Modernisation Agency

‘TOWARDS A MILLION CHANGE AGENTS’

A REVIEW OF THE SOCIAL MOVEMENTSLITERATURE: IMPLICATIONS FOR LARGE

SCALE CHANGE IN THE NHS

Paul Bate1, Helen Bevan2, Glenn Robert3

1 Professor of Health Services management, University College London; 2 Director, Innovation & Knowledge Group, NHS Modernisation Agency;

3 Senior Research Fellow, University College London

We would welcome any comments from readers on this draft review: please send all comments to Professor Paul Bate at: s.p.bate@chime.ucl.ac.uk

This review and related work was funded by the NHS Modernisation Agency.The views expressed are those of the authors and not necessarily of the

sponsoring organisation.

CONTENTS PAGEACKNOWLEDGEMENTS 3

EXECUTIVE SUMMARY 4-6

SECTION ONE: AIMS AND SCOPE OF THE LITERATURE REVIEW 7-8

SECTION TWO: WHY SHOULD NHS LEADERS BE INTERESTED IN SOCIAL MOVEMENT THEORY? 9-15

SECTION THREE: WHAT IS A SOCIAL MOVEMENT? 16-22

SECTION FOUR: SCHOOLS OF THOUGHT IN MOVEMENT RESEARCH 23-26

SECTION FIVE: MOBILISATION AND MOVEMENTS 27-29

SECTION SIX: RATIONAL FACTORS 30-31

SECTION SEVEN: EMOTIONAL FACTORS 32-34

SECTION EIGHT: SOCIAL AND NORMATIVE FACTORS 35-40

SECTION NINE: BEHAVIOURAL FACTORS 41-42

SECTION TEN: ORGANISATIONAL FACTORS 43-46

SECTION ELEVEN: LEADERSHIP FACTORS 47-59

SECTION TWELVE: TOWARDS A THEORY OF MOTIVATION FOR LARGE SYSTEM CHANGE IN HEALTHCARE? 60-63

REFERENCES 64-71

Annex 1 McAdam’s model of recruitment to high-risk activism 72

Annex 2 Additional dilemmas 73-74

Annex 3 Key questions for the next stage of thinking about social movements 75

ACKNOWLEDGEMENTS

This work would not have been possible without the input of the following colleagues,friends and peer reviewers of related papers:

Rob Bellingham Mark Butler

Stefan Cantore Liz Carter

Karen Castille Jerry Davis

David Dawson Sarah Elliott

Maulik Joshi Geraint Martin

Sean O’Kelly Mark Outhwaite

Linda Patterson Hayagreeva Rao

Hugh Rogers Blair Sadler

Kim Sutherland Tim Wilson

Mayer Zald

1

EXECUTIVE SUMMARYThis review has four objectives:

• To explore ‘social movements’ as a newway of thinking about large-scale systemsc h a n g e

• To assess the potential contribution ofapplying this new perspective to NHSi m p ro v e m e n t

• To enrich and extend NHS thinking inrelation to large-scale, system-widechange, and

• To begin to establish a re s e a rch andevidence base to support the emergence of an improvement movement in the NHS

The context for the review is the challengingchange agenda set out for the EnglishNational Health Service (NHS) in the NHSPlan. Since 2000, a wide range of local andnational improvement programmes haveb rought about significant - if mixed - re s u l t sto the benefit of patients and staff in theNHS. However, at almost the mid-way pointof the ten year NHS Plan, it is time to takestock and judge whether the scale and paceof the improvements underway will bes u fficient to achieve the goals of the Plan intime. Are the theories and constructs thatc u rrent NHS improvement plans based ons u fficient to deliver transformational changein healthcare delivery? Are some additionalperspectives re q u i red? This review offers anew perspective on large-scale systemschange which may provide new ways ofthinking and approaching serv i c ei m p rovement and organisational change anddevelopment within the NHS.

The central thesis of the review is that bycombining insights from org a n i s a t i o n a lstudies and social movements theory andanalysis, we may discover some pre v i o u s l yunused or under-utilised concepts andtheories of change that may - in parallel withexisting approaches - contribute to or extendNHS improvement eff o rts. To date, socialmovement analysts have looked too rganisational theory but there has been

little exchange of ideas in the opposited i rection. This review builds on recent work,mostly in the US, which has begun to re d re s sthat imbalance and to promote two-wayd i a l o g u e .

F rom the literature we have identified eightf e a t u res or characteristics of a socialmovement: radical action, transform a t i v eevents, collective action, voluntaryassociations and social re l a t i o n s h i p s ,o rganisation and spontaneity, politics, conflictand durability. We are concerned here withthe stream of social movement analysis that isc o n c e rned with ‘collective action’.

T h e re are at least three broad schools ofthought in social movements analysis.Collective behaviour and social movementsre s e a rch was the dominant school from the1940s to the early 1960s and focused on therole of emotion and non-rational behaviour(for example, by studying the Fascistmovements in 1930/40’s Europe). Resourc emobilisation and political process theories inthe 1970s and 1980s rejected this emphasison the emotionality of the crowd and applieda new focus on rational action and stru c t u r a lo p p o rtunities for movement emerg e n c e .Then in the 1990s ‘new social movements’theorists set movements in their social andhistorical context, shifting the focus yetagain to cultural issues (identity, meaningsand beliefs) and ‘framing’ processes. Ourreview seeks to bring together these thre eschools and examine the key emotional,s t ructural and cultural factors - and thei n t e rrelationships between them - that shapesocial movement emergence, growth andd e v e l o p m e n t .

