Minicourse M8: pre-reading and workbook

Minicourse M8: STUDY GUIDE
To read prior to the minicourse on 5th
December
2016 as “flipped classroom” pre-work
‘We need three kinds of people to transform healthcare;
patients, professionals and pirates.
Be a rebel pirate!’
Lucien Engelen
Faculty:
Helen Bevan @HelenBevan
Kathryn Perera @KathrynPerera
Hashtags #IHIFORUM #pirate

How to be a great change agent flipped classroompre-work
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Contents
Introduction.................................................................................................................................3
This study guide........................................................................................................................ 3
What are YOUR goals as a healthcare change agent?..................................................................3
Setting the scene: the challenge of change................................................................................. 4
Who are the most effective change agents in healthcare?........................................................... 6
Rebels versus troublemakers.........................................................................................................6
Rocking the boat and staying in it..................................................................................................8
Beingan effective healthcare change agentisaboutknowing,doing,living andbeing change that
makes a difference ....................................................................................................................... 9
Beginning to be the change: RCTs(Randomised Coffee Trials)....................................................... 10
What do we mean by resistance to change?................................................................................. 11
What is our mindset about resistance? .................................................................................... 11
The power of resistance.............................................................................................................. 12
Diversity................................................................................................................................. 12
Understanding why people resist and what to do aboutit............................................................. 13
Where am I in the change cycle and whatwill help me to progress to the next stage?................ 13
The Stages of Change (or Transtheoretical Change) model ........................................................ 14
Growingmovementsforchange ……………………………………………………………………………………….……… ……17
Statementof intent………………………………………………………………………………………………………………….………18
Mappingour communities……………………………………………………………………………………………………………….19
Effective framing........................................................................................................................ 20
My story…………………………………………………………………………………………………………………………………………..22
On strategyandtactics…………………………………………………………………………………………………………………….23
Reflectionandevaluation……………………………………………………………………………………………………….….……25
Reference list............................................................................................................................. 29

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This StudyGuide wasprepared byPipHardyandeditedby Dr HelenBevan andKathryn Perera.
Session 1: Being a healthcare change agent:
change starts with me
Introduction
‘Be the changeyou wantto see in the world.’ MK Gandhi
Welcome tothe M8 minicourse:“Rockingthe boatandstayingin it:how to be a great change agent”
It’stough beingachange agent in healthcare,particularlywhenotherpeople don’talwaysgetitor
wantto change.Yet bigchange happensin healthcare onlybecause of hereticsand rebels;
passionate people whoare willingtotake responsibilityforchange.We are people whosupportthe
goalsof our healthcare systems,butalsowantto change existingthinkingandpractice andimprove
care for patientsandpeople whouse services.
Beinga radical change agentisn’trelatedtohierarchyor positionandyoudon’thave to workinthe
official system toqualifyas one.Peoplewhohave previouslytakenpartin our workshops include
patientsand familymembers,students,seniorleaders,improvement facilitatorsand clinical and
care staff.
Thisminicourse seekstoprovide uswith tools,ideasandconnectionswithacommunityof change
agentsto helpusthrive andsurvive asagentsof positive change andimprovement
This study guide
‘Education is thekindling of a flame,notthe filling of a vessel.’ Socrates
Thisstudyguide isintendedtoenhance andcomplementthe minicourse andhelpdeepenyour
thinkingandreflection.Itisnotcompulsory, butitmay give yousome ideasof thingstothinkabout,
questionstoask and youmay take some inspirationfromsome of the examplesandquotations.If
youwouldfindithelpful,pleasefeel free touse thisguide asaplace to keeptrack of your own
thoughtsandideasso youwill have arecord of your workon the day of the minicourse.
Throughoutthe studyguide there are shadedsectionsforyoutoreflectonyour ownexperience or
respondtokeyquestions. Evenif youdon’twrite anythingdown,dotake a few minutestothink
aboutyour responsestothe questionsandprompts;again,these couldformgreatdiscussionpoints
on the day of the school.
What are YOUR goals as a healthcare change agent?
In orderto make the most of the one day minicourse,youmayfindithelpfultogive some thought
to yourown personal goals –what do youhope to achieve byengagingwithacommunityof change

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agents?You maylike tothink of thisas the beginningof the storyyouwill tell aboutdevelopingyour
skills,knowledge andconfidence asanagentof change.
REFLECTION: THE STORY BEGINS
What do you hope to achieve from the minicourse?
Here are some of the things otherpeople have suggested:
‘Createa networkof rebels!’
‘Reawaken interestin studying and applying knowledge.Connect with otherparticipantswho may
understand whatitfeels like to be an extreme left field thinkerin an ultra traditionalorganisation.’
‘I'd like to learn howNOTto get myself into trouble - ormy ideasand the peopleI represent to be
ignored - becauseIdon't rockthe boatin an appropriateway!’
Setting the scene: the challenge of change
Anyone whochoosestobe a change agent,improvementorpatientleaderin healthcare doesn’t
choose an easylife.There are somanyforcesopposingthe changeswe wantto see;a systemthat
rewardspeople for‘keepingthe trainsrunning’ratherthan change agentchange, those withthe
powerand/ora vestedinterest inkeepingthingsastheyare, colleaguesandleaderswhoare
sceptical,apatheticorscaredof change. Ofteninourrole as change agents,we feel isolated,
vulnerable andmisunderstood.Yetthe future of healthcare restswiththe non-conformists,the
change agents,the hereticsandmavericksinourmidst. We are the people whoare passionate
aboutchange,who questionexistingideasandmethodsandopenupnew fieldsforaction.As
Martin LutherKingdescribedit:
‘The saving of ourworld…will come, notthrough thecomplacentadjustmentof
the conforming majority,butthrough thecreativemaladjustmentof a non-
conforming minority.’
REFLECTION: PASSION AND CHANGE
What are you passionate about?
How do you ‘live’ your passion(s)?

