The School for Health and Care Radicals, British Columbia

@HelenBevan #SHCR #QF15
Supported by

So...................
What lights the “fire in your belly” and makes you
determined to improve things?

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”
“A one day school
for organisational
radicals”
Applying
community organising
principles to
healthcare
improvement
2015

Source: @NHSChangeDay

“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

Starts on the fringe
(at the edge)
Starts with the activists
Gary 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
Change from the edge

Leading change in a new era
Dominant approach Emerging direction

Most healthcare
transformation
efforts are driven
from this side

Source: Gary Hamel

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
‘

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

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

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

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

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

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

@helenbevan #IQTGOLD#NHSChangeDaySource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

@HelenBevan
Ostracism is experienced in the brain as
deeply as physical pain

@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
 we surrender a part of ourselves, and silence
our commitment, in order to survive
2. 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

@helenbevan#NHSChangeDay #SHCRchat
Source : Lois Kelly www.foghound.com
There’s a big difference between a rebel
and a troublemaker
Rebel

@helenbevan
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

@helenbevan
Change starts with me
Source of image: jasonkeath.com

@helenbevan#SHCR @School4Radicals
"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
‘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

@helenbevan
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
http://blogs.bmj.com/quality/2013/08/19/a-call-to-action-helen-bevans-blog-2/
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.
Image from novamagazine.com

@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

@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

@helenbevan
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 ?
(internally generated)

@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

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

@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”.

@helenbevan
Tactic for radicals:
Out-love everyone else
Source of image: Bradley Burgess

@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
Randomized Coffee
Trial!

@helenbevan
Outcomes of randomised coffee trials

@helenbevan
Randomized Coffee Trial!
• Instructions in News from Jo later today
• Send an email to say you want to take part in the RCT to
radicals@nhsiq.nhs.uk
• We will randomly match you with another participant in the
School for Health and Care Radicals from anywhere in the world
• At some time in the next four weeks, arrange to have a
conversation over Skype (or other communication system) with
a cup of coffee!

@helenbevan
Learning from the first section
YOU can make a difference
AND
You can’t do it ALONE
Source: TED talk by Barry Posner
http://workplacepsychology.net/2014/02/
01/the-truth-about-leadership-you-make-
a-difference-and-you-cant-do-it-alone/
Source of image: jamessamy.com

@helenbevan
Often as radicals, we feel different to
other people

@helenbevan
Often as radicals, we feel different
to other people

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

@helenbevan
From
module one

@helenbevan
What is community?
1. Locality
2. Interest or shared purpose
3. Sense of belonging: “community spirit”
“There is no power for change greater than a
community discovering what it cares about.”
~ Margaret Wheatley
Source of image:
rootedincommunity.org

@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

@helenbevan
Who are your communities?
Source: Celine Schillinger http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite
• In your role: through relationships and social
networks
• Through external social networks such as
Twitter and LinkedIn
• Through communities of practice and learning
groups

@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

@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

@helenbevan
Six characteristics of people or groups within
effective social movements
1. They share a sense of PURPOSE: There is purposefulness about
collaborations, discussions, actions, decisions and a sense of forward momentum
2. They are UNITED: They have learned to manage their differences well enough
that they can unite to accomplish their purpose. Differences are openly debated,
discussed, and resolved.
3. They share UNDERSTANDING: There is a widely shared understanding of
what's going on, what the challenges are and why what is being done has to be
done
4. People PARTICIPATE: Lots of people and organisations in the system are
active - not just in discussions and meetings, but getting the work done.
5. They take INITIATIVE: Rather than reacting to whatever happens in their
environment, they are proactive, and act upon their environment.
6. They ACT: People do the work they must do to
make the things happen that need to happen
Source: adapted from Wellstone Action

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

@helenbevan
What is strategy?
Strategy is the process of turning
the you have into
the you need to win
the you want
Source: Marshall Ganz

@helenbevan
Resources to improve health and care
Economic resources
diminish with use
• money
• materials
• technology
Natural resources
grow with use
• relationships
• commitment
• community
Based on principles from Albert Hirschman, Against Parsimony

@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)

@helenbevan
What’s the
financial incentive?
Who is
performance
managing?
What’s the
project plan?
Source: @RobertVarnam

@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

@helenbevan #IQTGOLD#NHSChangeDay
“I have some Key
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam

@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

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

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

‘‘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

@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

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

Vivid details

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

@helenbevan
Moving beyond us and them
to us and us
Source of image: www.delta7.com

@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
From Module 1

@helenbevan
strong ties (cohesive)
v.
weak ties (disconnected)
Source of image: 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

@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

@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

@helenbevan
strong ties
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

@helenbevan
strong ties
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

@helenbevan
Sources of weak ties

@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

@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

@helenbevan 100
http://weneedsocial.com/blog/2013/8/25/disr
upted-disruptors-unite

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

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

@helenbevan
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?

@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

@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
“

What do we mean by
?