Given the context for this review we arec o n c e rned to ask three questions of thed i ff e rent schools of social movements analysiswhich we consider to be of major re l e v a n c eto the NHS: firstly, why do people joinmovements, secondly, why do they stay inmovements and third l y, why do they leavemovements? Our readings of the social

movements literature point us towards sixg roups of factors which, to varying degre e s ,answer these three core questions as to whypeople are ‘moved’ or mobilised intocollective action and how such mobilisation iss p read and sustained. The six groups are :

• Rational: individuals are driven by self-i n t e rest and make rational assessments ofthe value or gain to themselves of joiningwith others in a movement - movementinvolvement is a calculative action .

• Emotional: movement involvement isimpelled from a ‘feeling’ within ratherthan being a response to any extern a lstimulus; beliefs are more powerful thanany personal calculus of costs or potentialgains, and it is also emotional rather thantask or instrumental relationships thatbind the people in a movement together

• Social and normative: underlying historical,institutional and cultural conditions aff e c tthe decision to join, support and remain ina movement; social networks play a keyrole in re c ruiting, mobilising and re t a i n i n gp a rticipants, and communities of practicecan be cultivated as important mechanismsfor mobilisation

• Behavioural: concrete forms ofinvolvement in internal as well as extern a lactivities re i n f o rce and sustain support fora movement. Shared cultural practices(rituals, celebrations, etc) strengthen andre a ff i rm the underpinning cultural andideological values of the movement

• O rganisational: some form of enablingo rganisation is re q u i red for a movementto survive and grow; movements withaccess to other organisations and policy-makers will act diff e rently to those that donot; re s o u rces (financial, time and human)a re important to mobilisation and surv i v a l

• Leadership: movements re q u i re individualleaders and a particular kind of multi-levelleadership system or process; ‘framing’ is akey leadership activity for ignitingcollective action and building commitmentand support for the movement.

Like a number of social movementre s e a rchers, we believe that there is value inconsidering large-scale organisational change(such as contemporary NHS impro v e m e n te ff o rts) from a social movement perspective.In applying a social movement lens to NHSi m p rovement, this review has raised anumber of questions (see annex 3). Thesequestions will be addressed in our futurecollaborative re s e a rch with the NHS andother social movement re s e a rc h e r s .

This review has focused on why people mightjoin a movement. Further qualitative re s e a rc hon the mechanisms which lead to movementsuccess and sustainability in the context ofthe NHS is re q u i red. As part of our ongoingre s e a rch we have begun to collect the storiesand ‘theories in use’ from a small number ofcase studies of ‘movements’ or ‘near-movements’ that have been forming andtaking root within the NHS. These casestudies include the stories both from within a single NHS organisation and across variouso rganisations, on both a local and nationals c a l e .

3

SECTION ONE: AIMS AND SCOPE OF THE LITERATURE REVIEW

During the period March to November 2003,we undertook a review of the relevantpolitical, sociological and organisationalliteratures around social movementsthinking1 . The review built upon scopingwork already carried out by the authors forthe NHS Modernisation Agency which issummarised elsewhere (Bate et al, 2004). Thespecific objectives of this review were:

• To explore ‘social movements’ thinking asa new way of thinking about large-scalesystems change

• To assess the potential use and value ofapplying this new perspective to NHSmodernisation and improvement activities

• To enrich and extend current NHSthinking around large-scale systemschange, and

• To begin to establish a research andevidence base to support the formation ofan improvement movement in the NHS.

With these four objectives in mind, thisreview is mainly concerned with explainingwhy individuals join and participate in amovement rather than formulating somekind of ‘n’ step guide to creating animprovement movement for the NHS. Allmovements are to some extent uniquehistorical events located, as Koopmans (2004)points out, in a particular time and place,therefore any attempt to generalise or drawup a recipe for movement creation can bedangerous. However, as in this review, onecan seek to identify the factors that shapethe dynamics of any particular social ororganisational movement, at this point moreas an aid to understanding than predictingor ‘designing’ a movement.

The review is an important step in our owncollaborative research process,2 as it hasuncovered debates between the manydifferent strands of thinking in regard tosocial movements and organisationalchange. A number of key questions havebeen prompted by the review, for example:do ‘movements’ have to arise out of unrestand deep grievance or can they emergethrough discernible and coherent, yetdecentralised and unorganised, shifts inthinking, acting and perceiving which do notentail any form of ‘protest’? Why do peoplejoin movements and why and how do theybecome ‘activists’? What is the appropriatemodel of leadership for a movement? Whydo ‘near movements’ like health carecoalitions, community networks,collaboratives, and communities of practicejust fall short of that elusive phenomenon ofa movement, where people are fired intotaking action collectively and the processacquires its own energy and momentum,ultimately becoming auto-catalytic (self-fuelling)?

Such debates have important implicationsfor determining the potential value of thesenew perspectives to large systems changesuch as that envisaged by NHS reformers, aswell as the design and content of ourongoing empirical research and dialoguewith leading NHS practitioners andacademics in Europe and the US.