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What have you already done to bring about change?
How did that work for you?
How can change agents work with different kinds of power?
It ishelpful tocontrastwhatTimmsand Heimanscall “oldpower”and “new power”
Ofteninhealthcare,the dominantformof poweris“oldpower”;the people whocanmake things
happenare the people withpositional authority,whopushcommandsthroughthe system.Old
powerislike acurrency,some people have alotof moneybutmostpeople don’t. Largely,old
poweristransactional;we holdpeople toaccountina rational wayfor performance agreementsand
qualitystandards.Bycontrast,newpowerislike acurrent; itsurgeswithenergywhenpeoplecome
togetherwithasharedpurpose.Itis relational;peopleengage innew powerwaysbecause they
wantto and it fitswiththeirownprioritiesandvalues,notbecause theyhave to.
Healthcare change agentsneedtobe able to operate inthe sig-saggyspace betweenoldandnew
power.We needtobe able tooperate withthe leversand opportunitiesof both.New powerbrings
us lotsof opportunitiesevenwhenwe don’thave alotof positional authoritytomake things
happen.Inour minicourse forchange agents,we will discusshow we canworkwithbothkindsof
power.

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Who are the most effective change agents in healthcare?
Researchby Debra Meyerson suggeststhatthe mosteffectivechange agentsare those who have
learntto oppose andconformat the same time. Or, as she putsit,‘theyare able torock the boat
and yetstay init.
These are change agentswho standup to challenge the statusquowhentheysee there could be a
betterway.They developthe abilitytowalkthe fine linebetweendifference andfit,inside and
outside.These peopleare drivenbytheirownconvictionsand valueswhichmakesthemcredible
and authentictoothers.Most importantlyof all,theytake action asindividualsthatignite broader
collective action thatleadstobigchange.Change agentsalreadyexistinandaroundeveryhealthor
care organisation, inmanydifferentrolesandmultiple levels.Oftentheyare notat the mostsenior
levelsof the organisationyetthe impactof theirchange activitiesare oftenjustassignificantasif
theywere.
REFLECTION
What makes you a change agent?
Rebels versus troublemakers
LoisKelly makesthe distinctionbetween ‘rebels’and‘troublemakers’. Aschange agentswho
challenge the statusquo,we fitwithher‘rebel’ criteria(andwe use the terms“rebel”and“change
agent”interchangeably).We continuously seekinnovativenew waysof deliveringcare.We are
committedtothe patient-centredmissionandvaluesof ourorganisations.We are drivenbyour

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passionforbettercare forpatients.We are optimisticaboutthe future,the potential forchange and
see manypossibilitiesfordoingthingsindifferentways.We generateenergyforchange which
attracts othersto unite withusfor a commoncause.
‘Troublemakers’alsochallenge the statusquobutina way that isverydifferentto ‘rebels’.
Troublemakerscomplainaboutthe currentstate of affairsbuttheirfocustendsto be aroundtheir
ownpersonal positionratherthanachievingthe goalsof the organisation.
‘Troublemakers’ are oftenangryabouthow thingsare and don’thave much confidence thatthings
will getbetterinthe future.Theyalienateotherpeople becauseif otherslinkwiththem,
troublemakerswill saptheirenergy. Thisjustconfirmswhattroublemakersprobablyknow already–
theydon’tbelong.
There are riskshere forrebel change agents.Firstly,some organisational leadersview ANYONEwho
challengesthe statusquoasa troublemaker.Therefore, rebelchange agentsgetunfairlylabelledas
troublemakers. Secondly,lotsof change activists inhealthcare startoutas rebels butwhentheir
voicesdon’tgetheard,theybegintoquestion the statusquo stridentlyandoften inamannerwhich
isself-defeating;andtheycrossthe line fromrebel totroublemaker.
As rebel change agents,we have aresponsibilitytolookoutforthisand try to preventithappening
by buildingrelationshipsandformingallianceswithotherswhochallenge the statusquo(there will
be more onthistopic later).

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REFLECTION: REBELS AND TROUBLEMAKERS
What is your experience of rebels and troublemakers?
How can you protect yourself against moving from rebel to troublemaker?
Rocking the boat and staying in it
Successful boatrockerstendto:
1. Be drivenby conviction andvalues
2. Have a strongsense of ‘self-efficacy’,thatis,the belief thattheyare personallyable tocreate
the change
3. Be able tojoinforces withotherstocreate action
4. Be able toachieve small wins whichcreate asense of hope,self-efficacyandconfidence
5. Be more likelytoview obstacles aschallenges toovercome
The issue of self-efficacyisaparticularlyimportantone for healthcare change agents.Byself-
efficacy,we meanthe belief thatapersonhas thatshe or he iscapable of deliveringthe specific
change required. There isa positive,significantrelationshipbetweenthe self-efficacybeliefs of a
change agentand her/his abilitytofacilitate change andgetgoodoutcomes.
ACTIVITY: BUILDING SELF-EFFICACY
What are some of the ways that you can build self-efficacy into your practice as a
healthcare change agent?