@helenbevan Source of image: sport-fitness-advisor.com
Any force that stops or
slows movement
Resistance

@helenbevan
Previously, we talked about:

• Change in human systems is
often emergent and hard to
predict
• Change results from
connections/interactions
stimulating different
perspectives, shaping how
people think about things
• Resistance is an inevitable
consequence of a complex
change process
• Resistance should be embraced
and rolled with
• Change can be planned and
managed through a rigorous
process
• Resistance is a force to
overcome
• Resistance prevents change
• Change agents must
diagnose, manage and/or
overcome resistance
• Resisters can otherwise be
known as “laggards”,
“blockers”, “in denial”

@helenbevan
Resistance to change: the dominant approach

@helenbevan
An example “dominant approach”
transformation programme

@helenbevan
“The role of the change agent is to recognise the
causes of resistance and address each one. If this is
not done, then the change will be much harder to
implement successfully and may not succeed at all”
David Stonehouse
The change agent: the manager’s role in change
British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013,
pp 443 - 445
Dominant approach:
the role of the change agent

“Change doesn’t rain down on us from on high. Rather, its stories are co-
created and co-owned by the community. Or, at least they are if you want
the change to stick”
Julian Stodd
https://julianstodd.wordpress.com/2013/11/29/the-co-creation-and-co-ownership-of-organisational-change/

@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
‘‘

@helenbevan
Cultural change
is a million
subversive acts
of resistance
Brene Brown
Source of image: zazzle.com
‘‘

Language constructs our world(s)
rather than reports the objective facts
about the world. Therefore changing
when, where, how and which people
talk about things – changing the
conversation – will lead to
organisational change
Robert J Marshak
Source of image: createbusiness.net.au
‘‘

@helenbevan
1. Create the conditions for transformational
conversations by asking questions that are focussed on
future possibilities, by inviting diversity into the system
and by being welcoming
2. Create opportunities for everyone to express their
views, spot opportunities and build on each other’s
ideas
3. Create ways for people to reflect together to find
meaning, understanding and shared purpose in the
change
Source: Peggy Holman
Emerging direction:
the role of the change agent
Source of image: rachtalks.pressprestige.com

@helenbevan
“Having care wrapped around the person rather
than the person pushed through the system”
Lesley Young-Murphy
North Tyneside Clinical Care Group

@helenbevan
“The most basic not-so-secret formula for building an
innovation culture is pretty simple - embrace diversity
and start to attract, retain and promote a diverse
workforce that looks differently, works differently, dress
differently, speaks differently and is inclusive of the full
spectrum of human sexual orientation and gender
identities. Do this before you start hiring consultants
and rethinking your innovation process, there is no
process that works without true diversity.”
Idris Moore
Source of image: idsgn.org
Diversity is critical to innovation and change

@helenbevan
“Leaders and organisations must let go of the idea
that there is “one right way” and instead focus on
creating a learning culture where people feel
accepted, are comfortable contributing ideas, and
actively seek to learn from each other”
Diaz_Uda, Medina and Schill (2013)
Source of image:fineartamerica.com
As health and care radicals, we should be
champions of diversity for change

@helenbevan
In the context of “rolling with resistance”
• What are the implications of embracing diversity
of thought, experience and background in our
change efforts?
• What skills and perspectives do health and care
radicals need to work effectively with diverse
teams for change?
Source of image:fineartamerica.com
Discussion

@helenbevan
Our effectiveness as change agents is not a
matter of intention; it’s a matter of impact

@helenbevan
• Helen’s intent was to give people quick
solutions, help them do their work faster
and get on to the next problem at hand
• However, her impact was that people did
not know how to solve their own
problems so that Helen’s style was
impeding their development
Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee
Source of image: thedigitalawards.com

@helenbevan
Stop talking
AT ME
Start talking
TO ME
Source of image: prepbeijing.com

@helenbevan
• Build a trusting and supportive work
environment
• Listen like an ally
• Be open with my intent
• Fully commit to the change
• Seek common purpose and common
interests
• Take time to build relationships
• Take responsibility for my own actions
What can I do?

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

@helenbevan#SHCR @School4RadicalsImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

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

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

@helenbevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal
PERFORMANCE target.

@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

@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.
—

@helenbevan
“Stages of change”
Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)

@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

@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

@helenbevan
Smoking
I am not aware my
smoking is a
problem – I have no
intention to quit

@helenbevan
Smoking
I am not aware my
smoking is a
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet

@helenbevan
I am not aware my
smoking is a
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.
Smoking

@helenbevan
I am not aware my
smoking is a
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!
Smoking

@helenbevan
I am not aware my
smoking is a
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
Smoking

@helenbevan
Transtheoretical model of behaviour change

@helenbevan
• Which stage do most change activities in
health and care focus on?
• Which stage are most people actually at?
Some questions

@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

• 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

@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

@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?

@helenbevan
The single biggest problem
in communication is the
illusion that it has taken
place
George Bernard Shaw
‘‘

@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?

@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

@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

@helenbevan
“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

@helenbevan
1. What does resistance means to you?
 think about the things you resist as well as your
responses to others’ resistance
2. How do you work with resistance as a change leader?
3. How can you make sure that the changes you make
achieve the impact you desire and also
 are sustainable?
 do not create dependency?
 generate self-efficacy in others?
4. Who you are interacting with and where they are on
the Stages of Change model?

@helenbevan
The “two levels down” rule
What can I achieve in:
a year?
a month?
a week?
a day?
an hour?
If you think your
improvement initiative
will take a year to test
and implement,
consider what you could
achieve in a week
If you think it
will take a
week, what
you could
achieve in an
hour?
Source: Paul Plsek

The School for Health and Care Radicals, British Columbia

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