the school for health and care radicals victoria

#SCHR @HelenBevan @FreerMary

A one day


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

community of change agents


100,000

2,000

20,000

65

348

25,000+

120 14,000

inc


The school is being formally evaluated by the Chartered Institute for Personnel and Development


http://www.slideshare.net/Downes/connectivism-and-personal-learning?next_slideshow=1





The Fundamental Law of Conventional Conferences

The sum of the expertise of the

people in the audience is greater

than the sum of expertise of the people on stage

Dave Winer

““

Source of image: www.citynet.com

http://www.citynet.com/


Joining in today and beyond• Please tweet using the hashtag #SHCR and the handle

@School4Radicals• Alumni from the School for Health and Care Radicals will

also be joining in• We will produce summaries of the content and

discussions today • Join our Facebook group School for Health and Care

Radicals


Everyone has gifts and strengthsWhat superpower do you have?


Source: @NHSChangeDay


People who are highly connected have twice as much power to

influence change as people with hierarchical power

Leandro Herrerohttp://t.co/Du6zCbrDBC

http://t.co/Du6zCbrDBC


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

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

Via @NeilPerkin

http://www.thisiscolossal.com/


Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always


So why do we keep reinventing the past and calling it the future?

Image used under Creative Commons licence: Kicki


Tomorrow belongs to those who can hear it coming

David Bowie

“ “


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

http://www.innovationexcellence.com/blog/2015/07/09/13th-annual-change-management-conference-highlights/?utm_source=hs_email&utm_medium=email&utm_content=20535245&_hsenc=p2ANqtz--W0963q5vEUgL7ecueQKfQ5nK0QPbROyo7BwHs10orC8Mhs-KVEWZbwEyxXf1c8rSQahhkhUXAPaEFtqlTzK5nEygUTw&_hsmi=20535245





DIGITALCONNECTION

SEISMIC SHIFTS


Work complexity

SEISMIC SHIFTS

DIGITALCONNECTION


DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity


Research by IBM

200841% of leaders considered they were successful in managing change

201420% of leaders considered they were successful in managing change

Source: Jorgensen, Bruel & Franke, Making change work….while the work keeps changing” quoted in Foster F (2015) “Using crowdsourcing to deliver transformational change


DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity

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


What does that mean?• One foot in the system and one foot beyond • Pulling in assets, ideas, knowledge and

connections rather than pushing them down• Working at the edge of the existing system so

we can see the potential and make connections that we couldn’t do if we were at the centre

• Prepare the existing culture by embracing pathfinders from the new culture

• Conform and rebel


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

https://www.youtube.com/watch?v=j-S03JfgHEA



The battle and balancing between the old and new power will be a defining feature

of society and business in the coming yearsJeremy Heimans and Henry Timms

Understanding new power, Harvard Business Review, December 2014 https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet

https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet




The battle and balancing between the old and new power will be a defining feature

of society and business in the coming yearsJeremy Heimans and Henry Timms

Understanding new power, Harvard Business Review, December 2014 https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet

The battle and balancing between old and new power will also be the defining feature of the

health and care system in the coming years




#SCHR @HelenBevan @FreerMary Source: Gary Hamel

#SCHR @HelenBevan @FreerMary Source:@Alfacarlo


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


From “have to” to “want to”

Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community


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

‘

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




The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

As a change agent, my centrality in the informal network is more

important than my position in the formal hierarchy


is the new normal!

“Tomorrow’s management systems will need to value

diversity, dissent and divergence as highly as conformance, consensus and cohesion.”

Gary Hamel

Image by neilperkin.typepad.com


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

http://t.co/6CQtA4wUv1


What happens to heretics/radicals/rebels/mavericks

in organisations?

#SCHR @HelenBevan @FreerMary#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out


We need to be boatrockers!

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

• Able to challenge the status quo when we see that there could be a better way

• Conform AND rebel• Capable of working with others

to create success NOT a destructive troublemaker

Source: Debra Meyerson


What are the risks for a boat rocker?

1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice we surrender a part of ourselves, and silence

our commitment, in order to survive2. leave the organisation

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

3. stridently challenge the status quo in a manner which is increasingly radical and self-defeating this just confirms what we already know – that

we don’t belong Source: adapted from Debra E Meyerson

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

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

Rebel

http://www.foghound.com/


Reflection

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

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

• How do we protect against this?