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Being an effective healthcare change agent is about knowing,
doing, living and being change that makes a difference
As change agentsitis important, butnotenough,to
continue to buildourknowledge of improvement
methodsandapproaches.It’salsoimportant, butnot
enough,totake responsibilityforourowndevelopment
as skilledleadersorfacilitatorsof change.
What setsthe most effective healthcare change agents
apart is the extenttowhichtheyseekto live and be
improvementinthe waytheyoperate inthe worldand
intheirinteractionsandrelationshipswithothers.
It’sonlywhenwe live the thingswe believe in(thatis,
we can alignour sense of deeperlifemissionorcalling,ourvaluesandthe activitiesthatwe
undertake everyday) thatwe can make ourfull contributionas healthcare change agentsand
generate the kindof signalsthatleadotherstotransformational change.
ACTIVITY: MAKING A DIFFERENCE
What are the opportunities for you to build yourperspectives and skills as an agent of
change and improvement?
How can you move beyond skills and knowledge of change to live and be the change?
Who can help and support you as a change agent?
What are the implications for the way you work?

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Beginning to be the change: RCTs (Randomised Coffee Trials)
It’shard to ‘do’change on your ownand one of the bestwaysof beingthe change youwant to see is
to workwithotherswhoshare your intentionsandvalues.
Duringthe minicourse,we willbe encouragingyoutodevelopyournetworksandfindotherpeople
withwhomyoucan share ideasandexplore opportunities. One greatwayof doingthisisby an RCT,
that is,a RandomisedCoffee Trial.RCTs can helpyouconnectwithpeople overacupof coffee (or
tea).It isa particularlyuseful approachwithinorganisationswhere peoplemayhave little timeto
getto knowone another,exchange ideasandshare storiesbutitisalsoa wonderful wayforcross-
pollinationtooccur acrossorganisations.
Do take a fewminutestolearnmore aboutRCTshere:
http://www.gurteen.com/gurteen/gurteen.nsf/id/randomised-coffee-trials
Andhere:http://www.nesta.org.uk/blog/institutionalising-serendipity-productive-coffee-breaks#
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?

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Session 3: Rolling with resistance
Introduction
‘Learning is in the relationships between people.’ McDermott 1999
ACTIVITY: THE STORY CONTINUES
How do you deal with resistance to your change ideas or actions?
Have you considered the ways in which you may able to use resistance to help you
achieve your goals?
What do we mean by resistance to change?
Resistancemeansany force that stopsor slowsmovement.
Resistanceis inevitable…learntoexpectit,welcomeit.
What is your mindset about resistance?
How we deal with‘resistance to change’ dependsonhow we perceivethe resistance.Isresistance
somethingnegative thatwill getinthe wayof the changesthat we are seekingtoimplement,
somethingthatwe needtoovercome if we are to deliverthe change?Oris itsomethingtowelcome
that ensuresadiversityof perspectiveandbuildsbetterchange?

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The power of resistance
Resistance ispowerful.If unharnessed,itcanbe
harmful,muchlike lightening.But,whenthe power
of electricityisharnessed,itisimmenselyuseful.
Findwaysof harnessingthe powerof resistanceto
helpyouachieve yourgoals.Gowiththe energy
rather thanagainstit.
Diversity
Researchstudiesshow thatteamsof people with
diverse backgrounds,experiencesandviewsof the
worldwill consistentlyoutperformgroupsof more
talentedbuthomogenousindividuals.
Diverse teamshave betterinsights,theyare more effective asproblemsolversandtheymake fewer
mistakes.
The ‘bestpeople’forourchange projectsare not necessarilythe peoplewhoare mostlike us.As
healthcare change agents,we wanttoembrace diversityandbringpeopleintoourchange teams
whothinkdifferentlytousor whohave had differentexperiencesof life.Thismayinclude patients
and families,communityleaders,peoplefromotherindustriesandorganisations.Bydeliberately
seekingdiversitywe create the riskof greaterresistance,challengeanddisagreementwithinthe
group,eventhoughthe outcome islikely tobe better.
Researchconductedintointerprofessional education(Anderson2014) has foundthat,bybringing
togetherpeople fromdifferentclinical professionstotalkwithandlistentopatients,clinical
outcomesare improved.Eachprofessionlooksfor andseessomethingdifferentandthe sumof their
perspectivesprovidesamore holisticunderstandingof the issuesfacingthe patient.Thisapproachis
a good example of the benefitsof embracingdiversity.
As change agents,we needtoembrace and value the differences.

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ACTIVITY: DIVERSITY - VALUING THE DIFFERENCE
In the context of ‘rolling withresistance’…
What are the implications of embracing diversity of thought, experience and
background in my change initiative?
What skills andperspectives doI needto developtowork effectively with
diverse groups of people for change?
Understanding why people resist and what to do about it
There are a numberof modelsandframeworksthatcan give usinsightintowhypeople are resisting
change and suggestactionstotake as a change agentto roll withresistance.Manyhealthcare
change agentsuse the ‘Stagesof Change’or‘Transtheoretical Model of BehaviourChange’from
Prochaska,DiClemente andNorcross tosupporttheirchange effort.Itisa model of health-related
behaviourchange thatmanycliniciansare alreadyfamiliarwiththroughtheirclinical practice.Itcan
be usedfor improving service qualityandpatientsafetytoo
Where am I in the change cycle and what will help me to progress
to the next stage?
The basic model consistsof five stagesof change thatindividualsgothroughinchangingtheir
behaviours.Byworkingoutwhere onthe cycle anindividual is,we canplansome appropriate
actionsto helpthatpersonto embrace andcontribute tothe change. Inhealthcare,whenpeople
‘resist’change isitmuch more likelytobe a resultof theirinterpersonal interactionwiththe change
processthan theirinnate charactertraits.Thismeansthat people are more likelytobe resisting
because of a bad change processnot because theyare a difficultperson.The Stagesof Change
model helpsustounderstandthisandworkout where the personisat.

