Championing change in a changing world

Championing change in
a changing world
Source of image: @voinonen
:
Helen Bevan
@HelenBevan
#LeadingChangeMHVC

3 |
• Welcome : what we will be doing today
• Table introductions: what is changing for me
• How change is changing and implications for change in
health and care
• How to make change happen: agency versus structure
• Change starts with me
• Being a boat rocker (but not falling out)
• An unconference (like a conference, only better)
• Action planning
• The commitment line: crossing it
Our agenda

4 |
Five proposed ground rules
1. we're all equal (no hierarchy)
2. Everyone participates and listens, equally
3. What is said here stays here
4. No idea is stupid
5. No topics are off the table

7 |
• Think about a change that you are leading or is
happening in your work or life right now.
• Pick a card that represents or captures something
about this change
• Introduce yourself to other people on your table and
tell your story using the card
Pick a card
@helenbevan #LeadingChangeMHVC

8 |
The English NHS: facts and figures
• The world’s largest publically funded health system
• Provides comprehensive healthcare to 54 million
people
• Sees a million patients every 36 hours
• Funded by direct tax
• It’s free at the point of use
• Provides 95% of the healthcare in England

The NHS is the 5th biggest employer
on the globe
Source: BBC@helenbevan #LeadingChangeMHVC

COMPLIANT POWERFUL!
CHANGE AGENTS
WANT TO ROCK THE BOAT BUT NOT FALL
OUT?
• ‘Live’ from 15th February 2018
• 5 modules, 5 weeks
• Every Thursday 15.00-16.00
GMT
• Live webinar
• Recordings available
• Completely free and open to all
• Handbooks and study guides
• Meet fellow change agents from
• across the globe
http://horizonsnhs.com/school/#S4Change
@SCH4Change
Join the

The Imagination Age: coming to a health
and care system near you soon
Imagination Age

The imagination age - an era beyond the
information age
• Creativity and imagination will become the primary creators
of economic value
• Film-based platforms will change the way humans interact
with each other and create economic and social structures
• Virtual reality and cyberspace will raise the value of
imagination-based work of designers, artists, video makers
and actors over rational thinking
Source: Goran Henriks

14 |
Advice for change agents

15 |
Two of our
sketchnotes have
been shared over a
million times

We still organise health and care like the
Tabulating Machine Co. of 1917
Source of image: @corp_rebels@HelenBevan #LeadingChangeMHVC

The biggest shifts we are seeing
are shifts in power
Power is the ability
to produce intended
effects
Bertrand Russell

Jeremy Heimens, Henry Timms New Power: How it’s changing the 21st Century and why you need to know
(2018)
new power
Current
Made by many
Pulled in
Shared
Open
Relationship
old power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction

The Network Secrets of Great
Change Agents
Julie Battilana &Tiziana Casciaro
As a change agent, my centrality in the
informal network is more important than my
position in the formal hierarchy

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

Find the superconnectors!
Just 3% of people in the organisation or system
typically influence 85% of the other people
Source: Organisational Network Analysis by Innovisor

Find the 3%:
meet Mandy Carney, Head of
Patient Flow at Yeovil Hospital
“Knows everyone in the hospital”
“Everyone follows Mandy on
Facebook”
The go-to person for advice
Mandy makes sense of things
and reduces ambiguity for people
Mandy presents her own monthly
award “the Carney cup”

As senior leaders, we are less
influential than we think
If we want to get the same level of influence
through top down change as the 3% get, we
need four times more people
Source : Jeppe Hansgaard

The 3% rule also appears true for social
media
Source: research by Graham MacKenzie using NodeXL
In health and
healthcare globally,
tweets by 3.3% of
tweeters accounted
for 85% of retweets
@HelenBevan #LeadingChangeMHVC

Across the world, trust is imploding
Source: http://www.edelman.com/news/2017-edelman-trust-barometer-reveals-global-implosion / 27
Peers are now as credible as experts

The inversion of influence
Based on the Edelman Trust Index: the
average of a country’s trust in the institutions
of government, business, media and non-
governmental organisations

A world of distrust: Edelman Trust Barometer

Patients, families, citizens & social media
Sources: Benetol et al (2018) How patients’ use of social media impacts their interactions with
healthcare professionals; @RealDoctorMike (2017) Patients trust social media, so be their trusted source
People living with long term conditions and with
cancer are some of the most engaged and active
audiences on social media
Research shows:
• Patients and consumers gain agency by using social
media for health-related purposes
• It improves their relationship with their healthcare
professionals
• Overt or tacit opposition from some healthcare
professionals
Patients trust social media, so we must be their
trusted source