Peter Fuda’s Transformational Change Agent framework

Skills and methods for creating change

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

Personal characteristics and qualities


Peter Fuda’s Transformational Change Agent framework: my perspective

“Doing”• Where most change agents

in health and care put most of their effort and emphasis

• What others typically judge us on

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

• What most change and improvement courses focus on


Peter Fuda’s Transformational Change Agent framework: my perspective

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

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

• Change begins with me• Hopeful futures, creative

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

my higher purpose


“Being” as a change agent

Personal characteristics and qualities


Change starts with me

Source of image: jasonkeath.com

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

"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


‘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


1. able to join forces with others to create action2. able to achieve small wins which create a sense

of hope, possibility and confidence3. More likely to view obstacles as challenges to

overcome4. strong sense of “self-efficacy”

belief that I am personally able to create the change

Four things we know about successful boat rockers

Source: adapted from Debra E Meyerson

CHANGE

me

BEGINS WITH


Self-efficacy

“If you think you can or think you

can't, you are right.”

Henry Ford

“The ability to act is tied to a belief that it is possible to do so”

Albert Bandura

There is a positive, significant relationship between the self-efficacy beliefs of a

change agent and her/his ability to facilitate change

and get good outcomes

Source of image:www.h3daily.com


What’s the difference between

self efficacyand

self esteem,self belief,

self-confidence?



What is the issue here?“permission” ?

(externally generated)or

Self efficacy ? (internally generated)

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

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

• failed attempts are learning opportunities• uncertainty becomes curiousity

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


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


Avedis Donabedian

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


Key tactic :Out-love everyone else

Source of image: Bradley Burgess


What is a

RCT?


Randomized Coffee Trial!


Outcomes of randomised coffee trials


Two kinds of people at work

• Feel connected to a higher purpose

• Controlled & coordinated through shared goals & values

• Collaborate• Embrace change• Work to who they are

The contributors The compliant

• Feel disconnected from purpose

• Controlled & coordinated through performance management & standardised procedures

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

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

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

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


Two kinds of people at work

• Feel connected to a higher purpose

• Controlled & coordinated through shared goals & values

• Collaborate• Embrace change• Work to who they are

The contributors The compliant

• Feel disconnected from purpose

• Controlled & coordinated through performance management & standardised procedures

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

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

engaged (contributors)• Contributors create six times the

value to an organisation compared to the compliant

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





Persistent application of power and authority drains energy

from those in its wakeDan Rockwell


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?


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



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

The easiest way to thrive as an outlier

...is to avoid being oneSeth Goodin

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

http://linkis.com/www.oscarberg.net/20/QwGqW

http://linkis.com/www.oscarberg.net/20/QwGqW


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


“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


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





Calls to Action


Leadership is….

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

aspirationsJim Kouzes

Source of image: environmentvictoria.org.au


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)


What’s the financial incentive?

Who is performance managing?

What’s the project plan?

Source: @RobertVarnam


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


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

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

Four gaps betweenhow we

communicate change

how people engage with that communication

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



#SCHR @HelenBevan @FreerMary#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton

“I have some Key Performance

Indicators

for you”

or

“I have a dream”

Source: @RobertVarnam


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

action

values

emotion

Source: Marshall Ganz


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

inertiaurgency

anger apathy

solidarity isolation

you can make a difference

Self-doubt

hope fear

Ove

rco

mes

Action motivatorsAction inhibitors



‘‘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

http://www.linkedin.com/company/activate-brand-agency


Effective framing: what do we need to do?

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

is)5. Build in a call for urgent action

Source of image: woccdoc.org


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





Vivid details



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


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

Source of image: www.tannerfriedman.com

http://www.tannerfriedman.com/


Moving beyond us and them to us and us

Source of image: www.delta7.com

http://www.delta7.com/


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

http://www.forbes.com/fdc/welcome_mjx.shtml

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


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


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

https://www.youtube.com/watch?v=w7AzRVxhEXA#t=45






• 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




• 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


Sources of weak ties


Three components of a great narrative• Diagnostic – what is the problem that

we are addressing? What is the extent of the problem? What is the specific source or sources?

• Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan?

• Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of our audience?

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

http://www.ecommercedefense.com/


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

#SCHR @HelenBevan @FreerMary112

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


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

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

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


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


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?


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


“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

“


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


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

‘‘

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




Cultural change is a million

subversive acts of resistance

Brene Brown

Source of image: zazzle.com

‘‘

#SCHR @HelenBevan @FreerMary#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/


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

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

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



Make it a personal PERFORMANCE target.



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

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

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,” Science, doi:10.1126/science.1227833, 2012.

—


“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


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)


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

• Which stage are most people actually at?

Some questions


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

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

Example from the worksheet

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

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


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


If your horse dies, get off itCherokee proverb

Source of image: fenwickgallery.co.uk

‘‘


Intrinsic motivationPeople engage in the activity for the pleasure and satisfaction of doing it

Invokes many positive behaviours

Extrinsic motivationPeople engage in the activity for the rewards or avoiding punishmentAny external influence is referred to as extrinsic motivation

Images: pixgood.com


The power of extrinsic drivers


Three types of levers for large scale change

‘Prod mechanisms’ targets

performance management

price & payment incentives regulation

competition

‘Proactive support’

relies on building ‘intrinsic motivation’ in

staff to make the right changes to

improve

‘People focused’ education and training

national contractsprofessional regulation

Clinical quality

Type one:

Type two: Type three:

Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015

Less than 10%of the

potential for improvement

at system level can be

delivered through type one change

http://www.health.org.uk/publications/constructive-comfort-accelerating-change-in-the-nhs/




Emotion is the fuel for change; data and information provide direction

Dan Heath (author of Switch)


Research shows that more than almost any other factor affecting an

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

destruction of its very core

Source: Bruch and Vogel


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


Energy for change

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

achieve its goals

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





Psychological

Physical

Spiritual

Social Intellectual

Energy for change


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”


Spiritual energy

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

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

different future that is more compelling than the status quo


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


Physical energy

Energy of action, getting things done and making progress

The flexible, responsive drive to make things happen


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


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


Some questions

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

• Nearer to CEO, higher or lower energy scores?


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

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

Energy for change profileSocial

Spiritual

PsychologicalPhysical

Intellectual

1

2

3

4

5


Social

Spiritual


Intellectual

1

2

3

4

5

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


Social

Spiritual


Intellectual

1

2

3

4

5

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


Where is your team?

Social

Spiritual


Intellectual

1

2

3

4

5


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

more pertinent

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

helping release the positive energy that exists naturally within people”

Henry Mintzberg

#SCHR @HelenBevan @FreerMary Source: Helen Bevan

Compliance

States a minimum performance standard that everyone must achieve

Uses hierarchy, systems and standard procedures for co-ordination and control

Threat of penalties/ sanctions/ shame creates momentum for delivery

What is our approach to change?

Commitment

States a collective goal that everyone can aspire to

Based on shared goals, values and sense of purpose for co-ordination and control

Commitment to a common purpose creates energy for delivery


Leaders who focus on meaning also

get compliance, without focusing on it

@JeremyScrivens


We know that ...

• Shared purpose is a common thread in successful change programmes*

• Organisations and change initiatives with strong shared purpose consistently outperform those without it.**

*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)

**Management Agenda 2013 Boury et al (Roffey Park Institute)

#SCHR @HelenBevan @FreerMary#NHSChangeDay #SHCRchat

A 3-word concept


[Shared] purpose goes way deeper than vision and mission; it goes right into your gut

and taps some part of your primal self. I believe that if you can bring people with similar primal-purposes together and get them all marching in the same direction,

amazing things can be achieved.Seth Carguilo


The power of shared purpose:

Perhaps the single most important influence on program response by individual units—either in promoting or resisting change—was the extent of consensus and

coalition among the senior medical and nursing staff on individual Intensive Care Units….

[Consultant says] ‘I think it’s been successful because it’s a unifying program, it’s one of the few things that we’ve done that hasn’t been just a doctor thing, or just a nurse thing, it’s involved the doctors and the nurses together.’