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The Stages of Change (or Transtheoretical Change) model
Prochaska, Di ClementeandNorcross offerusframework thatwe can use to work out whichstage of
change a particularindividual isatandplanactionsto helpthe person getto the nextstage. We
unpack the model onthe nextcouple of pages.

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Stage Where am I in the change cycle? What will help me move to the next stage of
change?
What’s a good
outcome from
efforts at this
stage?
PRECONTEMPLATION
I am not thinkingabout changingmy
behaviours,actions or work processes. The
problem or issueis outsidemy frame of
awareness or my perceived need.
Therefore, there is no problem because I am
not awareness of the situation as itmight
affect me. Obviously,I haveno intention to
change at this stage and my defences may
be raised if you push me to change. I often
get labelled as ‘resistant’,‘blocker’or ‘in
denial.’
The focus should be on creatingawareness for
me of the need to change.
 Use strategies to raisemy awareness and
lower my doubt
 Increasemy perception of risks and
problems with current ways of working
 Emphasisethe consequences and costs
associated with maintainingthe existing
system
 Emphasisethe benefits that I and others
will get from the change.
 Use basic skillssuch as reflectivelistening
and open-ended questions
 Function as my collaborator notmy
educator
Remember, the goal is not to make me (as a
pre-contemplator) change immediately, but to
help me move to contemplation.
I begin to recognise
that there might be
a problem that I
need to do
something about.
CONTEMPLATION
I am aware a problem exists and I am
seriously consideringaction,butI have not
yet made a commitment to an action. I have
some level of awareness of the problem. I
might not want to admit itbut I also havea
largedegree of fear of the unknown and of
the amount of effort I may need to make for
the change. If you force me to change at this
stage, there is a risk thatmy defences will
remain in place.This means that I might be
compliantwith the change but not
committed to it. As a result, the change may
not be sustained.
The focus should shiftto increasingthe
perceived benefits of the change and reducing
the expected or perceived negative
consequences of changingfor me. You will
want to create a ‘tippingpoint’ where the
expected benefits outweigh the expected costs
of the change. To get me to this point itmay be
necessary for you to help further clarify both
the benefits (which may be unknown) and
costs (which may be unrecognised).You need
to try to step into my shoes,considering the
pros and cons of change from my perspective.
I have made a
tentative
commitment to
changingthe way I
currently do things
but itis fragile.
PREPERATION
I have made a decision to take future action,
but I am not yet prepared to actually take
the action now. I need to do some more
thinkingabout the individual steps thatI
need to take prior to attempting the new
behaviour or new way of working. There is a
strong likelihood thatmy peers will still be
at the pre-contemplation and
contemplation stages (80% of others in
many research samples).As a result,I may
be discouraged or question my decision to
take action.
Help me to build my skills,knowledge and
confidence in the new way of working:
• build an action plan for change
• includeothers in the plan
• examine barriers to change and help me
work through potential solutions (whatwill
the firstweek be like?)
• encourage me to take partin formal
trainingsessions and workshops
• give me interesting articles to read that
show evidence
• agree how the change will be evaluated
I’m making clear
statements about
the change and I
have an action plan
in place.

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ACTION
I am aware a problem exists and have
actively modified my behaviour,work
process and/or environment in order to
overcome the problem. I’ve actually made
the changes and I’m working in a new way.
However, some of my old habits and
tendencies toward the old behaviour are
still in placeand itis quitelikely thatI will
revert to the old way of working. The good
news is that my commitment is clear and I
am making a bigeffort to change.
Reinforce the changes I have made by coaching
and mentoring me:
 Recognise and acknowledge the success of
the change even if the success is only the
attempt with results not yet evident
 Reaffirm your own commitment to the
change and engage in activeproblem
solvingwith me and my colleagues
I’m working in the
new way. The risk
of relapseis
diminishingas my
new
behaviours/ways of
operating replace
the old ones.
MAINTENANCE
I have made a sustained change.My new
ways of working have become firmly
established and the threat of relapseis
become less intense.It’s no longer
necessary for me to consciously think about
and plan the new way of working as ithas
become more automatic.I (and my patients
and colleagues) arerealisingthe benefits of
the change and my confidence that it was
the right thingto do is growing. However, in
times of stress there is still a risk thatI might
revert to the old ways of doing things
Understand that even though I am well
established in the ‘maintenance’ phase,I still
need ongoing supportand encouragement. Be
there for me if I relapse.If this happens, help
me to:
• Reaffirm the original reasons for the
change
• Explore the factors that precipitated the
crisis
• Get back on track
Hopefully, I
successfully exitthe
final stageof
change cycleand
move into a new
cyclefor a new
change. If I relapse,
I will re-enter the
contemplation or
preparation stage.
Adapted fromDiClemente, 1991;Prochaska and Norcross, 1994 andWirth 2004 byRobert Ferris-Rogers andHelenBevan
REFLECTION: STAGES OF CHANGE
At what stage of change are some of the key people that you need to influence for your
change initiative?
What actions can you take to help them move to the next stage?

