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OUSR

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Slides for 19th July

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OUSR

  1. 1. #OUSR 19th July 2016 School for Radicals
  2. 2. #OUSR WHO makes change happen in your organisation? Source: adapted by Helen Bevan from Leandro Herrera List A • The Transformation Programme Board [or alternative title] • 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
  3. 3. #OUSR WHO makes change happen in your organisation? 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
  4. 4. #OUSR WHO makes change happen in your organisation? 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
  5. 5. #OUSR Nearly 10,000
  6. 6. #OUSR Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs
  7. 7. #OUSR How we make a difference The School formally evaluated by the Chartered Institute for Personnel & Development Statistically significant positive effect on EVERY dimension 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
  8. 8. #OUSR 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
  9. 9. #OUSR Follow us on Twitter @School4Radicals @HelenBevan @KateSlater2 @OllyBenson
  10. 10. #OUSR Agenda 1. Being a health and care radical: change starts with me 2. Building energy for change 3. Forming communities and connecting emotionally with change 4. Change programmes versus change platforms 5. Rolling with resistance 6. An “unconference”
  11. 11. #OUSR
  12. 12. #OUSR
  13. 13. #OUSR Everyone has gifts and strengths What superpower do you have?
  14. 14. #OUSR 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” Applying community organising principles to healthcare improvement 2016 “A one day school for organisational radicals”
  15. 15. #OUSR The Five Year Forward View Mentions “radical” 12 times “transformation/transformational” 13 times “change” 42 times
  16. 16. #OUSR The OU Student First paper Contains the following words: • Change = 20 • Innovate = 19 • Adapt = 10 • Radical = 0
  17. 17. #OUSR “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
  18. 18. #OUSR Source: @NHSChangeDay
  19. 19. #OUSR People who are highly connected have twice as much power to influence change as people with hierarchical power Leandro Herrero http://t.co/Du6zCbrDBC
  20. 20. #OUSR Change is changing
  21. 21. #OUSR Kinthi Sturtevant, IBM 13th annual Change Management Conference June 2015 We rarely see two, three or four year change projects anymore. Now it’s 30-60-90 day change projects
  22. 22. #OUSR Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
  23. 23. #OUSR Change is changing
  24. 24. #OUSR
  25. 25. #OUSR
  26. 26. #OUSR How does the NHS improvement community prefer to communicate?
  27. 27. #OUSR Change is changing
  28. 28. #OUSR
  29. 29. #OUSR Change is changing
  30. 30. #OUSR
  31. 31. #OUSR
  32. 32. #OUSR Change is changing Change from the edge
  33. 33. #OUSR http://www.slideshare.net/Openpolicymaking/policy-lab-slide- share-introduction-final
  34. 34. #OUSR 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
  35. 35. #OUSR 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
  36. 36. #OUSR 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
  37. 37. #OUSR Is your change process a cathedral or a bazaar? http://www.unterstein.net/su/docs/CathBaz.pdf
  38. 38. #OUSR We have a lot of cathedrals Source: Sewell (2015) : Stop training our project managers to be process junkies
  39. 39. #OUSR “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!
  40. 40. #OUSR “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!
  41. 41. #OUSR
  42. 42. #SHCR @HelenBevan What happens to heretics/radicals/rebels/mavericks in organisations?
  43. 43. #SHCR @HelenBevan
  44. 44. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevanSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out
  45. 45. #SHCR @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
  46. 46. #SHCR @HelenBevan If you put fences around people, you get sheep. Give people the room they need William L McKnight
  47. 47. #SHCR @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
  48. 48. #SHCR @HelenBevan Source : Lois Kelly www.foghound.com There’s a big difference between a rebel and a troublemaker Rebel
  49. 49. #SHCR @HelenBevan Reflection • What are your insights around “rebels” and “troublemakers”? • What moves people from being “rebel” to “troublemaker”? • How do we protect against this?
  50. 50. #SHCR @HelenBevan Source : Lois Kelly www.rebelsatwork.com There’s a big difference between a rebel and a troublemaker Rebel
  51. 51. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
  52. 52. #SHCR @HelenBevan What is a RCT?
  53. 53. #SHCR @HelenBevan Randomized Coffee Trial!