After presenting the background to thework, the results of the review are presentedin nine sections, followed by a discussion ofthe implications of our findings for healthcare improvement efforts:

• What is a social movement? (pages 16-21)

• Schools of thought in movement research(pages 22-25)

• Mobilisation and movements (pages 26-28)

• Rational factors (page 29-30)

• Emotional factors (pages 31-33)

• Social and normative factors (pages 34-39)

• Behavioural factors (pages 40-41)

• Organisational factors (pages 42-45)

• Leadership factors (pages 46-57)

• Towards a theory of motivation forhealthcare improvement (pages 58-61)

1Journals that were hand-searched were: Academy of ManagementReview, Academy of Management Journal, Administrative SciencesQuarterly, American Journal of Sociology, American SociologicalReview, Contemporary Sociology. A Journal of Reviews,Mobilisation, and Social Movement Studies. Abstracts and papersfrom the American Sociological Association, 2003 conference werealso reviewed. We are particularly grateful to Mayer Zald and JerryDavis at the University of Michigan for granting us access to papersfrom their 2002 Social Movements and Organisations conference.Relevant books and journal references from these sources weresubsequently reviewed.2This process has included running workshops at two recentInstitute for Healthcare Improvement national forums (in 2003‘Building a health care improvement movement: learning from massmovements’ and in 2004 ‘Mobilising for Improvement. Learningfrom Mass Movements about how to achieve rapid large-scalechange and improvement in your organisation’) and a ‘MassMovements Masterclass’ for the London Learning Partnership (April2003); and presentations to the NHS ‘Leading ModernisationProgramme’ (May 2003), and NHS Modernisation Agency Associates‘Leadership for Improvement’ conference (Stratford upon Avon,November 2002). In addition, we have established a NHSpractitioners ‘thinktank’ which met for the first time in November2003 and will be reconvening to meet with US academics from themovements field in May 2004.

SECTION TWO: WHY SHOULDNHS LEADERS BE INTERESTEDIN SOCIAL MOVEMENTTHEORY?

Key points for healthcareimprovement leaders

• The NHS is at a crossroads in it’simprovement journey

• NHS improvement work is often underconceptualised and lacks reflection andanalysis

• Most ideas that underpin NHSimprovement have been based onmainstream organisational studies(organisational development, qualityimprovement etc.)

• However, large-scale change inorganisations relies not only on ‘externaldrivers’ but also the ability to connect withand mobilise people’s own ‘internal’energies and drivers for change

• Social movements frameworks may behelpful in understanding how to mobiliseimprovement efforts inside, as well asacross, NHS organisations

1.1 The context for this review: the NHS‘improvement revolution’

The NHS is at a crossroads in its improvementjourney. The NHS Plan (Department ofHealth, 2000) set out a transformationalblueprint for the NHS. The resulting deliverystrategy represents the “most ambitious,comprehensive and intentionally fundednational initiative to improve healthcarequality in the world” (Leatherman &Sutherland, 2003).

A key aspect of the delivery strategy is aseries of more than 30 national programmes.These aim to stimulate improvement forpatients in priority areas such as cancer,heart disease and mental heath services, toreduce or abolish delays for patients and toaccelerate the workforce and organisationalcapability of NHS systems. These

5

programmes, which are co-ordinated by theNHS Modernisation Agency, have made animportant contribution. They have targetedenergy, expertise, and focus on key areas ofchallenge. They have created improvementsfor specific groups of patients, and helped tomove NHS organisations on to higher levelsof improvement. Improvement has becomea way of life for thousands of clinical teamsacross the NHS. Few of these teams wereeven engaged in improvement work threeyears ago.

At this point questions are being asked as towhat next and where it will end. Will theprogrammatic approach, on its own, deliverthe desired results across the whole NHSsystem and for all NHS patients? And, willchange happen fast enough to meetnational goals in the time-scales required? Aspart of a wider survey, we asked thisquestion of approximately 100 local leadersof NHS modernisation (figure 1 below);approximately 75% did not agree that theexisting scale and rate of improvement weresufficient. We then asked the sameindividuals about the work of improvement‘activists’ within their local health careorganisation (figure 2 below). The resultswere mixed - respondents at a national orstrategic health authority were generallymore optimistic than improvement leadersand practitioners at the front line of clinicalcare.

FIGURE 1

FIGURE 2

There is a growing recognition at local andnational levels of the NHS that theimprovement process needs to change. Arecent paper (Modernisation Agency, 2004)sets out the reasons why a radicalreconceptualisation of the NHS improvementsystem is necessary (table 1).

Reflecting on what we have done and whatwe now know we could do with impro v e m e n tm e t h o d o l o g y, we believe that we are :

• Not progressing quickly enough

• Not always integrating improvementmethods into every priority effort

• At a national level, not always working inways that are coherent at local level

• At SHA and local level, not always makingbest use of improvement methods toimprove performance

• Good at piloting, but not always aseffective as we need to be at spreadingimprovement across the whole country

• Not capturing enough of the impact thatimprovement work is making

• Not always sustaining the improvementgains we have made

• Not yet establishing a strong successrecord at integrating and embeddingimprovement thinking into day-to-daymainstream workSource: How do we get a NHS that is continuously improving? A concept paper for the next stage of NHS improvement, NHSModernisation Agency 2004

TABLE 1: GAPS IN THE NHS IMPROVEMENT SYSTEM

Research into three local health communities(Matrix RHA, 2003a) identified that eachcommunity is typically undertaking between40 and 50 improvement projects sponsoredby the Modernisation Agency and 250 to 300locally initiated projects. In another survey(Matrix RHA, 2003b) only 18 per cent of NHSBoard Directors with responsibility forimprovement stated that their organisationwas making satisfactory progress in itsstrategic approach to improvement.

