How to rock the boat and stay in it: The School for Health and Care Radicals

1. #MEDX @HelenBevan 17th September 2016 How to the boat and stay in it: The School for Health and Care Radicals #MEDX @HelenBevan

2. # What are you passionate about? What lights the fire in your belly? Source of image: http://www.ignitepeterborough.co.uk/fire-in-your-belly/

3. #MEDX @HelenBevan The Horizons team • A small team of people within the NHS who support improvement and change. • We tune into and engage with the best change thinking and practice in healthcare and other industries around the world and seek to translate this learning into practical approaches to change. • The team has emerged through years of supporting change in the NHS and wider health and care system

4. #MEDX @HelenBevan Stanford Medicine X design principles BE A REBEL Lead as health care rebels. Stand up for what you believe health care should be

5. #MEDX @HelenBevan A question What happens to heretics/radicals/rebels/m avericks in organisations?

6. #MEDX @HelenBevan

7. #MEDX @HelenBevan Source: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

8. #MEDX @HelenBevan Source: @NHSChangeDay

9. #MEDX @HelenBevan How do we break down the wall?

10. #MEDX @HelenBevan Nearly10,000

11. #MEDX @HelenBevan Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

12. #MEDX @HelenBevan How we make a difference The School was formally evaluated by the Chartered Institute for Personnel & Development Statistically significant positive effect on all dimensions of impact at both individual and organisational level • Change knowledge • Sense of purpose & motivation to improve practice • Ability to challenge the status quo • Rocking the boat & staying in it • Connecting with others to build support for change

14. #MEDX @HelenBevan “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection) Installation by the artist Adam Katz www.thisiscolossal.com Source of image via @NeilPerkin

15. #MEDX @HelenBevan WHO makes change happen in healthcare? Source: adapted by Helen Bevan from Leandro Herrera List A • The Transformation Programme Board • The programme sponsor • The Programme Management Office • The leads of the [insert number] transformation work streams • The Clinical Director • The Team Leader /Unit Manager • The Change Facilitator

16. #MEDX @HelenBevan WHO makes change happen in healthcare? List A • The Transformation Programme Board • The programme sponsor • The Programme Management Office • The leads of the [insert number] transformation work streams • The Clinical Director • The Team Leader /Unit Manager • The Change Facilitator List B • The mavericks and rebels • The deviants (positive). Who do things differently and succeed • The contrarians, because they can • The nonconformists who see things through glasses no one else has • The hyper-connected. Good or bad, they spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on • The hyper-trusted. Multiple reasons, doesn’t matter which ones Source: adapted by Helen Bevan from Leandro Herrera

17. #MEDX @HelenBevan WHO makes change happen in healthcare? List A • The Transformation Programme Board • The programme sponsor • The Programme Management Office • The leads of the [insert number] transformation work streams • The Project Manager • The Team Leader /Unit Manager • The Change Facilitator List B • The mavericks and rebels • The deviants (positive). Who do things differently and succeed • The contrarians, because they can • The nonconformists who see things through glasses no one else has • The hyper-connected. Good or bad, they spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on • The hyper-trusted. Multiple reasons, doesn’t matter which ones Source: adapted by Helen Bevan from Leandro Herrera

18. #MEDX @HelenBevan What’s the evidence? The failure of strategic change projects is rarely due to the content or structure of the plans put into action It’s much more to do with the role of informal networks in the organisations/systems affected by change To make transformational change happen we need to connect networks of people who ‘want’ to contribute It therefore a critical ability for leaders of change to ‘craft’ informal networks of change agents to oil the wheels to enable that change to emerge Source: David Dinwoodie (2015) http://iedp.com/articles/vertical-leadership/

19. #MEDX @HelenBevan Which kind of activists are most successful at delivering change? Lone wolves Build power by expertise and information — through advocacy, oversight , contributing to committees, public comments and other forms of consultation Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action Organisers Build power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

20. #MEDX @HelenBevan 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” Applying community organising principles to healthcare improvement 2016 “A one day school for organisational radicals” The genesis of the school

21. #MEDX @HelenBevan Our curriculum 1. Being a health and care radical: change starts with me • How to rock the boat and stay in it • The differences between radicals and trouble makers • Conform AND rebel 2. Forming communities: building alliances for change • You can’t be a radical on your own • Using story and narrative to build a sense of “us” and call others to action • Forming alliances for action 3. Rolling with resistance • Understanding that dissent, disruption and diversity are a welcome part of change • Tactics and strategies for engaging others in change 4. Making change happen • Working with intrinsic and extrinsic motivators for change • Building energy for change • Creating shared purpose 5. Moving beyond the edge • What skills will the change activist of the future need? • Helping radicals to shape how they take their learning from the School forward • What can you do next and where else might you get support and resources?