  54. 54. #SHCR @HelenBevan Outcomes of randomised coffee trials
  55. 55. #SHCR @HelenBevan Change starts with me Source of image: jasonkeath.com
  56. 56. #SHCR @HelenBevan "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
  57. 57. #SHCR @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
  58. 58. #SHCR @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
  59. 59. #SHCR @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
  60. 60. #SHCR @HelenBevan What’s the difference between self efficacy and self esteem, self belief, self-confidence?
  61. 61. #SHCR @HelenBevan Source: @NHSChangeDay
  62. 62. #SHCR @HelenBevan Source: @NHSChangeDay What is the issue here? “permission” ? (externally generated) or Self efficacy ? (internally generated)
  63. 63. #SCHR @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
  64. 64. #SHCR @HelenBevan 1. strong sense of “self-efficacy”  belief that I am personally able to create the change 2. able to join forces with others to create action 3. able to achieve small wins which create a sense of hope, possibility and confidence 4. More likely to view obstacles as challenges to overcome Four things we know about successful boat rockers Source: adapted from Debra E Meyerson CHANGE me BEGINS WITH
  65. 65. #SCHR @HelenBevanImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
  66. 66. #SCHR @HelenBevan
  67. 67. #SCHR @HelenBevan C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  68. 68. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  69. 69. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  70. 70. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  71. 71. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  72. 72. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively Make it a personal PERFORMANCE target.
  73. 73. #SCHR @HelenBevanSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  74. 74. #SCHR @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
  75. 75. #SCHR @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. —
  76. 76. #SHCR @HelenBevan Being a great change agent is about knowing, doing, living and being improvement
  77. 77. #SHCR @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”.
  78. 78. #SHCR @HelenBevan Key tactic : Out-love everyone else Source of image: Bradley Burgess
  79. 79. #SHCR @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?
  80. 80. #SHCR @HelenBevan The capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals http://www.institute.nhs.uk/tools/energ y_for_change/energy_for_change_.html We need to focus on a different kind of energy for change
  81. 81. #SHCR @HelenBevan Psychological Physical Spiritual Social Intellectual Energy for change
  82. 82. #SHCR @HelenBevan Social energy Energy of personal engagement, relationships and connections between people It’s where people feel a sense of “us and us” rather than “us and them”
  83. 83. #SHCR @HelenBevan Spiritual energy Energy of commitment to a common vision for the future, driven by shared values and a higher purpose Gives people the confidence to move towards a different future that is more compelling than the status quo
  84. 84. #SHCR @HelenBevan Psychological energy Energy of courage, resilience and feeling safe to do things differently Involves feeling supported to make a change and trust in leadership and direction
  85. 85. #SHCR @HelenBevan Physical energy Energy of action, getting things done and making progress The flexible, responsive drive to make things happen
  86. 86. #SHCR @HelenBevan Intellectual energy Energy of analysis, planning and thinking Involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/ evidence
  87. 87. #SHCR @HelenBevan High and low ends of each energy domain Low High Social isolated solidarity Spiritual uncommitted higher purpose Psychological risky safe Physical fatigue vitality Intellectual Illogical reason
  88. 88. #SHCR @HelenBevan Some questions • Which group likely to have higher spiritual energy scores (clinicians/non clinicians?) • Nearer to CEO, higher or lower energy scores?
  89. 89. #SHCR @HelenBevan • Are particular energy domains more dominant than others for our team at the moment? • Is this the optimal energy profile to help us achieve our improvement goals? Energy for change profile 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual
  90. 90. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 1: what’s your assessment of their energy for change?
  91. 91. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 2: what’s your assessment of their energy for change?
