Transformation Programme
Board [or alternative title]
• The programme sponsor
• The Programme Management
Office
• The leads of the [insert number]
transformation work streams
• The Project Manager
• The Team Leader /Unit Manager
• The Change Facilitator

3. #OUSR
WHO makes change happen in your organisation?
List A
• The Transformation
Programme Board
• The programme sponsor
• The Programme Management
Office
• The leads of the [insert
number] transformation work
streams
• The Project Manager
• The Team Leader /Unit
Manager
• The Change Facilitator
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The contrarians, because they can
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected. Good or
bad, they spread behaviours, role
model at a scale, set mountains
on fire and multiply anything they
get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
ones Source: adapted by Helen Bevan
from Leandro Herrera

4. #OUSR
WHO makes change happen in your organisation?
List A
• The Transformation
Programme Board
• The programme sponsor
• The Programme Management
Office
• The leads of the [insert
number] transformation work
streams
• The Project Manager
• The Team Leader /Unit
Manager
• The Change Facilitator
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The contrarians, because they can
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected. Good or
bad, they spread behaviours, role
model at a scale, set mountains
on fire and multiply anything they
get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
ones Source: adapted by Helen Bevan
from Leandro Herrera

5. #OUSR
Nearly
10,000

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

7. #OUSR
How we make a difference
The School formally evaluated by
the Chartered Institute for Personnel
& Development
Statistically 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

8. #OUSR
The Horizons team
• A small team of people within the
NHS who support improvement
and change.
• We tune into and engage with the best change
thinking and practice in healthcare and other
industries around the world and seek to translate
this learning into practical approaches to change.
• The team has emerged through years of
supporting change in the NHS and wider health
and care system

9. #OUSR
Follow us on Twitter
@School4Radicals
@HelenBevan
@KateSlater2
@OllyBenson

10. #OUSR
Agenda
1. Being a health and care radical: change starts with
me
2. Building energy for change
3. Forming communities and connecting emotionally
with change
4. Change programmes versus change platforms
5. Rolling with resistance
6. An “unconference”

11. #OUSR

12. #OUSR

13. #OUSR
Everyone has gifts and strengths
What superpower do you have?

14. #OUSR
The genesis of the School
2002
2014
2013
2010 2012
2003
NHS Change Day
2013
“A school for
healthcare
radicals”
Applying
social movement
thinking to
healthcare
improvement
“The School for
Health and Care
Radicals”
Applying
community organising
principles to
healthcare
improvement
2016
“A one day school for
organisational
radicals”

15. #OUSR
The Five Year Forward View
Mentions
“radical”
12 times
“transformation/transformational”
13 times
“change”
42 times

16. #OUSR
The OU Student First paper
Contains the following words:
• Change = 20
• Innovate = 19
• Adapt = 10
• Radical = 0

17. #OUSR
“New truths begin as heresies”
(Huxley, defending Darwin’s theory of natural selection)
Source of image:
installation by the
artist Adam Katz
www.thisiscolossal.com
Via @NeilPerkin

18. #OUSR
Source: @NHSChangeDay

19. #OUSR
People who are highly connected
have twice as much power to
influence change as people with
hierarchical power
Leandro Herrero
http://t.co/Du6zCbrDBC

20. #OUSR
Change is changing

21. #OUSR
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

22. #OUSR
Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”

23. #OUSR
Change is changing

24. #OUSR

25. #OUSR

26. #OUSR
How does the NHS improvement community
prefer to communicate?

27. #OUSR
Change is changing

28. #OUSR

29. #OUSR
Change is changing

30. #OUSR

31. #OUSR

32. #OUSR
Change is changing
Change from the edge

33. #OUSR
http://www.slideshare.net/Openpolicymaking/policy-lab-slide-
share-introduction-final

34. #OUSR
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

35. #OUSR
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

36. #OUSR
The Network Secrets of Great Change Agents
Julie Battilana &Tiziana Casciaro
As a change agent, my centrality in the
informal network is more important
than my position in the formal
hierarchy

37. #OUSR
Is your change process a cathedral or a bazaar?
http://www.unterstein.net/su/docs/CathBaz.pdf

38. #OUSR
We have a lot of cathedrals
Source: Sewell (2015) : Stop training our project managers to be process junkies

39. #OUSR
“Tomorrow’s management systems
will need to value diversity, dissent
and divergence as highly as
conformance, consensus and
cohesion.”
Gary Hamel
Image by neilperkin.typepad.com
is the new normal!

