fab change day activists school (leeds)

Supporting large scale change in the NHS and the wider care system

Agenda

11am Coffee Break

12.30pm Lunch

2.45pm Coffee Break

4.30pm End of day

Agenda

Introduction to Fab Change Day

The future of Change

Change starts with me

From Me to We

Connecting with stories

Rolling with resistance

What are you going to do?

Housekeeping

Fire alarms and exits

Security

Toilet location

Slides Mobile technology Wifi

How we make a difference

The School has been 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

Twitter

#FabChangeDay

@FabChangeDay

Facebook group

facebook.com/

FabChangeDay

Join in on social media

@ollybenson

@kateslater2

@dementiaboy

@janedouthwaite

• Horizons is 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

Supporting Fab Change

Day

World’s largest

randomised coffee trial

The Edge

Edge Talks

Large Scale Spread

Hacks

Digital Activism and

broadcasting

People’s Transformathon

School for Health and

Care Radicals

Who’s in the room?

Previous involvement in Change Day

I have never previously

participated

I made a pledge and

completed my action.

I took part in an event

within my direct setting

e.g. office or ward.

I fully participated in

Change Day

Who’s in the room?

Have you previously attended the

School for Health and Care Radicals?

Yes

No

Who’s in the room?

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0.5

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1.5

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2.5

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3.5

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4.5

1 2 3 4 5 6 7 8 9 10

How confident do you feel about suggesting changes in

your own team/work-place/organisation?

Who’s in the room?

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1 2 3 4 5 6 7 8 9 10

How confident do you feel in

leading others through change?

Who’s in the room?

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1 2 3 4 5 6 7 8 9 10

Currently how well connected are you

to other change agents?

NHS Change Day 2013

• Aim of 65,000 pledges

• Achieved 189,000 pledges

• 25% of NHS organisations participated

• Social movement theory

• Distributed leadership

• Relational – people made commitments

• Collective action

Change Day 2014 & 2015

• Where pledges had been vital to NHS

Change Day in 2014, in 2015 the focus

moved to actions and campaigns.

• More than two thirds of Acute Trusts,

Clinical Commissioning Groups and

Mental Health Trusts were involved in NHS

Change Day 2015

Fab Change Day 2016

• Academy of Fabulous Stuff

• 34 days to go!

• App to capture actions

• Campaigns

• World’s largest RCT

How you can get involved

• Do something in your local organisation:

make it about what is important to you.

Visit fabchangeday.net for inspiration.

• Inspire and support others to do

something.

• If you are a manager, let permission

flourish.

How you can be supported

• Become a ‘hubbie’ – a support network of

likeminded people from across the

country.

• Weekly phone call, Wednesday at 6pm.

Dial in No: 0800 917 1950 User pin:

33136606#

• What’s App group. Message me on

+447920 845437 if you want to join.

Change begins with me

Photo credit: white_ribbons / flickr

“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

#

WHO makes change happen in health and care?

Source: adapted by Helen Bevan from Leandro Herrera

List A • The Transformation

Programme Board

• The programme sponsor

• The Programme Management Office

• The leads of the [insert number] transformation work streams

• The Clinical Director

• The Team Leader /Unit Manager

• The Change Facilitator

#

Who makes change happen in health & care?

Source: Sewell (2015) : Stop training our project managers to be process junkies

#

WHO makes change happen in health and care?

List A • The Transformation

Programme Board

• The programme sponsor

• The Programme Management Office

• The leads of the [insert number] transformation work streams

• The Clinical Director

• 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

#

WHO makes change happen in healthcare?

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

#

Change is changing

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

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

#

Change is changing

#

#

Change is changing

#

Change is changing

#

#

Change is changing

Change from the edge

#

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

#

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

#

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

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

People who are highly connected have twice as much power to

influence change as people with hierarchical power

Leandro Herrero

http://t.co/Du6zCbrDBC

#

What happens to

heretics/radicals/rebels/mavericks in

organisations?

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

#

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

If you put fences around people, you

get sheep. Give people the room

they need

William L McKnight

#

We need rebels!

Source : @PeterVan http://t.co/6CQtA4wUv1

•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

#

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

#

Source : Lois Kelly www.foghound.com

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

Rebel

#

Reflection

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

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

• How do we protect against this?

# Source : Lois Kelly www.rebelsatwork.com

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

Rebel

Coffee break.