The picture that is painted is one ofwidespread, energetic (sometime almostfrenetic) improvement activity at projectteam level but limited strategic co-ordinationand purposeful direction at the level of theorganisation. Furthermore, the prevalentstyle of project leaders is ‘pragmaticactivism’. NHS improvement work is typicallyunder conceptualised and often lacksreflection and analysis (Bevan, 2004).

As implied above, to date NHS impro v e m e n thas relied mainly upon a nationally-initiated,p ro g r a m m e - b y - p rogramme approach tos e rvice change and development, which in thet h ree years since the publication of the NHSPlan has spawned a multitude of diff e re n t ,and often impressive, improvement schemesand activities. Most ideas that underpin NHSi m p rovement have been based on mainstre a mo rganisational studies. This disciplineencompasses organisational development,quality improvement (total qualitymanagement, continuous qualityi m p rovement, etc.), individual and teamdevelopment, and a wide range of appro a c h e sto planned or programmatic change.

Part of the background to this review istherefore the all-too-common scenario of‘undershoot’ in planned changeprogrammes, in which neither the endresults or process goals are fully met duringimplementation:

‘Although no studies document comprehensively theoutcomes of such large-scale change efforts, expertsseem to agree that most organisations are left withdisappointing results’ (Young, 2000: 66)

The assumption underpinning this reviewalso resonates with the views of a number ofother leaders closely associated with healthcare improvement, namely that ‘theprevailing theory of motivation [forundertaking improvement activities] isdeficient’1 :‘At present, prevailing strategies rely largely onoutmoded theories of control and standardisation ofwork. More modern, and much more effective,theories of production seek to harness theimagination and participation of the workforce inreinventing the system’ (Berwick, 2003: p.448)

It is estimated that 15 to 20 per cent of NHSstaff are current actively engaged in qualityimprovement work. Achievement of NHSPlan goals may require 80 or 100 per centstaff engagement. How will this beachieved? Should the number of NHSimprovement projects be quadrupled? Or aresome different, additional ways of thinkingrequired?

Evidence from the social sciences suggeststhat other perspectives may help to recastlarge-scale organisational change efforts -such as implementation of the NHS Plan - ina new light and offer a different, thoughcomplementary, approach to improvementthinking and practice. Particularly prominentis recognition that such large-scale change inorganisations relies not only on ‘externaldrivers’ but the ability to connect with andmobilise people’s own ‘internal’ energies anddrivers for change (Palmer, 1997; Kotter &Cohen, 2002), in so doing, creating a bottom-up, locally led, ‘grass roots’ movement forimprovement and change.

However, until very recently, little work hasbeen done to combine or share learningfrom these two very different perspectiveson change. There is a need to be constantlymindful of the current NHS ‘taken forgranted’ approach to improvement, and the

7

social movements perspective, being sodifferent, may help us to reflect upon andcritique this. 1 Don Berwick, ‘Making it Mainstream. A day for local and nationalleaders of NHS modernisation’, London, March 2003.

1.2 Organisation studies and socialmovement analysis

In the early 1960s no connection existed, orappeared possible, between organisationalstudies and social movement analysis, as theformer concentrated on instrumental,organised behaviour while the latter’s focuswas unorganised and unstructuredphenomena (McAdam & Scott, 2002). Then,three decades ago, Zald and Berger (1978)drew our attention to the similaritiesbetween change processes in organisationsand those in social movements and the widersociety, later adding the intriguingsuggestion that most major ‘second order’changes in society had come about as theresult of social movements, not formal,planned change efforts - offering a directchallenge to mainstream organisationdevelopment thinking and practice: ‘In some measure, much of the social change we havewitnessed in America in the last several decades canbe attributed to social movements, large and small ...[these] have contributed to changes in the way welive.’ (Zald et al, 2002: 1).

However, whilst social movement theoristshave begun to look increasingly toorganisation studies perspectives for ideasfor the reason that‘...the most interesting problems and greatestadvances in the sciences, often take place at theintersection of established fields of study’ (McAdam &Scott, 2002: 3)

Until quite recently, at least, organisationalchange people have been unaware - or justnot interested - in social movement research: ‘Organisational Study scholars have been far lessopportunistic in taking advantage of movement ideas’(McAdam & Scott, 2002: 3).

Contemporary developments in the NHS,including the move towards devolution ofownership for improvement to Strategic

Health Authority and local levels, and theincreasing interest in the role of front-lineclinical microsystems in service improvement(Donaldson & Mohr, 2000; Mohr & Batalden,2002), highlight the timeliness of exploringthis interface between social movements andorganisational change further within the UKhealth care context1. As Strang and Il-Jung(2002) suggest, to traditional (organisationalstudies) questions like ‘what is thisprogramme?’ and ‘what evidence is therethat it works?’, a social movement analysisadds ‘who supports it?’, ‘how were theymobilised?’ and ‘how much influence dothey have?’. Zald et al (2002), examining theimpact of social movements onorganisations, pose similar questions: whatare the processes and organisationalstructures that shape how particularorganisations respond to movementdemands? How do the changes in discourse,and direct and indirect attempts toimplement movement goals, affect thecommitments and procedures oforganisations? How do movements ‘getinside’ organisations?1 McAdam & Scott (2002) recently used two case studies to illustratethe growing synergies and parallels between organisational studiesand social movement scholarship. One of these examinedinstitutional change in US health care during the period 1945-95(Scott et al, 2000).