22. #MEDX @HelenBevan Starts on the fringe (at the edge) Starts with the activists Gary Hamel always

23. #MEDX @HelenBevan http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final

24. #MEDX @HelenBevan Why go to the edge? “Leading from the edge brings us into contact with a far wider range of relationships, and in turn, this increases our potential for diversity in terms of thought, experience and background. Diversity leads to more disruptive thinking, faster change and better outcomes” Aylet Baron Why go to the edge?

25. #MEDX @HelenBevan Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA old power new power Currency Held by a few Pushed down Commanded Closed Transaction Current Made by many Pulled in Shared Open Relationship

26. #MEDX @HelenBevan 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”

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

28. #MEDX @HelenBevan For more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW

29. #MEDX @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

30. #MEDX @HelenBevan “I have some Key Performance Indicators for you” or “I have a dream” Source: @RobertVarnam

31. #MEDX @HelenBevan Leaders who focus on meaning also get compliance, without focusing on it @JeremyScrivens

32. #MEDX @HelenBevan “Tomorrow’s management systems will need to value diversity, dissent and divergence as highly as conformance, consensus and cohesion.” Gary Hamel Image by neilperkin.typepad.com is the new normal!

33. #MEDX @HelenBevan “Tomorrow’s management systems will need to value diversity, dissent and divergence as highly as conformance, consensus and cohesion.” Gary Hamel Image by neilperkin.typepad.com “The single biggest mistake to avoid? Creating disruption at work. Focus on developing relationships, not disrupting and alienating people. Peter Vander Awera on learning from setbacks and failures is the new normal!

35. #MEDX @HelenBevan 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 We need rebels!

36. #MEDX @HelenBevan “If you put fences around people, you get sheep. Give people the room they need” William L McKnight

37. #MEDX @HelenBevan We need to create more boat rockers! • 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 a destructive troublemaker Source: Debra Meyerson We need more boat rockers!

38. #MEDX @HelenBevan There’s a big difference between a rebel and a troublemaker Rebel Source : Lois Kelly www.rebelsatwork.com

39. #MEDX @HelenBevan • What are your insights around “rebels” and “troublemakers”? • What moves people from being “rebel” to “troublemaker”? • How do we protect against this? Reflection

40. #MEDX @HelenBevan Source : Lois Kelly www.rebelsatwork.com There’s a big difference between a rebel and a troublemaker Rebel

41. #MEDX @HelenBevan Change starts with me Source of image: jasonkeath.com

42. #MEDX @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

43. #MEDX @HelenBevan Four things we know about successful boat rockers 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 Source: adapted from Debra E Meyerson CHANGE me BEGINS WITH

44. #MEDX @HelenBevan Self-efficacy “If you think you can or think you can't, you are right.” Henry Ford 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

45. #MEDX @HelenBevan Source: @NHSChangeDay

46. #MEDX @HelenBevan Source: @NHSChangeDay What is the issue here? “permission” ? (externally generated) or Self efficacy ? (internally generated)

47. #MEDX @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 Building self efficacy: some tactics

48. #MEDX @HelenBevan Image credit: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

50. #MEDX @HelenBevan http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

51. #MEDX @HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

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

57. #MEDX @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

58. #MEDX @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. —

59. #MEDX @HelenBevan Being a great change agent is about knowing, doing, living and being innovation and improvement

60. #MEDX @HelenBevan “Ultimately, the secret of quality is love. …… If you have love, you can then work backward to monitor and improve the system” Avedis Donabedian

61. #MEDX @HelenBevan After years of intensive analysis, Google discovers that the key to high performing, innovative teams is being nice Project Aristotle: http://qz.com/625870/after-years-of- intensive-analysis-google-discovers-the-key-to-good-teamwork- is-being-nice/

62. #MEDX @HelenBevan Key tactic : Out-love everyone else Source of image: Bradley Burgess Key tactic: out-love everyone else

63. #MEDX @HelenBevan “You don’t need an engine when you have wind in your sails” Paul Bate

64. #MEDX @HelenBevan Four ways to connect! 1. Follow us on Twitter @HelenBevan @School4Radicals 2. Subscribe to theedge.nhsiq.nhs.uk 3. Get materials from theedge.nhsiq.nhs.uk/school …and sign up for our monthly #EdgeTalks theedge.nhsiq.nhs.uk/edgetalks

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