Empower your staff to be the voice of the
organisation. They’ve got audience & credibility

Mark Jaben on the science behind resistance
What NOT to do
(but what we usually do)
We don’t need buyers (who “buy-in” to change)
We need investors
What TO do
Engage
people here
Engage
people here

A big debate in social science
Structure versus Agency

34 |
The predominant approach in recent years has been
STRUCTURE but globally there is a big shift towards AGENCY
The design dilemma at the heart of change
Operational standards
Performance goals
Compliance
Assurance
Regulation
Programme
Management
Incentive systems
Activation
Ability to make choices
Co-production
Capability
Leaders everywhere
Social action
Solidarity
Social movements

The power, individually
and collectively, to
make a positive
difference

Source: @NHSChangeDay
36

37

Problematic:
changing a
“permission
culture” can
take years
The good
news: we can
usually build
agency much
more quickly 38

3 principles for spreading change through
agency
ACTIONABLE: The idea is designed to make you do
something. It might start with sharing but it’s a call to
action
CONNECTED: The idea promotes a closer connection with
people you care about or share values with. It makes you
feel part of a community and the network effect creates
further spread
EXTENSIBLE: The idea can be easily customised, remixed,
reshaped by people taking part. It’s structured with a
common stem that encourages communities to alter and
extend it Jeremy Heimens, Henry Timms New Power: How it’s
changing the 21st Century and why you need to know (2018)@HelenBevan #LeadingChangeMHVC

Making sure that only people who
should be in hospital are in
hospital
• The number of hospital beds occupied by patients
whose transfer of care has been delayed should be
reduced to 3.5%
• Less than 15% of assessments [for continuing care]
should take place in an acute hospital setting;
• a standardised performance dashboard

70 day challenge:
to give patients
back one million
days of their
precious time that
would otherwise
be wasted in bed
in a hospital or@HelenBevan #LeadingChangeMHVC

#endpjparalysis: connected social
communities

Royal Devon and Exeter Hospital

Source: Bromford P (2015) What’s the difference between a test and a pilo

Google image
search using the
word ‘nurse’
Google image
search using the
word ‘doctor’

#Futurenursing nhs70.crowdicity.com@HelenBevan #LeadingChangeMHVC

Transforming perceptions of nursing
A digital platform was set up to capture ideas on how about
transform perceptions of nursing and midwifery. It was live for five
weeks between December 2017 and January 2018, supplemented
by Twitter chats.
As a result there were:
29,000 interactions
212 original ideas from the ideas
platform
8,520 post views
Nearly 1,000 original tweets in twitter
chat which generated 40 more ideas

59 |
We are not outside of the change:
we ARE the change
Source of graphic: Reos Partners
Source of graphic: @gapingvoid@helenbevan #LeadingChangeMHVC

60 |
The success of our actions as change-makers
does not depend on what we do or how we do
it, but on the inner place from which we
operate”
Otto Scharmer
Leading from the emerging future

“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

62 |
What happens to
rebels/heretics/radicals/mavericks
in organisations?
Source of image: thinglink.com
?

Source: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-ou

65 |
We need to be boatrockers!
Source: Debra Meyerson
• Rock the boat but manage to stay in
it
• Walk the fine line between difference
and fit, inside and outside
• Conform AND rebel
• Capable of working with others to
create success NOT perceived by
others as a destructive troublemaker

Source: adapted from Rebels at Work

67 |
“A cynic, after all, is a
passionate person who
does not want to be
disappointed again.”
Source of graphic: Benjamin Zander’s TED talk

Source of image: Tord the Meme
by Marley Bryn
The world feels
terrible if I
choose to
distrust it

70 |
Reflection
• What are your insights around “boatrocking” and
“falling out”?
• What moves people from being “boatrockers” to
“falling out”?
• How do we protect against this?

72 |
More reading
Source of graphic : Umair Haqu
Lois Kelly and Carmen Medina The rebel at work handbook
Harvey Schachter How to be a rebel, not a troublemaker at
work
Debra Meyerson Tempered radicals: how people use difference
to inspire change at work
Jane Watson A spotter’s guide to rebels and cynics
Umair Haque How to be more loving in a cynical world
Clark Quinn Skeptical optimist or hopeful cynic? A science
mindset
Marcella Bremer Cynicism or opticism?