40. #OUSR
“Tomorrow’s management systems
will need to value diversity, dissent
and divergence as highly as
conformance, consensus and
cohesion.”
Gary Hamel
Image by neilperkin.typepad.com
“The single biggest mistake to
avoid? Creating disruption at work.
Focus on developing relationships,
not disrupting and alienating
people. Peter Vander Awera on
learning from setbacks and failures
is the new normal!

41. #OUSR

42. #SHCR @HelenBevan
What happens to
heretics/radicals/rebels/mavericks
in organisations?

43. #SHCR @HelenBevan

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

45. #SHCR @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

46. #SHCR @HelenBevan
If you put fences around people, you
get sheep. Give people the room they
need
William L McKnight

47. #SHCR @HelenBevan
We need to create more boat rockers!
• Rock the boat but manage to
stay in it
• Walk the fine line between
difference and fit, inside and
outside
• Conform AND rebel
• Capable of working with
others to create success NOT
a destructive troublemaker
Source: Debra Meyerson

48. #SHCR @HelenBevan
Source : Lois Kelly www.foghound.com
There’s a big difference between a rebel and
a troublemaker
Rebel

49. #SHCR @HelenBevan
Reflection
• What are your insights around “rebels” and
“troublemakers”?
• What moves people from being “rebel” to
“troublemaker”?
• How do we protect against this?

50. #SHCR @HelenBevan
Source : Lois Kelly www.rebelsatwork.com
There’s a big difference between a
rebel and a troublemaker
Rebel

51. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan

52. #SHCR @HelenBevan
What is a
RCT?

53. #SHCR @HelenBevan
Randomized Coffee
Trial!

54. #SHCR @HelenBevan
Outcomes of randomised coffee trials

55. #SHCR @HelenBevan
Change starts with me
Source of image: jasonkeath.com

56. #SHCR @HelenBevan
"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

57. #SHCR @HelenBevan
‘I do not think you can really deal with
change without a person asking real
questions about who they are and how they
belong in the world’
David Whyte, The Heart Aroused 1994
Source of image: fistfuloftalent.com

58. #SHCR @HelenBevan
1. able to join forces with others to create action
2. able to achieve small wins which create a sense
of hope, possibility and confidence
3. More likely to view obstacles as challenges to
overcome
4. 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
me
BEGINS WITH

59. #SHCR @HelenBevan
Self-efficacy
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

60. #SHCR @HelenBevan
What’s the difference between
self efficacy
and
self esteem,
self belief,
self-confidence?

61. #SHCR @HelenBevan
Source: @NHSChangeDay

62. #SHCR @HelenBevan
Source: @NHSChangeDay
What is the issue here?
“permission” ?
(externally generated)
or
Self efficacy ?
(internally generated)

63. #SCHR @HelenBevan
Building self-efficacy: some tactics
1. Create change one small step at a time
2. Reframe your thinking:
• failed attempts are learning opportunities
• uncertainty becomes curiousity
3. Make change routine rather than an exceptional
activity
4. Get social support
5. Learn from the best

64. #SHCR @HelenBevan
1. strong sense of “self-efficacy”
 belief that I am personally able to create the change
2. able to join forces with others to create action
3. able to achieve small wins which create a sense
of hope, possibility and confidence
4. More likely to view obstacles as challenges to
overcome
Four things we know about successful
boat rockers
Source: adapted from Debra E Meyerson
CHANGE
me
BEGINS WITH

65. #SCHR @HelenBevanImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

66. #SCHR @HelenBevan

67. #SCHR @HelenBevan
C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

68. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

69. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

70. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

71. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

72. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal
PERFORMANCE target.

73. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

74. #SCHR @HelenBevan
Research from the sales industry:
How many NOs should we be seeking to get?
• 2% of sales are made on the first contact
• 3% of sales are made on the second contact
• 5% of sales are made on the third contact
• 10% of sales are made on the fourth contact
• 80% of sales are made on the fifth to twelfth
contact
Source: http://www.slideshare.net/bryandaly/go-for-no

75. #SCHR @HelenBevan
“Papers that are more likely to contend against
the status quo are more likely to find an
opponent in the review system—and thus be
rejected —but those papers are also more
likely to have an impact on people across the
system, earning them more citations when
finally published”
V. Calcagno et al., “Flows of research manuscripts among
scientific journals reveal hidden submission patterns,”
Science, doi:10.1126/science.1227833, 2012.
—

76. #SHCR @HelenBevan
Being a great change agent is about knowing, doing,
living and being improvement

77. #SHCR @HelenBevan
Avedis Donabedian
“Ultimately, the secret of
quality is love.
…… If you have love, you
can then work backward
to monitor and improve
the system”.

78. #SHCR @HelenBevan
Key tactic :
Out-love everyone else
Source of image: Bradley Burgess

79. #SHCR @HelenBevan
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?

80. #SHCR @HelenBevan
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/energ
y_for_change/energy_for_change_.html
We need to focus on a different kind of
energy for change

81. #SHCR @HelenBevan
Psychological
Physical
Spiritual
Social Intellectual
Energy for change

82. #SHCR @HelenBevan
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”

83. #SHCR @HelenBevan
Spiritual energy
Energy of commitment to a common
vision for the future, driven by shared
values and a higher purpose
Gives people the confidence to move towards a
different future that is more compelling than
the status quo

84. #SHCR @HelenBevan
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

85. #SHCR @HelenBevan
Physical energy
Energy of action, getting things done and
making progress
The flexible, responsive drive to make things
happen

86. #SHCR @HelenBevan
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

87. #SHCR @HelenBevan
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

88. #SHCR @HelenBevan
Some questions
• Which group likely to have
higher spiritual energy
scores (clinicians/non
clinicians?)
• Nearer to CEO, higher or
lower energy scores?

89. #SHCR @HelenBevan
• 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 profile
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual

90. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual
Team 1: what’s your assessment of
their energy for change?

91. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual
Team 2: what’s your assessment of
their energy for change?

92. #SHCR @HelenBevan
There has never been a time in the history of health
and care 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

93. #SHCR @HelenBevan
The power of the platform
“Facebook, YouTube, Twitter and their lesser cousins have
proved the power of the platform. They have shown that if
your average 21st century citizen is given the tools to
connect and the freedom to create, they will do so with
enthusiasm, and often with an originality that blindsides
the so-called creative industries. …..
Good leadership is no longer about ‘taking charge’ or
imposing a strategic vision but about creating the
platforms that allow others to flourish and create”
Ashoka
http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in-
the-21st-century

94. #SHCR @HelenBevan
• systematic “change
management”
• too often, leaders
prescribe outcome
and method of change
in a top-down way
• change is experienced
by people at the front
line as “have to”
(imposed) rather than
“want to” (embraced)
Change
Programmes
• everyone (including
service users and families)
can help tackle the most
challenging issues
• value diversity of thought
• connect people, ideas and
learning
• Role of formal leaders is to
create the conditions and
get out of the way
Change
Platforms
“Tear down the walls”

95. #SHCR @HelenBevan
Why platforms?
Platforms today power learning and innovation
at the speed of change by providing
collaborative and sometimes exponentially
productive spaces for people to create value
John Hagel
Source of image: Pinipa

96. #SHCR @HelenBevan
Evolving kinds of change platforms:
They overlap!
1. Connecting platforms
2. Mobilising platforms
3. Learning platforms
4. Knowledge platforms
5. Crowdsourcing platforms