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Session 3: Growing movements for change
Introduction
“Peoplewho haveideas and drive areon every street, in every project,every workplaceand
school,waiting in the wings,ready to be discovered.Someonehasto reach them and
recognisethem.Someonehasto ask themto step out,notto be consumersorpropsor
spectatorsbutto be playersin theunfolding drama if public life. And thatsomeoneis what
we call a leader or organiser.”
Michael Gecan,GoingPublic
As humanbeings,we are inherentlysocial animals.We formpairs,families,communities,societies
and cultures.As the previoussection remindedus,we are all interconnected.Itiswhenthe
connectionsare brokenthat change agentsmay become trouble makers.Without those connections
it isunlikelythatwe can bring aboutsignificantsocial change and improvement.
So howcan we harnessthe powerof oursharedhumanitytohelpus accomplishpositive change?
In adaptingtochange in the 21st
century, the mostprogressive organisationsare shiftingawayfrom
hierarchical modelsof leadershipthatseektoshape the workforce tothe goalsandethosof the
organisationandtowardsthe recognitionof the needforsharedpurpose,sharedvaluesandasense
of community.Sowhatcan we learnfromthose leaderswho hadfew economicresourcesandlittle
powerina formal sense,yetwere able tochange the course of history? These people are the
leadersof the greatsocial movements, forexample,the women’ssuffrage movement,the Civil
Rightsmovement,the Anti-Apartheidmovement, the climatecampaignersof the 1970s and leaders
of the ArabSpring.
In thissection,youwill learnabout:
 Growingmovementsforchange inhealthandsocial care
 Developingcommunityrelationships forcommonpurpose
 Usingstories(‘PublicNarrative’)tomotivate others
 The value of campaignstrategyand tactics inleadingchange

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ACTIVITY: SOCIAL MOVEMENTS
What learning and inspiration can we take from social movement leaders to help us in our
roles as agents of change in healthcare?
Statement of Intent
Who am I seeking to organise?
Are you seekingto organise aparticulargroupinyour community?Are youworkingwithinan
organisation,suchasa hospital,local medical centerorsimilar?Doyouwant to organise aparticular
groupof people acrossa regionorarea? Are you seekingtobetteruse people insideyourown
organisationtoexploittheirnetworksandresources?Dothe people inquestionwantyouto
organise them(yet)?
Wheream I organising?
If you are one personor a small team,youmayneedgeographical limitstoensure youare focusing
your resources.Whatisthe physical locationof yourwork?What doesthat communitylooklike?
Who livesthere?If youare organisingamore dispersedcommunity,forexample membersof a
particularclinical profession acrossaregion,whatdoyou know aboutthem?
What am I organising for?
What change do youwant? What issue orproblemare youorganisingaround?Whatwouldsuccess
looklike ina campaign?Are there short-termandlong-termgoalswhichyouhave inmind?Doyou
have a practical solutionwhichyouare seeking?Isthere supportforthisspecificchange?
Developinganswerstothese questionswillhelpyoutoshape astatementof intent,whichyoucan
referback to as yourworkdevelopstocheckthat you’re ontrack.
I AMORGANISING(who?) _________________ TO (dowhat?) ______________________ THROUGH
(howwill youdoit?) ______________.

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Mapping our communities
“As an organiserI startwhere theworld is, asit is, notas I would like it to be.That we accept
the world as it is doesnotin any sense weaken ourdesire to changeit into whatwe believe it
should be— it is necessary to begin wherethe world is if weare going to changeit to what
we thinkit should be.”
Saul Alinsky,RulesforChangeagents
“Organisersidentify,recruit and develop leadership;build community around leadership;and
build poweroutof community.”
Marshall Ganz, KennedySchool of Government
Increasingly,thereisanemphasisinhealthcare onthe needtoworkinand withcommunities,soitis
a good ideatobe aware of the communitiesof whichyouare apart. Most of us belongtoa number
of communities:some maybe virtual,suchasFacebookandLinkedIngroups,whileotherswill be
actual,real time,perhapsevenface-to-face groups.Itisworthwhiletoconsiderhow eachof these
communitiescontributestoyoureffortstobringabout change – and whethertheyare the right
communitiesforyou.
Make a listbelowof the institutions,leadersandotherpeople whomyouthink have,orcouldhave,
significantinfluence onyourcause (positive andnegative).Youmightchoose todivide thislistinto
local,regional andnational actors,dependingonthe complexityof the workyouare undertaking.
Considerthe actorson yourlistin termsof their“ability toact” (power).Towhatextentcouldthey
influencethe successorfailure of yourcause (positivelyornegatively)?Whatwouldbe the impactof
theirsupport?
Nowconsiderthe actors onyour listintermsof how youunderstandtheirpositiontoyourcause
currently.Doyou thinktheyare on-boardwithwhatyou’re tryingtodo? Neutral?Opposed?
Throughthissimple exercise,youare startingtomap yourunderstandingof how able youare to
make the change you seekwithinyourcommunity.
Take the exercise one stepfurther.Of those whomyouthinkhave significantinfluence onyour
potential success,andwhoare currentlyopposedorneutral,whomdoyouthinkyoucouldmost
readilyconverttosupport?What stepsmighthelpyoutoachieve this?
Framing
Framingisthe processbywhichleadersandagentsof change construct,articulate and convey their
message ina powerful andcompellingwayinorderto winpeople totheircause andcall themto

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action.Effective framingisacritical firststage to creatingthe conditionsthat leadtomobilisation
and large-scale change.
ACTIVITY: FRAMING
How can you frame your messages about change in a way that will win others to your
cause and call them to action?
“Storytelling is themodeof description best suited to transformation in new
situationsof action.”
Schön,1988
“All real life is meeting not meetings”
Michael Gecan, Going Public
Most of us,if we are passionate aboutsomething,
wantto share our passionwithothersinthe hope
of drawingthem intothe future we wantto
create for our patients,serviceusers,colleagues
and communities.Thisrequiresmore thanjust
visionorpassion.We needtogive somethingof
ourselves,toconnectwithothersandletthem
knowthat we are authenticinourattemptsto
bringabout change.A story that offerssome
insightintousas individualswill have amore
powerful effectthanastory that isbasedon
statisticsortargets.A visionof improvingcare
that isbasedon an experience of care thatwas
eitherwonderful orterrible ismore likelyto
engage people thanavisionthatisbasedon the
numberof people affectedbyaparticularcondition.