74 |
• Teresa Amabile, Harvard Business School: studied the
"inner work life" diaries of 238 professionals
• Best days were when they were able to move forward in
their work
Source: The Progress Principle: Using Small Wins to Ignite Joy,
Engagement, and Creativity at Work
Emphasise progress
 700 managers were asked
to rank five employee
motivators, including
recognition and incentives.
They ranked progress last

the collective brilliance of people
who work in ambulance services
(with the help of a few critical friends)

Ideas platform 12th July to 5th September
https://projecta.crowdicity.com/

80 |
Ambulance service improvement tweet chat
#ProjectA
17th July: A one hour tweet
chat on partnerships
between ambulance staff,
patients and the public
537 people participated,
generating 1,409 tweets
and 77 new ideas!
This analysis shows a high level of engagement with the community and
strong connections between key influencers. Source: NodeXL
Source: FollowtheHashtag
People took part
in the tweet
chat from across
the world
Source:

82 |
What we are working on now
Action on falls: a collaboratively designed falls response framework
Action on mental health and emotional distress: an actionable
“knowledge bank” for use by frontline ambulance staff
Action on partnership: people, families and the wider community:
Co-producing a campaign that focusses on how to access and use
services; a social movement rather than broadcasting messages
Action on staff wellbeing: implementing clinical supervision across all
ambulance services
A directory of ideas for improvement: Share 70 ideas from #ProjectA
and create a series of challenges to help make them happen.
Virtual collaboration: Building the capability of the ambulance
workforce to collaborate virtually; reducing time away from work and
abstraction; increase opportunities for sharing, learning and speeding

The process has been 90% virtual

“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

86 |
What do successful social movements
do?
• Define the change they want
to see
• Identify the pillars of power
• Create a spectrum of allies
• Seek to attract not overpower
• Build a plan to survive victory
Source: Satell G (2017)
How to create
transformational change,
according to the world’s
most successful social@HelenBevan #LeadingChangeMHVC

87 |
• Did we accomplish the goal we were trying to
accomplish?
• Did our community grow stronger? (create
capacity; new power – power we didn’t have before)
• Did individuals involved in the whole effort learn,
grow and develop their capacity to organise with
others?
How would we know if we are successful
from a social movement perspective?
Source: Greg Satell

89 |
What is the best way to spread new
knowledge?
Source of data: Nick Milton
http://www.nickmilton.com/2014/10/wh
y-knowledge-transfer-through.html
Social connection/discussion is
14 times more effective
than
written word/best practice
databases/toolkits etc.
Source of image: www.happiness-one-quote-time.blogspot.com

91 |
The Fundamental Law of Unconferencing
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

92 |
Our unconference process
• Having taken part in the workshop so far,
think about a topic that you would like to
explore with other people
• It should be a topic that you want to take
action on over the next twelve months to
take your agenda forward
• Line up to pitch your idea

94 |
The unconference:
4 principles and a law
Principles:
1. Whoever comes are the right people
2. Whatever happens is the only thing that could have
happened.
3. When it starts is the right time
4. When it's over it's over
The Law is known as the Law of Two Feet:
"If you find yourself in a situation where you are not contributing
or learning, move somewhere where you can."

Feedback
95
• Identify one person from your table
to feedback to the wider group
• Feedback:
• The topic you discussed
• One insight you gained from the
activity
• Give your feedback in two breathes

ABC, 30 – 60 – 90 Days - Ideas for Action
Longer Term Actions
Adapted from www.idenk.com
What could we
speed up / do
more of ?
(Accelerate)
What could we
stop doing ?
(Brake)
What could we
start doing?
(Create)
The next month The next 2 months The next quarter

Crossing the
commitment line
97
You’ve
crossed
the line!

98 |
Have we got the power to change things?
Research with groups shows a 25%-10%-3% pattern:
When a minority group pushing change was below
25% of the total group, its efforts failed. But they reached 25%,
the majority of the population adopted the new way of thinking
very quickly
When just 10% of a population holds an unshakable
belief, their belief is likely to be adopted by the majority
Typically in organisations, around 3% of people (the
informal influencers) drive conversations and influence 85% of
other people. They are not typically the senior leaders
Source: Harold Jarche 2018: 25-10-3

Championing change in a changing world

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