97. #SHCR @HelenBevan
Example platforms
Source of image: @JenniferClemo

98. #SHCR @HelenBevan
What are the features of your ideal change platform?
Resource bank
Library
Crowdsourcing
Social media feed
Blog
CURATION
- Resource bank
- Library
- Best practice
- News feeds
- Guidelines and policy
- Webinars
- FAQs
COMMUNITY
- Social media feed
- Blogs - Vlogs
- Personal profiles
- Forums
- Chat function
- Communities of Practice
- Topic of the month
- Stories
COMMUNICATION
- Bulletins
- Press releases
- Notice board
- Diary / calendar
- Document share
- Project Management
CREATION
- Crowdsourcing
- Challenges
- Innovation
- Prizes / funds
Collaboration

99. #SHCR @HelenBevan
http://biggerboat.org/exploring-moodocs/
MOODOCs
(Massive, Online, Open, Disease Oriented Communities)

100. #SHCR @HelenBevan
The Academy of Fabulous Stuff
• Half a million page views
• Over 700 fab shares
• 1,500 to 4,000 page views
a day
• Nottingham Safe staffing
app: 2,500 views
• Dovetailing vaccinations
Scheme: 160 direct queries

101. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
https://youtu.be/eUApgJBZU8M

102. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
Source: OpenIdeo https://challenges.openideo.com/challenge/end-of-life/refinement

103. #SHCR @HelenBevan

104. #SHCR @HelenBevan
Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

105. #SHCR @HelenBevan
Nearly
100,000
connections
(defined as a viewing, a
download of material or
an original tweet)
• Latest no-cost
solutions
• 150 speakers
• 28 topics
• Live broadcast and
on-demand

106. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan

107. #SHCR @HelenBevan
Should we undertake routine radiology
investigations overnight for all our inpatients?
How to build a
change
platform in an
hour

108. #SHCR @HelenBevan
• Platform established and presented to global audience in
less than three days
• 60 minute sprint followed by a two week window for
further ideas and discussion
• 3,000+ connections
• good level of support for a 24/7 service for inpatients
• consensus that the decision to receive a scan during
unsocial hours was patient led
• yet many participants commented that it should be a
joint decision between clinician and patient
• Panel at Nottingham University Hospitals is reviewing
findings, ideas and agreeing next steps for
implementation
elp create a change platform in an hourRather than a consultation exercise that can take weeks,
we set up a crowdsourcing platform to get an answer in
an hour

109. #SHCR @HelenBevan
The Change Challenge
Tapping the collective brilliance
of the NHS

110. #SHCR @HelenBevan
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

111. #SHCR @HelenBevan
14,000 contributions identified
11 building blocks for change:
Inspiring & supportive
leadership
Collaborative 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

112. #SHCR @HelenBevan
Project Aristotle: http://qz.com/625870/after-years-of-intensive-
analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/
After years of intensive analysis, Google
discovers that the key to high performing,
innovative teams is psychological safety

113. #SHCR @HelenBevan
Some lessons
1. You can’t control the outputs of the crowd
2. People want a relationship
3. Always, always, follow up

114. #SHCR @HelenBevan
The Natural Environment Research Council asked the
crowd to name its new £200 million polar research vessel

115. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
TEN
TIMES as
many
votes as
the next
most
popular
answer

116. #SHCR @HelenBevan

117. #SHCR @HelenBevan
”If people give to a cause,
they expect a relationship,
not a transaction”
Nilofer Merchant
Once you start down this path, you
have to follow up and continue

118. #SHCR @HelenBevanSource of image: outskirtsbattledome.wikispaces.com
The easiest way to thrive as an
outlier
...is to avoid being one
Seth Goodin

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

120. #SHCR @HelenBevan
Power in community
“Power used to come largely through and from big
institutions.
Today power can and does come from connected individuals
in community.
When community invests in an idea, it co-owns its success.
Source of image: orton.org
Instead of trying to
achieve scale all by
ourselves, we have a new
way to have scale. Scale
can be in, with and
through community.”
Nilofer Merchant