On the face of it, orchestratingorganisational movements (such as an NHSimprovement movement) should not be thatdissimilar from social movements: forexample, social movement researchers have‘spent much time and effort’ exploring theconditions under which new (movement)organisations emerge and how they gainsufficient mass and momentum to surviveand flourish (McAdam & Scott, 2002). Thereare also strong similarities in terms of themechanisms by which organisations andsocial movements develop and change(Campbell, 2002). Moreover, some sorts oforganisational change have already beenfruitfully approached as social movements,for example, ‘coup d’etats’, and ‘whistle-blowing’ (Zald & Berger, 1986). On the faceof it at least, social movements frameworks

may therefore have utility for understandingmobilising efforts inside as well as acrossorganisations.

Social movement research has become amajor field of research today, especially inthe United States (see references for variousjournals and recent conferences), and it istherefore timely to begin to consider what itmay have to offer to organisational change,especially in the light of some inconsistentresults from Organisation Development (OD)and planned change efforts to date.

Social movement and organisation theoristsalike have recognised that change is usuallygradual and evolutionary, often running outof steam before reaching its finaldestination. The question is how toaccelerate or speed it up and to give it theenergy required to carry it to its desireddestination. Broadly speaking, a socialmovement perspective would suggest thatNHS improvement needs to move away froma planned, ‘programmatic’ (Pettigrew, 1998)concept of change to one of unstructuredand largely self-organised phenomena, ascharacterises social movements. This is whywe find the phrase ‘orchestrated socialmovement’ in the literature when referringto organisational movements, suggestingthat change is not created or managed assuch but liberated or released, channelledand enabled.

To this end, ‘elites’ seek to trigger and setmobilisation processes in motion rather thanto set organisational rules or roles or createprogrammes for change (Strang & Jung,2002)1. The theory and practice of ‘activism,’‘mobilisation’ and ‘conversion’ are basicallythe same in both paradigms, incorporating aprocessual component: the activist-ledmobilisation of relatively autonomous actorsaround an ideology or cause: ‘A small cadre of professionals plays the role ofactivists, involving workers and managers in trainingsessions and problem-solving teams. The hope is thatpositive feedback between the converted and the

unconverted will lead new behaviours to diffuse andbecome self-sustaining’ (Strang & Jung, 2002: 3).

Before proceeding to draw lessons fromsocial movement analysis for the NHS, someinitial words of caution are called for. Firstly,some commentators remind us that ‘theoutcomes of most movements are modest’(Palmer, 1997; 180), that most ‘operate onthe margins of success with burnout acommon companion to mobilisation’ (Strang& Jung, 2002) and that most movements donot overturn the prevailing order but onlymake incremental adjustments to it. In short,just as with organisational changeprogrammes, we only tend to hear aboutsuccessful movements and cannot assumethat the success rates with movements is anyhigher than conventional changeprogrammes. Most are not revolutionary(except in intent) and fairly small scale interms of level of achievement: ‘Movements are more likely to fine-tune reality thanto give rise to the brave new world.’ (Palmer, 1997:180)

Secondly, given the strength of the‘managerialist’ and functionalist paradigm inorganisational and business managementwritings (which assumes managers have ahigh level of control over events), it isimportant from the outset to resist thenotion that movements can bemanufactured, engineered, directed orcontrolled and generally counsel against thefutility of trying to ‘plan’ a movement: ‘ ... social movements are not now and were never assubject to direction and control as most of thediscourses with them once assumed ... We cannotpredict their emergence, we cannot make themhappen, or consciously construct them .. and wecertainly cannot control their direction or impact.’(Kling, 1995). 1 Strang and Il-Jung’s case study of an ‘orchestrated socialmovement’ (taking a quality initiative within a global financialservices corporation as its focus) is particular relevant in the contextof NHS improvement.

9

Consequently,‘An organisational reform initiative contains much lessdrama. Action is on a smaller scale, and there is noequivalent to the public and episodic character ofsocial movement participation. While we see theprogram as social movement-like in form, we wouldnot describe it as collective action. Organisationalreform is structurally closer to a religious movement(Snow, 1976) than it is a political movement.’ (Strang& Jung, 2002: 29)

Finally, before going further we need to flagup some of the moral and ethical issues, aswell as some of the dangers that may belurking in the movements concept. Forexample:‘change programmes often appear to be ‘potentiallyliberating’ to their participants in offering a solutionto life’s deeper existential dilemmas; they can insteadrepresent an insidious form of tyranny by seeking togovern the very ‘soul’ of the organisational members’(Turnbull, 1997: 27).

At best it needs to be recognised thatmovements are polyvalent: they can beforces for good just as much as they can beforces for evil, the challenge being tounderstand what makes the one or theother. Key issues in this regard are whetherthe movement is driven by passion orobsession, whether it is voluntary or coercive,open or closed, whether it is unitary orpluralistic in structure and ideology, andwhether its leadership exists for itself or forthe wider membership. A movement doesnot start out good or bad. There is noinherent genetic predisposition of amovement. As a human construction, theform and direction it takes will reflect wherepeople want and intend it to go. It will onlyend up good or bad depending on humanagency and action.