  92. 92. #SHCR @HelenBevan There has never been a time in the history of health and care when this advice has been more pertinent “Leadership is not about making clever decisions and doing bigger deals. It is about helping release the positive energy that exists naturally within people” Henry Mintzberg
  93. 93. #SHCR @HelenBevan The power of the platform “Facebook, YouTube, Twitter and their lesser cousins have proved the power of the platform. They have shown that if your average 21st century citizen is given the tools to connect and the freedom to create, they will do so with enthusiasm, and often with an originality that blindsides the so-called creative industries. ….. Good leadership is no longer about ‘taking charge’ or imposing a strategic vision but about creating the platforms that allow others to flourish and create” Ashoka http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in- the-21st-century
  94. 94. #SHCR @HelenBevan • systematic “change management” • too often, leaders prescribe outcome and method of change in a top-down way • change is experienced by people at the front line as “have to” (imposed) rather than “want to” (embraced) Change Programmes • everyone (including service users and families) can help tackle the most challenging issues • value diversity of thought • connect people, ideas and learning • Role of formal leaders is to create the conditions and get out of the way Change Platforms “Tear down the walls”
  95. 95. #SHCR @HelenBevan Why platforms? Platforms today power learning and innovation at the speed of change by providing collaborative and sometimes exponentially productive spaces for people to create value John Hagel Source of image: Pinipa
  96. 96. #SHCR @HelenBevan Evolving kinds of change platforms: They overlap! 1. Connecting platforms 2. Mobilising platforms 3. Learning platforms 4. Knowledge platforms 5. Crowdsourcing platforms
  97. 97. #SHCR @HelenBevan Example platforms Source of image: @JenniferClemo
  98. 98. #SHCR @HelenBevan What are the features of your ideal change platform? Resource bank Library Crowdsourcing Social media feed Blog CURATION - Resource bank - Library - Best practice - News feeds - Guidelines and policy - Webinars - FAQs COMMUNITY - Social media feed - Blogs - Vlogs - Personal profiles - Forums - Chat function - Communities of Practice - Topic of the month - Stories COMMUNICATION - Bulletins - Press releases - Notice board - Diary / calendar - Document share - Project Management CREATION - Crowdsourcing - Challenges - Innovation - Prizes / funds Collaboration
  99. 99. #SHCR @HelenBevan http://biggerboat.org/exploring-moodocs/ MOODOCs (Massive, Online, Open, Disease Oriented Communities)
  100. 100. #SHCR @HelenBevan The Academy of Fabulous Stuff • Half a million page views • Over 700 fab shares • 1,500 to 4,000 page views a day • Nottingham Safe staffing app: 2,500 views • Dovetailing vaccinations Scheme: 160 direct queries
  101. 101. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan https://youtu.be/eUApgJBZU8M
  102. 102. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan Source: OpenIdeo https://challenges.openideo.com/challenge/end-of-life/refinement
  103. 103. #SHCR @HelenBevan
  104. 104. #SHCR @HelenBevan Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs
  105. 105. #SHCR @HelenBevan Nearly 100,000 connections (defined as a viewing, a download of material or an original tweet) • Latest no-cost solutions • 150 speakers • 28 topics • Live broadcast and on-demand
  106. 106. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
  107. 107. #SHCR @HelenBevan Should we undertake routine radiology investigations overnight for all our inpatients? How to build a change platform in an hour
  108. 108. #SHCR @HelenBevan • Platform established and presented to global audience in less than three days • 60 minute sprint followed by a two week window for further ideas and discussion • 3,000+ connections • good level of support for a 24/7 service for inpatients • consensus that the decision to receive a scan during unsocial hours was patient led • yet many participants commented that it should be a joint decision between clinician and patient • Panel at Nottingham University Hospitals is reviewing findings, ideas and agreeing next steps for implementation elp create a change platform in an hourRather than a consultation exercise that can take weeks, we set up a crowdsourcing platform to get an answer in an hour
  109. 109. #SHCR @HelenBevan The Change Challenge Tapping the collective brilliance of the NHS
  110. 110. #SHCR @HelenBevan 14,000 contributions identified 10 barriers to change: Confusing strategies Over controlling leadership Perverse incentivesStifling innovation Poor workforce planning One way communication Inhibiting environment Undervaluing staff Poor project management Playing it safe
  111. 111. #SHCR @HelenBevan 14,000 contributions identified 11 building blocks for change: Inspiring & supportive leadership Collaborative working Thought diversityAutonomy & trust Smart use of resources Flexibility & adaptability Long term thinking Nurturing our people Fostering an open culture A call to action Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015 Challenging the status quo
  112. 112. #SHCR @HelenBevan Project Aristotle: http://qz.com/625870/after-years-of-intensive- analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/ After years of intensive analysis, Google discovers that the key to high performing, innovative teams is psychological safety
  113. 113. #SHCR @HelenBevan Some lessons 1. You can’t control the outputs of the crowd 2. People want a relationship 3. Always, always, follow up
  114. 114. #SHCR @HelenBevan The Natural Environment Research Council asked the crowd to name its new £200 million polar research vessel