121. #SHCR @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
‘

122. #SHCR @HelenBevan
“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

123. #SHCR @HelenBevan
Learning from social movement leaders
http://www.slideshare.net/NHSIQ/the-power-of-one-the-power-of-
many?qid=97bb3464-07c2-4883-9531-c3d436a66aa1&v=qf1&b=&from_search=2

124. #SHCR @HelenBevan

125. #SHCR @HelenBevan
Calls to Action

126. #SHCR @HelenBevan
Leadership is….
…the art of mobilising others
to want to struggle for shared
aspirations
Jim Kouzes
Source of image: environmentvictoria.org.au

127. #SHCR @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)

128. #SHCR @HelenBevan
What’s the
financial incentive?
Who is
performance
managing?
What’s the
project plan?
Source: @RobertVarnam

129. #SHCR @HelenBevan
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

130. #SHCR @HelenBevan
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 between
how we
communicate
change
how people
engage with that
communication

131. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
“I have some Key
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam

132. #SHCR @HelenBevan
If we want people to take action, we have to
connect with their emotions through values
action
values
emotion
Source: Marshall Ganz

133. #SHCR @HelenBevan

134. #SHCR @HelenBevan

135. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
But not all emotions are equal.........
inertiaurgency
anger apathy
solidarity isolation
you can make a
difference
Self-doubt
hope fear
Overcomes
Action motivators Action inhibitors
Source: Marshall Ganz

136. #SHCR @HelenBevan
‘‘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

137. #SHCR @HelenBevan
Effective framing:
what do we need to do?
1. Tell a story
Source of image: woccdoc.org

138. #SHCR @HelenBevan
http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-
crafting-visual-stories-with-data?sf3881865=1

139. #SHCR @HelenBevan
Effective framing:
what do we need to do?
1. Tell a story
2. Make it personal
Source of image: woccdoc.org

140. #SHCR @HelenBevan
Effective framing:
what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
Source of image: woccdoc.org

141. #SHCR @HelenBevan
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)
Source of image: woccdoc.org

142. #SHCR @HelenBevan
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
Source of image: woccdoc.org

143. #SHCR @HelenBevan
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
Source of image: woccdoc.org

144. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
Vivid details
Source: Marshall Ganz

145. #SHCR @HelenBevan
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

146. #SHCR @HelenBevan
Harvard researchers put a gorilla image on this
lung scan

147. #SHCR @HelenBevan
Harvard researchers put a gorilla image on this
lung scan

148. #SHCR @HelenBevan
What proportion of the radiologists who
reviewed this scan actually saw the gorilla?
90%
25% 17%
80%
9%
60%

149. #SHCR @HelenBevan
Question: what’s the most reliable way to
predict the future effectiveness of a team?
Source:
http://www.fastcompany.com/3049524/know-it-all/the-
science-behind-team-intelligence

150. #SHCR @HelenBevan
How do we create a sense of
“us” to build momentum for
change?
Source of image: www.tannerfriedman.com

151. #SHCR @HelenBevan
Moving beyond us and them
to us and us
Source of image: www.delta7.com

152. #SHCR @HelenBevan
The Network Secrets of Great Change Agents
Julie 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

153. #SHCR @HelenBevan
strong ties (cohesive)
v.
weak ties (disconnected)
Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml

154. #SHCR @HelenBevan
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

155. #SHCR @HelenBevan
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

156. #SHCR @HelenBevan
The pros and cons of strong ties
Pros Cons

157. #SHCR @HelenBevan
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

158. #SHCR @HelenBevan
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

159. #SHCR @HelenBevan
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

160. #SHCR @HelenBevan
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

161. #SHCR @HelenBevan
Sources of weak ties

162. #SHCR @HelenBevan
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 Snow
Source of image: www.ecommercedefense.com

163. #SHCR @HelenBevan
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

164. #SHCR @HelenBevan

165. #SHCR @HelenBevan
165
http://weneedsocial.com/blog/2013/8/25/disr
upted-disruptors-unite

166. #SHCR @HelenBevan
Source of image: http://switchandshift.com/transactional-or-
transformational-which-leadership-style-is-best

167. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
“You don’t need an engine when you have
wind in your sails”

168. #SHCR @HelenBevan
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?