See you at 11.30am

From Me to We

Photo credit: hmoong / flickr

Photo credit: Flickr / hugobernard

So how can we harness the

power of our shared humanity

to help us accomplish positive

change?

Photo credit: Flickr / mikemcsharry

“Communities are

characterized by three things:

common interests,

frequent interaction, and

identification.“

Wally Block

Photo credit: Flickr / geoffandsherry

“There is no power for change

greater than a community

discovering what it cares

about.”

Margaret Wheatley

Where are your communities?

Photo credit: Flickr / stjc

Learning from previous social

movements

How do organisations develop

activists?

Photo credit: Flickr / Angell Williams.

Photo credit: Flickr / memespring

Photo credit: Flickr / santanuvasant

“Great social movements get

their energy by growing a

distributed leadership”

Joe Simpson

Lunch.

See you at 1.15pm

Connecting with stories

Photo credit: bulke41 / flickr

“That’s so important that we’ll

put it in the staff newsletter”

“[My biggest mistake] was thinking that this job

was just about getting the policy right. And

that's important.

But the nature of this office is also to tell a story

to people that gives them a sense of unity and

purpose and optimism, especially during tough

times.”

“I have some Key

Performance Indicators

for you”

“I have a dream”

Using emotions to create change

inertia

apathy

fear

isolation

self-doubt

urgency

passion/anger

hope

solidarity

you can make a difference

Story of self

Photo credit: gonzale / flickr

Story of us

Photo credit: anti_mullet9 / flickr

Story of now

Photo credit: gonzale / flickr

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.

Pixar storytelling formula

Once upon a time there was ___.

Every day, ___.

One day ___.

Because of that, ___.

Because of that, ___.

Until finally ___.

@janedouthwaite

O

O

X

X

O

X

O

X

B O X

Who knows where it may lead …

Think outside of the

Rolling with resistance

Photo credit: alohateam / flickr

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

50 reasons not to change

“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

Think about when you were last told ‘no’

How did it make you feel?

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

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

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

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

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

Make it a personal

PERFORMANCE target.

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

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 5th to 12th

contact

Source: http://www.slideshare.net/bryandaly/go-for-no

“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,”

Reflect Seek better

evidence Sharpen

your idea

How people see your change initiative

“Resistant behaviour is a good

indicator of missing relevance” Harald Schirmer

‘Outlove’ those who resist your ideas Throw people off balance by not reacting

negatively to their resistance

Transtheoretical model of

behaviour change

Prochaska, DiClemente & Norcross (1992)

Where the model has been used

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

I am not aware my smoking is a problem – I have no intention

to quit

Prochaska, DiClemente & Norcross (1992)

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

Which stage do most change activities in health and

care focus on?

Which stage are most people actually at?

90% of the tools available for health and

care change agents are designed for the

“action” stage

Focussing on 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…

Example – WHO Surgical Safety Checklist

• Designed by one

organisation and

worked

fantastically.

• Dropped into

another

organisation –

didn’t work as well.

• Missed the ‘why’

So what do we tend to do

when people resist?

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: “blocker” “resister” or “laggard”

Blame “the management” for not enforcing change

“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 Change Challenge

• Ground-breaking: the first-ever crowd-

sourced theory of change in the NHS

• 14,000 contributors to the joint campaign

to “challenge top down change”

10 barriers to change

Confusing strategies

Over controlling

leadership

Perverse incentives Stifling 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

11 building blocks for change

Inspiring & supportive

leadership

Collaborative working

Thought diversity

Autonomy & trust

Smart use of resources

Flexibility &

adaptability

Long term thinking

Nurturing our

people

Fostering an open

culture

A call to action

Challenging the

status quo Source: Health Service Journal, Nursing Times, NHS

Improving Quality, “Change Challenge” March 2015

If your horse dies, get off it

Cherokee proverb

Source of image: fenwickgallery.co.uk

Coffee break.

See you at 3pm

Unconference session

Four principles and a law

Principles:

• Whoever comes are the right people

• Whatever happens is the only thing that could have

happened.

• When it starts is the right time

• 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."

Our process

• Think about a topic that you would like to

focus on for Fab Change Day and explore

with other people based on what you have

heard today

• Suggest your idea to the big group

Unconference: The task

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

• Summarise your discussion on the sheet of paper provided

• Write one “big idea” for an action you can take tomorrow, within a week and within a month