organisational radicals

@helenbevan #Quality2013 #Qradicals#Quality2013 #Quality5

M12A half day school for

organisational radicals

Helen BevanDelivery Team

NHS Improving Quality

@HelenBevan #Quality2013 #Quality5


A half day school for organisational radicals Big change only happens in healthcare organisations because of heretics and radicals; the passionate people who are willing to take responsibility for change, who support their organisation in its patient-centred mission but also challenge the status quo. It's tough being an organisational radical so we invite you to spend an inspiring half day with people of like minds. We will explore how we can apply the thinking and practice of other radical leaders to achieve a "revolution in healthcare quality" in our own organisations

Session Objectives• Learn the survival and success tactics of other organisational radicals and

increase your effectiveness as a leader of change• Build a toolkit of alternative/additional approaches to supporting change• Ignite a movement of organisational radicals in your own organisation


We are a learning community!

• We want to work together this afternoon with a philosophy of “all teach, all learn”

• We will use the Twitter hashtags #Quality2013 and #Quality5


Film: Apple commercial on rebels


You have come to this minicourse today as an “organisational radical”

Draw a quick picture of what this means to you (5 minutes)

Introduce yourself to other people at your table by sharing your pictures (10 minutes for everyone to share)

15 minute total

We will revisit the pictures at the end of the minicourse


What happens to heretics/radicals/rebels/mavericks

in organisations?


Are you a boat rocker?• One who challenges the status

quo when they see that there could be a better way

• Energise their organisation by working from their true self

• Capable of working with others to create success NOT a destructive troublemaker

• Walk the fine line between difference and fit, inside and outside, rock the boat but manage to stay in it

@helenbevan #Quality2013 #Qradicals

“Bad” Rebels/Radicals “Good” Rebels/RadicalsBreak rules Change rulesComplain CreateAssertions Questions

Me-focused Mission-focusedAnger Passion

Pessimist OptimistEnergy-sapping Energy-generating

Alienate AttractProblems Possibilities

Vocalize problems Socialize opportunitiesWorry that......... Wonder if...........

Point fingers Pinpoint causesDoubt Believe

Social loner Social

Source : Lois Kelly www.foghound.com

http://www.foghound.com/


Task

• Talk to others at your table about your experiences around “good” and “bad” rebels/radicals

• Which have you been and why?• What moves people from being “good” to

“bad”?• How do we protect against this?


First they ignore you, then they laugh at you, then they fight you, then you win

Gandhi


Valuing radicals

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

• big things only happen in organisations because of heretics and radicals


The contrarians and rebels, the people on the fringes of organizations who question and

deviate from the status quo, which so often leads to inertia and inflexibility, are huge

assets for any organizationTim Leberecht


Radicals provide to significant help to organisations

Source: Foghorn survey http://www.slideshare.net/Foghound/corporate-rebel-ebook#btnNext

http://www.slideshare.net/Foghound/corporate-rebel-ebook#btnNext


The 90/30 conundrum

90% senior leaders say to improve a corporate culture involve radicals/

rebels in finding ways to improve

90% senior leaders say to create more innovation, activate the radicals/rebels

37% senior leaders very satisfied that radicals/rebels can

provide this value in their organisations


90%90%

37%


@helenbevan #Quality2013 #Qradicals#Quality2013 #Quality5 Source: Foghound


Four tactics for organisational radicals

1. Start with myself2. Build alliances3. Work out what might help others to change4. Don't be a martyr


“There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who profit by the new”

Niccolo Machiavelli 15th century


“Great spirits have always encountered violent opposition from mediocre minds. The mediocre mind is incapable of understanding the man who refuses to bow blindly to conventional prejudices and chooses instead to express his opinions courageously and honestly.”

Albert Einstein


"There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley


‘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)


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



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

@helenbevan #Quality2013 #Qradicals#Quality2013 #Quality5 Source: Foghound



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


1. convictions and values – driven2. strong sense of “self-efficacy”

belief that I am personally able to create change belief in others

3. action orientated ignite collective action mobilising others, inspiring change

4. able to join forces with others work as a collective body for commonly valued changes

5. able to achieve small wins which create a sense of hope, self-efficacy and confidence

6. optimistic in the face of challenge see opportunities take account of obstacles

What do we know about successful boat rockers?


What is the “Stockdale Paradox”?