169. #SHCR @HelenBevan
Employee resistance is the
most common reason
executives cite for the
failure of big
organizational-change
efforts
Scott Keller and Colin Price
(2011), Beyond Performance: How
Great Organizations Build Ultimate
Competitive Advantage
Source of image:
Businessconjunctions.com

170. #SHCR @HelenBevan
“
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
“

171. #SHCR @HelenBevan
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

172. #SHCR @HelenBevan
Resistant behaviour is a good
indicator of missing relevance
Harald Schirmer
http://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
‘‘

173. #SHCR @HelenBevan
Cultural change
is a million
subversive acts
of resistance
Brene Brown
Source of image: zazzle.com
‘‘

174. #SHCR @HelenBevan
“Stages of change”
Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)

175. #SHCR @HelenBevan
• 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

176. #SHCR @HelenBevan
• 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

177. #SHCR @HelenBevan
“Stages of change”
Smoking
I am not aware my
smoking is a
problem – I have no
intention to quit
Prochaska, DiClemente & Norcross (1992)

178. #SHCR @HelenBevan
“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)

179. #SHCR @HelenBevan
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)

180. #SHCR @HelenBevan
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)

181. #SHCR @HelenBevan
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)

182. #SHCR @HelenBevan
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)

183. #SHCR @HelenBevan
Prochaska, DiClemente & Norcross (1992)
“Stages of change”
Transtheoretical model of behaviour change

184. #SHCR @HelenBevan
• Which stage do most change activities in
health and care focus on?
• Which stage are most people actually at?
Some questions

185. #SHCR @HelenBevan
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

186. #SHCR @HelenBevan
• 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

187. #SHCR @HelenBevan
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

188. #SHCR @HelenBevan
• 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?

189. #SHCR @HelenBevan
The single biggest problem
in communication is the
illusion that it has taken
place
George Bernard Shaw
‘‘

190. #SHCR @HelenBevan
• 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?

191. #SHCR @HelenBevan
• 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
• 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

192. #SHCR @HelenBevan
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

193. #SHCR @HelenBevan
If your horse dies,
get off it
Cherokee proverb
Source of image: fenwickgallery.co.uk
‘‘

194. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan

195. #SHCR @HelenBevan
Traditional event
The agenda is pre-set
One way learning style
with Q&A
People sit in rows or round
tables
Networking between
sessions
Hard to leave the session
once it starts
Absorbing information
Unconference
People set the agenda
Based on discussion
People sit in a circle
Networking the whole
time
Encouraged to find the
right session
Connecting to action
Source: adapted from @BCPSQC

196. #SHCR @HelenBevan
The unconference:
4 principles and a law
Principles:
1. Whoever comes are the right people
2. Whatever happens is the only thing that could
have happened.
3. When it starts is the right time
4. When it's over it's over
The Law is known as the Law of Two Feet:
"If you find yourself in a situation where you are not
contributing or learning, move somewhere where
you can."

197. #SHCR @HelenBevan
Our unconference process
• Having heard all the content so far, think
about a topic that you would like to explore
with other people
• It should be a topic that you want to take
action on over the next twelve months
• Raise your hand and we will bring you a sheet

198. #SHCR @HelenBevan
Four keys to collaboration
• Lean into discomfort
• Listen as an ally
• State your intent
• Share your “street corner”
Source: Judith Katz and Fred Miller

199. #SHCR @HelenBevan
What’s our approach to change?
Deficit based
• what is wrong?
• solve problems
• identify what we
need to improve
• fill gaps and
deficiencies
Strength based
• what is strong?
• work with our
existing assets and
resources
• amplify what works
• “positive deviants”

200. #SHCR @HelenBevan
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