Rocking the boat and staying in it

@helenbevan
Rocking the boat and
staying in it:
respiratory leader
as organisational radical
Helen Bevan
Delivery team
NHS Improving Quality
@helenbevan
@NHSIQ

@helenbevan
How does it feel to be a
heretic/radical/rebel/maverick in
our organisation?

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

@helenbevan
Are you a boat rocker?
• One who challenges the status
quo when they see that there
could be a better way
• Energise their organisation by
working from their true self
• Capable of working with others
to create success NOT a
destructive troublemaker
• Walk the fine line between
difference and fit, inside and
outside, rock the boat but
manage to stay in it

@helenbevan
Troublemaker Radical
Complain Create
Me-focused Mission-focused
Anger Passion
Pessimist Optimist
Energy-sapping Energy-generating
Alienate Attract
Problems Possibilities
Alone Together
Source : Lois Kelly www.foghound.com
Sometimes people see us radicals as
troublemakers

@helenbevan
Task
• Talk to others at your table about your
experiences around “rebels” and
“troublemakers”
• Which have you been and why?
• What moves people from being “good” to
“bad”?
• How do we protect against this?

@helenbevan
First they ignore you, then they laugh at you,
then they fight you, then you win
Gandhi

@helenbevan
Valuing radicals
• “New truths begin as heresies” (Huxley, defending
Darwin’s theory of natural selection)
• big things only happen in organisations because of
heretics and radicals

@helenbevan
Four tactics for organisational radicals
1. Start with myself
2. Build alliances
3. Work out what might help others to
change
4. Don't be a martyr

@helenbevan
“There is nothing more
difficult to carry out, nor
more doubtful of success,
nor more dangerous to
handle, than to initiate a
new order of things. For the
reformer has enemies in all
those who profit by the old
order, and only lukewarm
defenders in all those who
profit by the new”
Niccolo Machiavelli 15th century

@helenbevan
"There’s only one corner of the
universe you can be certain of
improving, and that’s your own self."
Aldous Huxley

@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

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

@helenbevan
2. leave the organisation

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

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

@helenbevan
3. stridently challenge the status quo in a manner
which is increasingly radical and self-defeating
 this just confirms what we already know – that
we don’t belong

@helenbevan
1. convictions and values – driven
2. strong sense of “self-efficacy”
 belief that I am personally able to create change
 belief in others
3. action orientated
 ignite collective action
 mobilising others, inspiring change
4. able to join forces with others
 work as a collective body for commonly valued changes
5. able to achieve small wins which create a sense of hope, self-
efficacy and confidence
6. optimistic in the face of challenge
 see opportunities
 take account of obstacles
What do we know about successful boat rockers?

@helenbevan
Three assumptions for organisational
radicals
1. Assume that everyone has a noble intention
2. Motivation and behaviour in a change
process are due to interpersonal interaction
(not just innate character trait)
3. My role as a change agent is about
alignment, not judgement

@helenbevan
The easiest way to thrive as an outlier
...is to avoid being one
Seth Goodin

@helenbevan
“if you want to go fast, go alone. If you want to
go far, go together”
African proverb quoted by Al Gore

@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 do we need to do?
1. Tell a story

@helenbevan
1. Tell a story
2. Make it personal

@helenbevan
1. Tell a story
2. Make it personal
3. Be authentic

@helenbevan
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us”
is)

@helenbevan
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

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

@helenbevan
The model is mostly used around
health-related behaviours
• 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

@helenbevan
The model is mostly used around
health-related behaviours
• 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!

@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
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
I am making plans
& changing things
I do in
preparation.

@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
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!

@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
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

@helenbevan
90% of the tools available for healthcare change
agents are designed for the “action” stage
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

@helenbevan
Example - Surgical Checklist
• 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

@helenbevan
“One key issue is that many doctors already feel
that they are delivering patient centred care –
unfortunately that is not what patients report.”
Dr Nigel Mathers, Vice Chair, Royal College of
General Practice

@helenbevan
So what do we TEND to do?
• 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 leadership for not enforcing change
• Overestimate the motivation of those who say
they’re ready to change and underestimate the
motivation of those who indicate no interest in
change (Lundberg)

@helenbevan
So what SHOULD we do
• Listen and understand
• appreciate the starting point
• elaborate interests
• Build meaning and conviction in the change
• Roll with resistance (Singh)
• Don’t argue against it
• Encourage elaboration of resistance
• What makes it so hard?
• What would help?
• Build shared purpose

@helenbevan
Outwitted
He drew a circle that shut me out -
Heretic, rebel, a thing to flout.
But Love and I had the wit to win:
We drew a circle that took him in.
Edward Markham

@helenbevan
Discussion
What might you do to:
• enhance your own role as a respiratory
maverick, radical or heretic?
• Support other mavericks, radicals or rebels in
your organisation or system?

@helenbevan
....the last era of management was about how
much performance we could extract from
people
.....the next is all about how much humanity we
can inspire
Dov Seidman

@helenbevan
We have a choice
“This is the true joy of life, the being used up for a
purpose recognised by yourself as a mighty
one, being a force of nature instead of a
feverish, selfish little clot of ailments and
grievances, complaining that the world will not
devote itself to making you happy”
George Bernard Shaw

Rocking the boat and staying in it

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