Advice for senior leaders on how to encourage the true mavericks who can help you:

• give them a long tether – they need space to soar• put them in charge of something they can really own• listen to their ideas and give them time to grow• let them work on their own it they wish• leave them alone and give them time to blossom

Source: Hanz Finzel


How to stifle the mavericks in your midst:

• create as many layers of management as possible for decision-making

• keep looking over their shoulder• make your policy manual as thick as possible• send everything to committees for deliberation• make them wait

Source: Hanz Finzel


Three assumptions for organisational radicals

1. Assume that everyone has a noble intention2. Motivation and behaviour in a change

process are due to interpersonal interaction (not just innate character trait)

3. My role as a change agent is about alignment, not judgement


Tactics for change agents

1. Start with myself2. Build alliances3. Work out what might help others to change4. Don't be a martyr


The easiest way to thrive as an outlier...is to avoid being one

Seth Goodin


“if you want to go fast, go alone. If you want to go far, go together”African proverb quoted by Al Gore


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)


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

action

values

emotion

Source: Marshall Ganz


What do we need to do?1. Tell a story


What do we need to do?1. Tell a story2. Make it personal


What do we need to do?1. Tell a story2. Make it personal3. Be authentic


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)


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


Film: James Croft’s Public Narrative


Watch James Croft

• How does he make his talk authentic?• How does he use detail?• How does he create a sense of “us” (and who

is part of his “us”)?• How does he build in a call for urgent action?


Tactics for change agents

1. Start with myself

2. Build alliances3. Work out what might help others to

change4. Don't be a martyr


Three assumptions for organisational radicals

1. Assume that everyone has a noble intention2. Motivation and behaviour in a change

process are due to interpersonal interaction (not just innate character trait)

3. My role as a change agent is about alignment, not judgement


“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)


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


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!


“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

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” Transtheoretical model of behaviour change



90% of the tools available for healthcare change agents are designed for the “action” stage

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


Example - Surgical Checklist

• 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


Case study: Call to action for shared decision making for

people with end stage kidney disease


The Case For Change

50, 000 people living with end stage renal failure in England61% of people on dialysis regretted their decision


People with end stage kidney disease

• around half are treated with a kidney transplant • around 4 out of 10 are treated with

haemodialysis • around 1 out of 10 are treated with peritoneal

dialysis• conservative treatment is another alternative

Source NHS Choices


Film: call to action for people with end stage kidney disease


Our call to action

• We set things up as though our clinical community was at stage 4 – ACTION

• Reality was that most people were at stage 1 or 2

• We made huge assumptions in respect of commitment and motivation – and read signals in the way that we wanted to read them


“One key issue is that many doctors already feel that they are delivering patient centred care – unfortunately that is not what patients report.”Dr Nigel Mathers, Vice Chair, Royal College of General Practice


So what do we TEND to do?• 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 leadership for not enforcing change• Overestimate the motivation of those who say

they’re ready to change and underestimate the motivation of those who indicate no interest in change (Lundberg)


So what SHOULD we do

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

• Build meaning and conviction in the change• Roll with resistance (Singh)

• Don’t argue against it• Encourage elaboration of resistance

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

• Build shared purpose


TaskYou are acting as a change agent for an initiative that is about shared decision making.How would you know which stage people are at?What actions would you take to support them with change?

Patients Clinicians

Precontemplation

Contemplation

Preparation

Action

Maintenance


What did we learn?

• The need to listen to and understand all our stakeholders – not misunderstand signs in the first stages of change

• The need to build strong foundations of commitment – and work out whether commitment was compliance

• Take time to really build the shared purpose with the whole community

• Use resistance as an opportunity to understand and build commitment


Outwitted

He drew a circle that shut me out -Heretic, rebel, a thing to flout.But Love and I had the wit to win:We drew a circle that took him in.

Edward Markham


Discussion

What might you do to:• enhance your own role as an

organisational/system maverick, radical or heretic?

• Support other mavericks, radicals or rebels in your organisation or system?


Are you ready to do what hasn’t been done before?

Corporate Rebels Unitedhttp://www.corporaterebelsunited.com

http://corporaterebelsunited.us6.list-manage.com/track/click?u=36db43b6540e4eb791f989cab&id=756611af73&e=9f2608f0bf

http://corporaterebelsunited.us6.list-manage.com/track/click?u=36db43b6540e4eb791f989cab&id=756611af73&e=9f2608f0bf


Corporate Rebels UnitedWe are architects and scouts into the future, and we want to guide

our organisations in navigating a safe path from now to then:Relentlessly

Challenging the status quoChanging the rulesSaying the unsaid

Spreading the innovation virusSeeding tribal energy

With no fearWith a cause to do good

Leading by being from our true selvesGoing after the un-named quality

Relentlessly


We have a choice

“This is the true joy of life, the being used up for a purpose recognised by yourself as a mighty one,

being a force of nature instead of a feverish, selfish little clot of ailments and grievances, complaining that the world will not devote itself to making you

happy”

George Bernard Shaw

organisational radicals

Health & Medicine