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The beststoriesalsoreveal the storyteller’sabilitytomeetandovercome challengesbymakingthe
mostappropriate choice or choicestoachieve the desiredoutcome.
‘No matter whatformthedragon may take,it is of this mysteriouspassage
pasthim, orinto his jaws,thatstoriesof any depth will alwaysbe concerned
to tell….’
O’Connor1969
Framing your story
If you wantpeople tojoinyouinyour change attempts,youwill needtoengage them.Stories
provide the basistodo this:
1. Make itpersonal andauthentic(‘storyof self’)
2. Create a sense of sharedpurpose (‘storyof us’)
3. Buildina call for urgentaction(‘storyof now’)
ACTIVITY: CHALLENGES AND CHOICES
Give some thought to your story. How will you attract the attention of the people you
want to call to action? What personalexperience will enable them to connect their
experiences with yours? How will you make your story authentic?
Imagine that you have to write the story that will convey your mission for change in four
sentences.
In the first sentence, make a connection with your audience.
In the second sentence, give us the context of your story.
In the third sentence, tell us about the challenge or crisis in your story.
In the final sentence, provide closure to your story – tell us the outcome of yourchoices.

22
Of course,tellingastoryin foursentencesisatall order, especiallyif youare tryingto be specific
and provide vividdetail.Itisa goodway of establishingthe skeletonof yourstorythough,and you
can alwaysgo back laterto fill inthe details.Itisalsoworthbearinginmindthatthe average
attentionspanof 21st
centuryhumansisabout twominutes, soif youcan keepyourstoryshort and
to the point,youwill winthe admirationandrespectof yourcommunity!
My Story
A “storyof self”communicatesthe valuesthatcalledyoutoleadinthisway,at thistime.
People tendtooverthinkwritingtheirownpublicstory,orworrythat ithas to be verydramaticor
tragic. Infact, some of the simpleststoriescanbe the mosteffective.Gettingyourstoryrightcan
take a while,sodon’tworryif youstruggle atfirst– mostpeople do.Take 5 minutesnow tolook
back at the notesyou wrote priorto comingthisweekend,addinganythingyoumighthave thought
of duringthissession.Youcanuse thisstick-persontohelpyou - write downanythingthatis
importantto whoyouare- people,values,ideas,moments,experiences,places,anything.Youcan
use thisto buildonlater.
 What change do youwant to see inthe world?
 Why?
Our story
A “storyof us” communicatessharedvaluesthatanchoryour community,valuesthatmaybe at risk,
and mayalso be sourcesof hope.
 What urgentchallenge mightyoucall onusto face?
 What visioncouldwe achieve if we act?
Story of now
A “storyof now”is urgent,anurgencybasedon threat,or, equally,onopportunity:itismeantto
inspiredotherstodropotherthingsandpay attention;itisrootedinthe valuesyoucelebrate in
your storyof self andus,but posesachallenge tothose values.Itcontrastsa visionof the worldasit
will be if we fail toact withthe worldas it couldbe if we doact, andcallson us to act.
 Why doesitmatterto us now?
 What “action” mightyoucall uponus to joinyouin taking?
The abilitytoarticulate ourstories(of ourselves,oursharedpurpose andourcall to action) iscentral
to our abilitytoorganise andleadchange.Publicleadershiprequiresthe use of boththe “head”and
the “heart” to mobilise otherstoact effectivelyonbehalf of sharedvalues.Itengagespeople in

23
interpretingwhytheyshouldchange the world –theirmotivation–andhow theycan act to change
it – theirstrategy.
Publicnarrative isthe “why”– the art of translatingvaluesintoactionthroughstories.These stories
provide the basisformeaningfulconversationswe have withpeople inourcommunitiestoidentify,
recruitand developleadership,buildcommunityaroundthatleadership,andcreate change through
that organisedcommunity.Meaningful conversationsbasedonstories,oftensharedone-to-one
withothers,are the breadand butterof organisingforchange.
Thinkof a storyyou have heardwhichhasinspiredormeantsomethingtoyou.Whywas the story
effective?
On strategy and tactics
In orderto create change in the worldwe have to engage inaction.But inorderfor that actionto
meansomethingitneedsto be guided bya clear,compellingstrategy thatlaysouta believable path
to change. That doesn’tmeanthe pathwill be easyor certain,butithas to make sense toyou and
your team.
Strategyenablesyoutoturn whatyouhave intowhat youneedto getwhatyou want;how toturn
the resourcesyouhave intothe poweryouneedto achieve aspecific,measurablegoal.Tacticsare
the meansby whichyouachieve yourstrategicgoals.Youconstantlytestyourstrategybytryingnew
tactics,evaluatingthemandimprovingovertime,while stayingcompletelycommittedtoyour
ultimate goal.Goal first: thenstrategy.
Tactics are the on the groundimplementationof yourstrategy,whenyoucanturn yourresources
intoactions.It’simportantnotto thinkof strategyasbig and tacticsas small:theyare equally
important.Strategywithouttacticsisjustsome goodideas,andtacticswithoutstrategyisa waste of
resources:youwill lose powerasyougo - insteadof buildingit - and burnout.
Beloware some questionswhichmaypromptyourthinkingasyoudevelopastrategyto grow a
movementforchange.Theyare designedtohelpyoudevelopconcrete,realisable goalsaround
whichyoucan organise withotherpeople inyourcommunity.

