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

The School for Health and Care
Radicals
www.changeday.nhs.uk/healthcareradicals

Module 1:
Being a health and care radical:
Change starts with me
Supported by
#NHSChangeDay #SHCRchat

Welcome to the School for Health and Care
Radicals – a global community of change agents
• Nearly 1000 registrants for The School for Health and Care
Radicals
• Nearly 90 volunteer coach and mentor volunteers
• From 22 countries, including:
Australia, Belgium, Canada, Czech Republic, Denmark, England,
France, Germany, Ireland, Netherlands, New Zealand, Norway,
Northern Ireland, Philippines, Saudi Arabia, Scotland, Spain,
Sweden, Ukraine, United Arab Emirates, USA, Wales


Why the School for Health & Care Radicals?
It’s tough being a change agent in health and care, particularly
when other people don’t always get it or want to change.
Yet big change happens in health and care only because of
heretics and radicals: passionate people who are willing to take
responsibility for change. We are people who support the goals
of our health and care systems, but also want to change
existing thinking and practice and improve care for patients
and people who use services.
The School for Health and Care Radicals provides tools, ideas
and connections with a community of radicals to help us thrive
and survive as agents of positive change


Pledge today!
http://changeday.nhs.uk

Joining in today and beyond
• Please use the chat box to contribute continuously during the
web seminar
• Please tweet using hashtags #NHSChangeDay and #SHCRchat
• We will produce summaries of the discussions on each module
using Storify.com and put on the website
• The conversation continues on the live chat forum at
www.changeday.nhs.uk/healthcareradicalsforum


for
today
• Background to The School for Health and Care
Radicals
• Learning processes
• Context: emerging directions in transformation and
change
• Some challenges for health and care radicals
• The difference between a radical and a troublemaker
• How to thrive and survive as a radical
• Questions and call to action

Source of image: www.freshnessmag.com

Why are we here? Why are you here?


Why did you join the school?
‘I want to:
• be part of changing the NHS and to learn how to be more
effective as a change maker’
• learn how to implement change effectively and encourage
others to join the vision’
• help others realise they're able to make changes without
seeking permission first’

• network with other healthcare radicals


Why did you join the school?
‘I want to:
• learn, gain more inspiration and courage to continue what I
started’
• share the joy of participating in NHS Change Day
• share, be inspired and inspire others to support and coach
others to be the best they can with the aim of improving the
NHS we love and cherish

• drive quality improvement, promote harm free care, make
the improvement sustainable, remember patients are at the
centre of everything we do
• spread change in a stealthy way!’

Modules
31st January:

Being a health and care radical:
change starts with me
7th February: Forming communities: building
alliances for change
14th February: Rolling with resistance
21st February: Making change happen
28th February: Moving beyond the edge

The genesis of the School
NHS Change Day
2013

2013
Applying
community organising
principles to
healthcare
2010
improvement
“A one day school
for organisational
radicals”

2014

“The School for
Health and Care
Radicals”

2012

“A school for
healthcare
radicals”

2003
2002

Applying
social movement
thinking to
healthcare
improvement

Source: @NHSChangeDay


The school is based on two kinds of learning
Transactional learning

Transformational learning

A “toolkit” of ideas &
approaches

Learning through
motivation, practice &
feedback

Seeks to transfer useful
knowledge

Seeks to transform beliefs
& underlying assumptions

Learning events,
presentations & materials

Experiential, interactive &
action-based

Generates understanding of
“what to do”

Generates increased
capacity in “how to do it”

Source: #SHCRchat
#NHSChangeDayJohn Wenger https://medium.com/corporate-learning/3deb1bb2e865

What the school can offer

What you might do

 Take part in the programme at
 Five learning modules, live on
whatever level of engagement
Friday mornings and available 24/7
you want
 Materials, inc a weekly study guide
 Encourage others in your
to back up the modules
organisation or locality to join
changeday.nhs.uk/healthcareradicals
the school
 A weekly telephone discussion 7 Create your own local learning
8pm on Sunday evenings (if
set or group
demand)
 Join the Change Day
 A weekly tweetchat, 4-5pm on
movement and mobilise
Wednesdays #SCHRchat
others
 A chat forum
 Keep a learning log, complete
www.changeday.nhs.uk/healthcareradicalsforum
all modules and action your
 Potential to link you and/or your
Change Day pledges to gain
group with a mentor
certification

Emerging themes in change and transformation
Dominant
approach

Organisation
Power through hierarchy
Mission and vision
Making sense through
rational argument
Leadership-driven (top
down) innovation
Tried and tested,
based on experience
Transactions

Emerging
direction
Community
Power through connection
Shared purpose
emotional connection
Viral (grass-roots
driven) creativity
“ Open” approaches , sharing
ideas & data, co-creating
change
Relationships
Source: @HelenBevan

John Kotter: “Accelerate!”
• We won’t create big change through hierarchy
on its own
• We need hierarchy AND network
• Many change agents, not just the usual few
• Changing our mindset
Source of
• From “have to” to “want to”

• Head and heart, not just head


image:www.slideshare.net/m
exicanwave/champions-trolls10-years-of-the-cipd-onlinecommunity

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


Discussion
What are the implications of the
“emerging direction” for the way
change agents work?
Dominant approach

Organisation

Power through hierarchy
Mission and vision

Emerging direction
Community
Power through connection
Shared purpose

rational argument

emotional connection

Leadership-driven (top
down) innovation

Viral (grass-roots
driven) creativity

Tried and tested,
based on experience
Transactions


“ Open” approaches , sharing
ideas & data, co-creating change
Relationships

is the new normal!