SECTION THREE: WHAT IS ASOCIAL MOVEMENT?

Key points for healthcareimprovement leaders

• Well known social movements include theCivil Rights movement in the United Statesand the environmental movement

• Social movements involve collective actionby individuals who have voluntarily cometogether around a common cause; theyoften involve radical action and protestwhich may lead to conflict with acceptednorms and ‘ways of doing’ things.

• Social movements can lead totransformational change

• Although their beginnings arespontaneous, movements do require someform of organisation if they are to havean impact; and they often last for a longtime

• The study of social movements may havesome important lessons for bringing aboutlarge-scale improvement in the NHS;particularly in relation to sustainingimprovement efforts

3.1 Definitions

Crossley (2002) offers a composite of fourdefinitions of a social movement from theliterature1 (pp. 3-7):‘Social movements can be viewed as collectiveenterprises seeking to establish a new order of life.They have their inception in a condition of unrest,and derive their motive power on one hand fromdissatisfaction with the current form of life, and onthe other, from wishes and hopes for a new system ofliving. The career of a social movement depicts theemergence of a new order of life.’ (Blumer, 1969: 99)

‘Social movements are ... best conceived of astemporary public spaces, as movements of collectivecreation that provide societies with ideas, identities,and even ideals.’ (Eyerman & Jamison, 1991: 4)

‘Contentious politics occur when ordinary people,

often in league with more influential citizens, joinforces in confrontation with elites, authorities andopponents ... when backed by dense social networksand galvanised by culturally resonant, action-orientedsymbols, contentious politics leads to sustainedinteraction with opponents. The result is the socialmovement.’ (Tarrow, 1998: 2)

‘Social movements are: informal networks, based onshared beliefs and solidarity, which mobilise aboutconflictual issues, through the frequent use of variousforms of protest2 .’ (Della Porta & Diani, 1999: 16)1 Commonly cited social movements include: Labour Movements,Religious Movements, Green Party/environmental movements, AntiGlobalisation Movement, Anti nuclear activists/CND/PeaceMovement, Civil Rights Movement/black militancy,Feminist/women’s movements, Gay and Lesbian Rights, Suffragettes,Animal Rights Movement, Countryside Movement, Urbanneighbourhood movements, Mother’s Against Drunken Driving andAnti-smoking groups.2 Movements do much more besides - and sometimes instead of -protesting (Melucci, 1986; 1996). Blumer (1969) suggests somemovements consist of little more than a ‘cultural drift’ - adiscernable and coherent yet decentred and unorganized shift inparticular ways of thinking, acting and perceiving. Drifts are‘movements’ but they entail no protest.

Crossley proposes the notion thatmovements arise out of unrest anddissatisfaction (Blumer, 1969), therebyhinting at a central controversy in theliterature. This used to be uncontroversialbut more recently has seen a number ofmovement analysts challenging the idea of adirect link between dissatisfaction andmovement emergence - an important debatein the context of NHS improvement that willbe discussed later.

Eyerman and Jamison (1991) - the seconddefinition - add two points to that ofBlumer: (a) they specify more clearly thatmovements are a source of creativity andthat what they tend to create are identities,ideas and even ideals, and (b) the referenceto ‘public spaces’ conjures an image ofpreviously privatised individuals being drawninto a public debate over matters of commonconcern.

In the third definition Tarrow (1998) makesreference to social networks, thus conveyinga sense of the collective web-like nature of

movements, and the fact that they areessentially socio-cultural phenomena. Morecontroversially, Tarrow specifies ‘elites,authorities and opponents’ who areconfronted in struggle. Again this is animportant area of academic debate, as manycontemporary movements struggle againstmore abstract targets which are not so easilyidentified or personified (for example,institutionalised racism). Finally, Tarrow alsosuggests that many contemporarymovements involve at least a partial focusupon the complicity of their own participantsin what they perceive to be an unacceptablestate of affairs1.

In the final definition, Della Porta & Diani(1999) add a further point concerning‘shared beliefs and solidarity’ andinformality. However, Koopmans (1993: 637)calls into question this unity and solidarity,arguing that ‘social movements arecharacterised by a low degree ofinstitutionalisation, high heterogeneity, alack of clearly defined boundaries anddecision-making structures, a volatilitymatched by few other social phenomena.’This is not to say that solidarity is neverevident in movements but suggests ratherthat we cannot take it for granted as astable and inherent feature.

More recently, Snow et al (2004) providedthe following definition as an introductionto a major new collection of writings onsocial movements. According to themmovements are :‘collectivities acting with some degree of organisationand continuity outside of institutional ororganisational channels for the purpose ofchallenging or defending extant authority, whether itis institutionally or culturally based, in the group,organisation, society, culture or world order of whichthey are a part.’ (11)

Similarly, In the context of this review, weare concerned with social movements asrelatively enduring organisations rather thanwith ‘evanescent forms’ of collectivebehaviour, such as panics, riots, fads and

11

fashions (Rao et al, 2000):1 For example, the anti-psychiatry movement of the 1960s involvedpsychiatrists turning back upon and criticizing their own role inprocesses of social control).