24
ACTIVITY: Strategy and tactics
What is the problem that is bothering us that we want to change?
Can we break that problem down into issues?
Can we think of a creative and realistic solution tothose issues?
Is the change both worthwhile and winnable?
Who has the ability to deliver the change we want to see?
What action is needed for us to engage that person? What do we thinkwould motivate
them to engage with us and to make the change we want to see?
How powerful are we (do we have the ability to act)?
Can we grow a team that is prepared to commit time, resources and take action to run
this campaign? Who else do we need to make it happen?
Reflection and evaluation
“You did whatyou knewhowto do and when you knew better you did better.”
Maya Angelou
No matterhowtalentedyouare,nomatter how committedyouare,nomatter how much time you
spendwinningoverpeople inyour hospital,yourworkplace oryourcommunity:youwill face
resistance. Leadingchange isnoteasy.Oftenthe problemscome notfromexpectedopponentsbut
fromthose who “should”be friendsandallies.Youwill face those inyourowngroupwho organise
to maintainastatus quorather than tochallenge it.

25
Evaluatingthe actionswe take to leadchange withothersisessential tobeingeffective. If youare
foreverwalkingalonethenyouneedtoreassesswhatyouare doing.Self-reflectionandevaluation
are notthe same as self-doubt.Usedasa central part of strategy,theyhelpustobuildthe resilience
neededforsustained actioninthe face of resistance.
Unlessyouare repeatedlyaskingyourself whatyouhave,whatyouneedandwhatyouwantyou are
not beingstrategic.Developingleadershipmeansensuringyourteam members are learningfrom
each campaignaction.Evaluationisessential tostrategybutitisalsodependentonstrategic
thinkinginthe firstplace:withoutaclearobjective for yourwork itisdifficulttoevaluate whether
we were successful inachievingit.
Be relentlessinyourpursuitof change throughshort-termvictoriesanddefeats. Be preparedfor
meetingswhenno-one turnsupbefore youbuildthe supportyouneedto winchange.Be prepared
to be out-manoeuvredandout-thoughtbypowerful interests,atleastatthe outset.“Fight,fail,fight
again”has beenthe path every leaderof change hashadto tread.
Buildingevaluationintoourorganisingissoeasythat itis difficulttounderstandwhywe don’tdoit
more often.Incampaignsitcan be as easyas askingpeople atthe endof a meeting oractionto wait
aroundfor 5 minutesandassesshowthingswent.Thiscanbe done standingupand witha simple
listof questions.

26
ACTIVITY Reflection and evaluation
How do we each feel?
What happened?
What was our plan of action?
Did we follow it? (why not?)
What was the reaction?
Did we achieve our goal today?
Were there any surprises?
What did we learn?
What will we do differently next time?
Did we need more information?
What are our next steps?
Reference list
Here are some of the referencesthatwe will refertointhe minicourse andinthe studyguide and/or
whichwe have usedto helpshape the content.Clickonthe reference togetthe link.
AndersonL(2014) ‘Collectivewisdom:are we makingthe mostof interprofessional education?’
Lecture presentedatUniversityof Leicester,6th
February2014
Babasab P(2013) SlideShare onself-efficacy
Bandura,A. (1997). Self-efficacy:theexercise of control.New York: W.H. Freeman

27
Baron A (2014) Preparing fora changing world:thepowerof relationships
Bate P,BevanH, RobertG (2004) Towardsa millionchange agents:areview of the social movements
literature:implicationsforlarge scale change inthe NHS
BattilanoJ,CasciaroT (2013) The networksecretsof the great change agents Harvard Business
Review,July-August
BevanH (2011) Leading Large Scale Change - Part2, The Postscript
BevanH (2013) Rockingthe boatand stayinginit: how to succeedasa change agentinhealthcare
BMJ blogs
BevanH, PlsekP,Winstanley(2011) Leading LargeScale Change - Part 1, A Practical Guide
BevanH, FairmanS (2014) The neweraof thinkingandpractice inchange and transformation, NHS
ImprovingQuality
BoydS (2014) Is cultural fita cop-out?
Bushe G (2009) DialogicOD TurningAwayfrom Diagnosis
Bushe G, Marshak R (2010) RevisioningOrganisationDevelopment:DiagnosticandDialogicPremises
and Patternsof Practice
Cancer PreventionResearchCentre DetailedOverview of the Transtheoretical Model
Change AgentsWorldwide(2013) Moving forward with socialcollaboration SlideShare
ChangeAgentsWorldwide websitehttp://changeagentsworldwide.com
CroftJ, “Catch ThemBefore TheyJump”,Harvard KennedySchool,(2010)
Corporate rebelswebsite http://corporaterebelsunited.com
Dias-UdaA, MedinaC,Schill E (2013) Diversity’snew frontier
Dias-UdaA, MedinaC andSchill E (2013) Diversity’snew frontier
Ehrenreich,B(2008) Dancingin the Streets:A Historyof Collective Joy
FarquharK (2013) NTL’s ‘Conference onthe New OD’: TurningThoughtintoAction
Fuda P(2012) 15 qualitiesof a transformationalchange agent
GaloppinL (2013) Communitydevelopmentisthe new change management
Ganz M (2007) Tellingyourpublicstory:self,us,now
Ganz M (2009) Why storiesmatterSojourners
Gecan,M (1992) Going Public: AnOrganizer’sGuide toCitizenAction
GerberL (2011) Innovationself-efficacy:fosteringbeliefsinourabilitythroughandbydesign Core77
Granovetter,M(1983), The Strengthof Weak Ties:a NetworkTheoryRevisited SociologicalTheory
(Blackwell) 1:201–233
Grant, M (2014) Humanise:Howpeople centric organisationssucceed in a social world
http://presi.com/usju20i0nshd/humanise-how-people-centric-organisations-succeed-in-a-social-
world/
Hamel G (2014)Why bureaucracy mustdie
Han, H (2014) How OrganizationsDevelopActivists,“ChapterOne:Introduction”(pp.1-28)