“By questioning existing ideas, by
opening new fields for action, change
agents actually help organisations
survive and adapt to the 21st Century.”
Céline Schillinger

Image by neilperkin.typepad.com

Across the world, the change agent
movement is exploding!
@chagww
Changeagentsworldwide.com

@rebelsatwork rebelsatwork.com

@corprebels
Corporaterebelsunited.com

Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
@helenbevan #1000LivesPlus

What happens to
heretics/radicals/rebels/mavericks
in organisations?

@helenbevan

@helenbevan

“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
@helenbevan

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
@helenbevan

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

Source: adapted from Debra E Meyerson

@helenbevan

 we surrender a part of ourselves, and silence
our commitment, in order to survive


@helenbevan

@helenbevan

Source: Foghound

@helenbevan

Source of image: quote.lifehack.org

2. leave the organisation


@helenbevan

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


@helenbevan

3. stridently challenge the status quo in a manner
which is increasingly radical and self-defeating

@helenbevan

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
@helenbevan

Sometimes people see us radicals as
troublemakers
Rebel

@helenbevan

Source : Lois Kelly www.foghound.com

Discussion
• What are your insights around “radicals” and
“troublemakers”?
• What moves people from being “radical” to
“troublemaker”?
• How do we protect against this?

@helenbevan

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.

GALILEO DESCRIBES HIS DISCOVERIES TO THE CHURCH ESTABLISHMENT

@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

@helenbevan
@HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents

‘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

@helenbevan

Source of image: fistfuloftalent.com

History tells us that personal
transformation comes before
organisational or system transformation
If we want to play our role, we have to focus
deeply on our own perspective and the ways
we interact with and influence
others. The more that we can
unleash that powerful reservoir
of energy for change, the more
our influence and impact will
grow.
http://blogs.bmj.com/quality/2013/08/19/a-call-to-action-helen-bevans-blog-2/
@helenbevan

Image from novamagazine.com

Five things we know about successful
boat rockers

CHANGE

BEGINS WITH
1. Driven by conviction and values
me
2. strong sense of “self-efficacy”
 belief that I am personally able to create the change

3. able to join forces with others to create action
4. able to achieve small wins which create a sense
of hope, self-efficacy and confidence
5. More likely to view obstacles as challenges to
overcome
@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
@helenbevan

Source of image:www.h3daily.com

What’s the difference between

self efficacy
and

self esteem,
self belief,
self-confidence?

@helenbevan


@helenbevan


What is the issue here?

“permission” ?
(externally generated)
or

Self efficacy ?
@helenbevan

(internally generated)

Brainstorm
What are some ways that health and care
radicals can build self-efficacy?

@helenbevan

Building self-efficacy: some tactics
1. Invest in your own change agent development (modules 2-5)
• create the conditions where success is more likely to happen

2. Create change one small step at a time
3. Reframe your thinking:
• failed attempts are learning opportunities
• uncertainty becomes curiousity

4. Make change (and learning cycles from change) routine
rather than an exceptional activity
5. Get social support
6. Learn from the best
7. Get people whose opinions you value to encourage you
(mentor?)
@helenbevan

The most effective change agents:
• don’t waste their time and energy
blaming and complaining
• take calculated risks to achieve the
outcomes they sought
Now is the time to plan steps to keep
moving myself forward, with positive
momentum, as a health and care radical

@helenbevan

Three assumptions for health and care
radicals
1. Assume that everyone has a noble intention.
2. When people “resist” change is it more likely
to be a result of their interpersonal
interaction with the change process than
their innate character traits (“a bad change
process not a difficult person”).
3. My role as a change agent is about
alignment, not judgement.
@helenbevan

Source of image:help.adobe.com

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

@helenbevan

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

@helenbevan

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

@helenbevan

Calls to action campaigns for this week
Post these or similar actions as a pledge on the NHS
Change Day pledge wall
http://changeday.nhs.uk/wall
• Reflect on your own role/knowledge/skills as a
health and care radical and create an action plan
to “start with me”
• Discuss tactics for rocking the boat and staying in
it with other radicals
• Identify and support others who are at risk of
crossing the line from “radical” to “troublemaker”
@helenbevan

Next opportunities for learning
• Sunday 2nd February
19:00-20:00 conference call discussion of
module one
• Wednesday 5th February
16:00-17:00 Tweet chat #SHCRchat
• Next Friday morning module 2:
Building alliances: forming communities
for change
@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?
@helenbevan

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

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