‘Collective action’ refers to a broad range ofpurposive collective behaviour, the mostorganised of which are social movementsthat occur over longer time stretches, aredriven by long-term goals and developformal organisations.’ (244)

Having defined what we mean by the phrase‘social movement’, our next introductory taskis to briefly reflect on why social movementsare an important topic for our attention.Crossley (2002: 7-9) suggests that it isbecause they are key agents for bringingabout change within societies. Whilst such aportrayal commonly conjures up an image ofrevolution or major legislative change, weneed to be cautious because this iscomparatively rare and the kinds of changethat movements achieve are more often localand cultural in nature (McAdam, 1994).According to Crossley, movementsproblematise the ways in which we live ourlives and call for changes in our habits ofthought, action and interpretation - in otherwords they have an important role to play inconsciousness raising, re-framing and socialpraxis. Movement actions my also triggerchains of events which cannot always beforeseen or controlled and they sometimesprovoke backlashes and other unintendedresponses. Well-known examples include thepeace movement, religious movements, civilrights and pro-democracy movements, theLabour movement, Women’s movements,Gay and Lesbian rights, environmentalmovements and fascist movements. This lastexample highlights that social movementsare not necessarily a force for ‘good’ (at leastnot in everyone’s eyes), an important caveatto which we have already referred (page 15).

3.2 Characteristics

From our reading of the literature we haveidentified eight core characteristics (figure 3)of social movements which are summarisedbelow:

FIGURE 3

3.2.1 Public protest and radical action

Public protest and the use of radical andunconventional means of political persuasionis a fundamental feature of mostmovements, large and small (Taylor & VanDyke, 2004: 283), their purpose being eitherto foster or to halt change (Snow et al,2004). If the former, the agenda of a socialmovement is normally large-scale change ata rapid pace; second-order rather than firstorder change (Watzlawick et al, 1974). Thisagenda is based on the belief that changecannot be achieved within the system and soaspects of the system itself have to bechanged. Social movements are often bornof this belief (and frustration) thatincremental change is not working or is notdelivering the desired or anticipated benefitswithin an acceptable time-scale; there is arecognition that scale and pace need to be‘radicalised’ and redefined.

3.2.2 Transformative events

There is substantial evidence that socialmovements can be transformative events1. Asalready pointed out, writers have arguedthat all major changes in the US have beenbrought about as the result of a socialmovement, never a planned - and certainlynot an incremental - programme of change.Morris (2000; 452) suggests we need to carryout a lot more research on movements astransformative events. 1 For example, the Vietnam protests in the US arguably broughtdown two Presidents, turned Congressional thinking - andmembership - around, redefined Cold War philosophies (Franklin,2000) and later deterred Ronald Reagan from sending troops toNicaragua on the grounds of wanting to avoid another antiwarmovement (Fendrich, 2003: 353).

3.2.3 Collective

‘Social movements are uninstitutionalised,but co-ordinated collective activities’ (Strang& Jung, 2002: 28). Hence collectivity andcommonality define a movement: the wholebasis of a movement being joint action,common outlooks and change goals andcollaboration (Huy, 1999). Kebede and othersdefine them as ‘collective identities inmotion’ (2000: 317), whilst Croteau & Hicks(2003: 257) talk about them involving ‘theidentification and articulation of commonground among [participants]’ Tucker (1993)similarly talks about a ‘sense of collectiveinjury’ that drives mobilization, and Tilly(1978, cited in Crossley, 2002) suggests thatmobilization is always possible where there issome form of collectivity or naturalcommunity: ‘where a group of people live together in form ofclose association and network, the historical recordsuggests that they are more likely to mobilize aroundan issue of shared grievance than groups who are notnetworked in this way. Close-knit networks orcommunities are more prone to mobilisation around ashared grievance where they manifest some form ofcollective identity.’

The necessary translation of a commonsituation into a shared grievance requires thebringing together of a multiplicity ofidentities under a common social vision; this‘translation’ resonates with our discussionbelow of ‘frame alignment’ (page 50). Suchideational factors and interpretive processesalso shape the later tactics employed by asocial movement

3.2.4 Voluntary association and socialrelationships

People do not have to join a socialmovement; they join because of choice andsome kind of commitment to join withothers. ‘Movements’ are voluntary, not a‘programme’ as such: they are spontaneousand self-organising (although as we notelater organisation is an important element).What we are talking about in the NHScontext, therefore, is more accuratelydescribed as an improvement aspiration or

ideal than an improvement programme.

Individuals do not act in isolation; they are atleast aware of others and - because of theirsocial ties - often influenced or evenpressurised by them. Consequently, incollective action ‘social networks matter’(Marwell & Oliver, 1988) particularly in termsof recruiting participants (Tilly, 1978; Fireman& Gamson, 1979). How recruitment works,and why it works better in some networksthan others, is an extremely complex issuethat will require further discussion (see pages34ff).

3.2.5 Organised and spontaneous

Social movements are a wonderful exampleof organisation and disorganization. They doexplode into life without being organisedbut if they are to stay in existence they needcentral co-ordinating and resourcing1. Snowet al (2004) suggest that there is ‘absolutelyno question’ about the fact that socialmovement activity needs to be organised insome fashion or another but that there areclearly different forms of appropriateorganisation. In this respect, Tarrow (1998:123-4) offers the distinction between socialmovements as (a) formal organisations, (b)the organisation of collective action, and (c)social movements as connecting structures ornetworks.1 For example, ‘The Students for a Democratic Society (SDS)’ playeda key role in the antiVietnam war movement (Fendrich, 2003). In1965, SDS became the major catalyst in organising opposition to thewar. Other examples include the ‘Student Nonviolent Co-ordinatingCommittee’ which organised the Vietnam sit-ins anddemonstrations, ‘teach-ins’ and the Mississippi Freedom SummerProject in 1964. SNCC went from movement to electoral politicswhen it formed the Mississippi Freedom Democratic Party tochallenge the all-white segregationists at the 1964 Democraticconvention.