28
Heifits,R(1998) LeadershipWithoutEasyAnswers,“ValuesinLeadership”,Chapter1(pp.13-27)
HeimensJ,TimmsH (2014) Understandingnew power, Harvard BusinessReview
https://hbr.org/2014/12/understanding-new-power
HolmanP (2013) A Call to Engage:Realisingthe Potentialof DialogicOrganisationDevelopment
Jarche,H (2013) Rebels on the edges
Jarche H (2014) Moving to the edges
JohnsonS(2010) Where good ideascome from A fourminute videothatexplainshow atruly
innovative environmentencouragesdiversityof thoughtand experience
Kegan,R and Lahey,L (2009) Immunityto change.Boston,Mass:Harvard BusinessSchool Press.
Kelly,L‘Rebelsatwork’website http://www.rebelsatwork.com/
KotterJ (2014) Accelerate! Harvard BusinessReview Press
KotterJ and CohenD (2011) The heartof change:real-life storiesof how peoplechangetheir
organisations.Boston,Mass:HarvardBusinessReview Press
LeVanA (2010) If you thinkyoucan’t…thinkagain:the swayof self-efficacy PsychologyToday
LlopisG (2014) Every leadermustbe a changeagentor faceextinction
Merchant N (2012) 11 rules forcreating valuein a social era
Merchant N (2013) elevenrulesforcreatingvalue inthe social era
MeyersonD (2001) Change agentchange,the quietway Harvard BusinessPress
MeyersonD (2001) Tempered Changeagents:how peopleusedifferencesto inspire changeatwork
MeyersonD (2008) Rocking the boat:how to effectchangewithoutmaking trouble HarvardBusiness
Press
Miller,D (2011) A millionmilesinathousandyears
Miller,JB (1991) Women’sGrowthin Connection:Writingsfromthe StoneCenter,Chapter11,
“Womenand Power”(pp.197-205)
Mintzberg,H (1987) “CraftingStrategy”, Harvard BusinessReview,July1987 (pp.67-74)
Moore,R (2011) Competency modelforunderstanding and working with systemenergy.
http://rickhuntleyconsulting.com/resources.html
Mootee I (2013) Diversityisthe shortcut to buildinganinnovationculture
NHS Institute forInnovationandImprovement(2010) Resistance –workingwithit
Page S (2007) Making the difference:applyingalogicof diversity Academy of Management
Perspectives
PosnerB (2013) TED talk ‘The truth aboutleadership:“Youmake a difference andyoucan’tdo it
alone”’
ProchaskaJ, DiClemente C,NorcrossJC(1992). In search of how people change.Applicationsto
addictive behaviours AmPsychol47:1102
PerkinsN (2014) Batsand pizzas (agilityand organisationalchange)
Rockwell D(2014) Tenwaysto eliminate isolationandconnect
http://leadershipfreak.wordpress.com/2014/01/30/10-ways-to-eliminate-isolation-and-connect/

29
SchillingerC(2013) Disrupted,Disruptors…..Unite!
SchillingerC(2014) Top-Down isa Serious Disease.But It Can Be Treated
School forHealthcare change agents(2014) www.changeday.nhs.uk/healthcarechange agents
ShinnersC(2014) NewMindsetsforthe WorkplaceWeb
SitkinS(1992) “LearningThroughFailure:The Strategyof Small Losses”,Research in Organizational
Behavior,Vol.14,1992, (pp.231-256).
SmithP (2012) Leadwitha Story: A Guide toCraftingBusinessNarrativesthatCaptivate,Convince,
and Inspire (AMACOMBooks,August,2012) http://www.amason.com/Lead-Story-Crafting-
Narratives-Captivate/dp/0814420303/ref=sr_1_1?s=books&ie=UTF8&qid=1344862047&sr=1-
1&keywords=Lead+with+a+Story
Sparks,D (2013) The everydayleadershipof tempered change agentsChangeagentLearnersblog
Stepper,J(2015) Working outLoud http://johnstepper.com/working-out-loud-the-book/
StoddardJ (2014)The future of leadership
VerjansS(2013) How socialmedia changestheway we work together
WeberShandwick(2014) Employeesrising:seizing the opportunity in employeeactivism
Wenger,E (1998) ‘Communitiesof Practice.Learningasasocial system’,SystemsThinker
Wilson,D.(2010) BuildingBridgesforChange:How LeadersEnable Collective Changein
Organisations,Developmentand Learning in Organisations, Vol.24Iss: 1, pp.21 – 23
WilliamsB(2014) WorkingOutLoud: WhenYou Do That… I Do This

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