  115. 115. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan TEN TIMES as many votes as the next most popular answer
  116. 116. #SHCR @HelenBevan
  117. 117. #SHCR @HelenBevan ”If people give to a cause, they expect a relationship, not a transaction” Nilofer Merchant Once you start down this path, you have to follow up and continue
  118. 118. #SHCR @HelenBevanSource of image: outskirtsbattledome.wikispaces.com The easiest way to thrive as an outlier ...is to avoid being one Seth Goodin
  119. 119. #SHCR @HelenBevanFor more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW
  120. 120. #SHCR @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
  121. 121. #SHCR @HelenBevan 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 ‘
  122. 122. #SHCR @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
  123. 123. #SHCR @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
  124. 124. #SHCR @HelenBevan
  125. 125. #SHCR @HelenBevan Calls to Action
  126. 126. #SHCR @HelenBevan Leadership is…. …the art of mobilising others to want to struggle for shared aspirations Jim Kouzes Source of image: environmentvictoria.org.au
  127. 127. #SHCR @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)
  128. 128. #SHCR @HelenBevan What’s the financial incentive? Who is performance managing? What’s the project plan? Source: @RobertVarnam
  129. 129. #SHCR @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
  130. 130. #SHCR @HelenBevan 1. People speak intellectually but engage emotionally 2. Facts are hard to remember and easy to challenge 3. If we only talk about our success people won’t believe us 4. People don’t want more communication; they want meaningful communication http://www.peterfuda.com/2014/10/30/traditional-comms-fail-engage/ Four gaps between how we communicate change how people engage with that communication
  131. 131. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan “I have some Key Performance Indicators for you” or “I have a dream” Source: @RobertVarnam
  132. 132. #SHCR @HelenBevan If we want people to take action, we have to connect with their emotions through values action values emotion Source: Marshall Ganz
  133. 133. #SHCR @HelenBevan
  134. 134. #SHCR @HelenBevan
  135. 135. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan 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 Source: Marshall Ganz
  136. 136. #SHCR @HelenBevan ‘‘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
  137. 137. #SHCR @HelenBevan Effective framing: what do we need to do? 1. Tell a story Source of image: woccdoc.org
  138. 138. #SHCR @HelenBevan http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk- crafting-visual-stories-with-data?sf3881865=1
  139. 139. #SHCR @HelenBevan Effective framing: what do we need to do? 1. Tell a story 2. Make it personal Source of image: woccdoc.org
  140. 140. #SHCR @HelenBevan Effective framing: what do we need to do? 1. Tell a story 2. Make it personal 3. Be authentic Source of image: woccdoc.org
  141. 141. #SHCR @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) Source of image: woccdoc.org
  142. 142. #SHCR @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
  143. 143. #SHCR @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
  144. 144. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan Vivid details Source: Marshall Ganz
  145. 145. #SHCR @HelenBevan Talk to the person next to you • Tell your story about why the change you are involved in now is so important to you • Relate it to a personal experience You have: • 2 minutes to prepare your story • 3 minutes each to tell your story
  146. 146. #SHCR @HelenBevan Harvard researchers put a gorilla image on this lung scan
  147. 147. #SHCR @HelenBevan Harvard researchers put a gorilla image on this lung scan
  148. 148. #SHCR @HelenBevan What proportion of the radiologists who reviewed this scan actually saw the gorilla? 90% 25% 17% 80% 9% 60%
  149. 149. #SHCR @HelenBevan Question: what’s the most reliable way to predict the future effectiveness of a team? Source: http://www.fastcompany.com/3049524/know-it-all/the- science-behind-team-intelligence
  150. 150. #SHCR @HelenBevan How do we create a sense of “us” to build momentum for change? Source of image: www.tannerfriedman.com
  151. 151. #SHCR @HelenBevan Moving beyond us and them to us and us Source of image: www.delta7.com
  152. 152. #SHCR @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
  153. 153. #SHCR @HelenBevan strong ties (cohesive) v. weak ties (disconnected) Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml
  154. 154. #SHCR @HelenBevan 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
  155. 155. #SHCR @HelenBevan 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
  156. 156. #SHCR @HelenBevan The pros and cons of strong ties Pros Cons
  157. 157. #SHCR @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
  158. 158. #SHCR @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
  159. 159. #SHCR @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 • 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
  160. 160. #SHCR @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 • 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
  161. 161. #SHCR @HelenBevan Sources of weak ties
  162. 162. #SHCR @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
  163. 163. #SHCR @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
  164. 164. #SHCR @HelenBevan
  165. 165. #SHCR @HelenBevan 165 http://weneedsocial.com/blog/2013/8/25/disr upted-disruptors-unite
  166. 166. #SHCR @HelenBevan Source of image: http://switchandshift.com/transactional-or- transformational-which-leadership-style-is-best
  167. 167. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan “You don’t need an engine when you have wind in your sails”
  168. 168. #SHCR @HelenBevan Questions for reflection 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?