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/





Avoiding “de facto” purpose

• What leaders pay attention to matters to staff, and consequently staff pay attention to that too

• Shared purpose can easily be displaced by a “de facto” purpose: hitting a target reducing costs eliminating waste completing activities within a timescale complying with an inspection regime

• If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce

Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector

#SCHR @HelenBevan @FreerMary@SimonJGuilfoyle Police Inspector and systems thinker

https://twitter.com/SimonJGuilfoyle



Purpose

Obfuscation O-

meter

@SimonJGuilfoyle Police Inspector and systems thinker




Police





Education





Healthcare





....the last era of management was about how much performance we could extract from people .....the next is all about how much humanity we can inspireDov Seidman


“Tomorrow’s management systems

will need to value diversity, dissent and

divergence as highly as conformance, consensus

and cohesion.”Gary Hamel

Source of image: www.fastcompany.com


1. Follow on Twitter @HelenBevan @BoelGare

2. Subscribe to 3. Get materials from The School for Health and Care

Radicals: www.theedge.nhsiq.nhs.uk/school4. Sign up to our MOOC (Massive Open Online Course)

on “Improvement Fundamentals”)5. Come to the #Folkslab on Wednesday, Thursday or

Friday

TheEdge.nhsiq.nhs.uk

Five ways to connect!

@JackieLynton@School4Radicals@TheEdgeNHS

http://www.theedge.nhsiq.nhs.uk/school


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

http://www.slideshare.net/fullscreen/ayeletb/preparing-for-the-future-the-power-of-relationships/1

http://www.slideshare.net/fullscreen/ayeletb/preparing-for-the-future-the-power-of-relationships/1

http://cci-catalyst.s3-us-west-1.amazonaws.com/uploads/1384364389642-ybp7cg76g1rzr529-33ce7d6c1677a906fea8a88cd3b37a0a/The+Network+Secrets+of+Great+Change+Agents.pdf

http://changeday.nhs.uk/files/Leading%20Large%20Scale%20Change%20Part%201.pdf

http://changeday.nhs.uk/files/Leading%20Large%20Scale%20Change%20Part%202.pdf

http://www.nhsiq.nhs.uk/resource-search/publications/white-paper.aspx

http://www.slideshare.net/chagww/moving-forward-with-social-collaboration

http://dupress.com/articles/diversitys-new-frontier/

http://www.peterfuda.com/category/the-transformational-change-agent/

http://www.peterfuda.com/category/the-transformational-change-agent/

http://prezi.com/usju20i0nzhd/humanize-how-people-centric-organizations-succeed-in-a-social-world/



http://management.fortune.cnn.com/2014/03/26/bureaucracy/

http://www.jarche.com/2013/11/rebels-on-the-edges/


Jarche H (2014) Moving to the edges

Kotter J (2014) Accelerate! Harvard Business Review Press

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

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

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

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

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

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

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

References and links

http://www.jarche.com/2014/01/moving-to-the-edges/

http://www.jarche.com/2014/01/moving-to-the-edges/

http://www.amazon.co.uk/Accelerate-John-P-Kotter/dp/1625271743

http://www.slideshare.net/missrogue/11-rules-for-the-social-era-book-by-nilofer-merchant

http://www.forbes.com/sites/glennllopis/2014/03/24/every-leader-must-be-a-change-agent-or-face-extinction/

http://hbr.org/2001/10/radical-change-the-quiet-way/ar/1

http://hbr.org/product/rocking-the-boat-how-to-inspire-change-from-within/an/2138-PBK-ENG

http://www.slideshare.net/neilperkin/google-squared-online-0114

http://www.slideshare.net/neilperkin/google-squared-online-0114

http://www.changeagentsworldwide.com/assets/doc/caww_ebook_11.pdf

http://www.changeday.nhs.uk/healthcareradicals


http://www.slideshare.net/JulianStodd/the-future-of-leadership-by-julian-stodd


http://www.webershandwick.com/uploads/news/files/employees-rising-seizing-the-opportunity-in-employee-activism.pdf

http://www.slideshare.net/sverjans/how-social-media-changes-the-way-we-work-together

http://www.slideshare.net/sverjans/how-social-media-changes-the-way-we-work-together

the school for health and care radicals victoria

Healthcare

freermary people

freermary source

freermary http

freermary research

freermary welcome

freermary kinthi sturtevant

freermary new truths

change source