  169. 169. #SHCR @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
  170. 170. #SHCR @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 “
  171. 171. #SHCR @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
  172. 172. #SHCR @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 ‘‘
  173. 173. #SHCR @HelenBevan Cultural change is a million subversive acts of resistance Brene Brown Source of image: zazzle.com ‘‘
  174. 174. #SHCR @HelenBevan “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
  175. 175. #SHCR @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
  176. 176. #SHCR @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
  177. 177. #SHCR @HelenBevan “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit Prochaska, DiClemente & Norcross (1992)
  178. 178. #SHCR @HelenBevan “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet Prochaska, DiClemente & Norcross (1992)
  179. 179. #SHCR @HelenBevan I am not aware my smoking is a problem – I have no 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. “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  180. 180. #SHCR @HelenBevan I am not aware my smoking is a problem – I have no 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! “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  181. 181. #SHCR @HelenBevan I am not aware my smoking is a problem – I have no 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 “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  182. 182. #SHCR @HelenBevan I am not aware my smoking is a problem – I have no 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 “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  183. 183. #SHCR @HelenBevan Prochaska, DiClemente & Norcross (1992) “Stages of change” Transtheoretical model of behaviour change
  184. 184. #SHCR @HelenBevan • Which stage do most change activities in health and care focus on? • Which stage are most people actually at? Some questions
  185. 185. #SHCR @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
  186. 186. #SHCR @HelenBevan • 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
  187. 187. #SHCR @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
  188. 188. #SHCR @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?
  189. 189. #SHCR @HelenBevan The single biggest problem in communication is the illusion that it has taken place George Bernard Shaw ‘‘
  190. 190. #SHCR @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?
  191. 191. #SHCR @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
  192. 192. #SHCR @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
  193. 193. #SHCR @HelenBevan If your horse dies, get off it Cherokee proverb Source of image: fenwickgallery.co.uk ‘‘
  194. 194. #SHCR @HelenBevan#IQTGOLD#SCHR @HelenBevan
  195. 195. #SHCR @HelenBevan Traditional event The agenda is pre-set One way learning style with Q&A People sit in rows or round tables Networking between sessions Hard to leave the session once it starts Absorbing information Unconference People set the agenda Based on discussion People sit in a circle Networking the whole time Encouraged to find the right session Connecting to action Source: adapted from @BCPSQC
  196. 196. #SHCR @HelenBevan 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."
  197. 197. #SHCR @HelenBevan Our unconference process • Having heard all the content 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 • Raise your hand and we will bring you a sheet
  198. 198. #SHCR @HelenBevan Four keys to collaboration • Lean into discomfort • Listen as an ally • State your intent • Share your “street corner” Source: Judith Katz and Fred Miller
  199. 199. #SHCR @HelenBevan What’s our approach to change? Deficit based • what is wrong? • solve problems • identify what we need to improve • fill gaps and deficiencies Strength based • what is strong? • work with our existing assets and resources • amplify what works • “positive deviants”
  200. 200. #SHCR @HelenBevan Four ways to connect! 1. Follow us on Twitter @HelenBevan @KateSlater2 @Ollybenson @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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