3.2.6 Political

Protest movements are contentious politics(McAdam et al, 1996) and movementparticipants are invariably ‘protesters’ of onekind or another (Piven & Cloward, 1979):‘Protest movements are acknowledged as a form ofpolitical struggle. Protest is political action using non-institutionalised means to influence those in power tobring about change.’ (Fendrich, 2003: 338)

13

The primary goal of any movement is tohave influence, and in order to do this it hasto engage in a political process with thoseupon whom its satisfactory outcomesdepend.

3.2.7 Conflict and resistance

Movements relate to the ‘underlife’(Goffman, 1962) of an organisation orsociety, often seeking to avoid detection.They are also often seen as an unwelcome,subversive or forbidden oppositionary forceand conflicts often occur ‘in whichchallengers contest authorities over theshape and governance of institutionalizedsystems of power’ (Morrill et al, 2003). Suchpolarisation can have a strong impact onbringing and binding participants together:‘The sense of crisis that develops in such conflictsstrengthens participants’ belief that their fate is tiedto that of the group. Because of the need to actquickly in a crisis, participants also become willing tosubmerge their differences with respect to the group’stactical choices.’ (Hirsch, 1990, as cited in Goodwin &Jasper, 2003)

So, Palmer (1997) asks:‘Has significant social change ever been achieved inthe face of massive institutional opposition? Theanswer seems clear: Only in the face of suchopposition has significant social change beenachieved. If institutions had a capacity for constantevolution, there would never have been a crisisdemanding transformation ... Resistance helps changehappen. The resistance itself points to the need forsomething new. It encourages us to imaginealternatives. And it energises those who are called towork toward those ends’ (p. 164-165).

‘Resistance’ also suggests subversion and awill to destroy but not necessarily so:‘People who start movements do so not because theyhate an institution but because they love it too muchto let it descend to its lowest form’ (Palmer, 1997).

Hence, it is more often an act of love thanan act of subversion.

3.2.8 Durable

As McAdam and Snow (1997: xxii) aptly point

out, social movements are not ‘fly-by-nightphenomena that are here today and gonetomorrow.’1 The social movements literaturemight therefore help cast new light on issuessuch as the spread and sustainability ofimprovement throughout the NHS. Forexample, (and relating back to the issue ofidentity described above), some argue that:‘social movement endurance is largely determined bythe ability of social movement participants to developand sustain a meaningful (and fluid) collectiveidentity’ (Kebede, 2000: 331).

1 For example, the Rastafarian movement has been in existence formore than 60 years.

The kind of changes movements pursue,whatever their degree or level, typicallyrequire some measure of sustained,organised activity (Snow et al, 2004: 11). Inthis case, the basis of sustained commitmentis social cohesion and identity - Durkheim’s‘communitas’. As Gamson (1991:27)concludes: ‘any movement that seeks tosustain commitment over a period of timemust make the construction of collectiveidentity one of its most central tasks’ (Hunt &Benford, 2004).

In this vein, McAdam (1986) shows howmuch easier it is to get sustainedcommitment once people have entered the‘circle’ of an active movement and begun toforge social relationships and a sharedidentity with each other (see annex 1). Oncepeople are in the movement circle they willtherefore be more likely to remain there byvirtue of the centrifugal forces of contact,interaction, socialisation, sharedunderstandings, belongingness andcommunity. This implies that sustainability ismore a social and cultural matter than it isan institutional matter, although recognisingthe latter may also be important. People areheld in by the ‘pull’ of commonly heldaspirations and beliefs and the social tiesthey are able to forge with one another.(McAdam, 1986). They stay there becausethey want, and to some extent need, to sincepersonal identity becomes inextricably bound

up with group identity. As with all of theabove stages, personality, personal biographyand experience will be a mediating ‘push’factor in this (some will feel the pull morethan others). However, McAdam (1986), andothers, suggest that this - especially in thecontext of the low risk/low cost activismlikely to be found in an NHS movement -may be less important than we previouslybelieved. Again, it underlines the importantcontact with the recruitment agent(entreater) because it is this single personwho usually introduces the individual intothe social circle, where the glue and thebonds and ties may be found.

SECTION FOUR: SCHOOLS OFTHOUGHT IN MOVEMENTRESEARCH

Key points for healthcareimprovement leaders

• Research into social movements falls intothree broad categories that focus on:

• emotions and non-rational behaviour asthe central reason why social movementsform

• the need for social movements to beorganised and properly resourced

• the importance of shared social processes(such as language and interpersonalrelationships) to formation of, and actionby, social movements

• Each of these has implications for how wego about improvement in the NHS but it isthe interactions between these threegroups of factors (emotion, structure andculture) that determine the form andsuccess of social movements

• We need to discuss what an improvementmovement might look like in the NHS andwhat combination of these factors is mostlikely to help bring it about

How do social and political scientists explainand make sense of social movements?Crossley (2002; pp. 11-13) distinguishesbetween American and European schools ofmovement analysis. US researchers havegenerally been less concerned with pinningmovements to the dialectics of history or aspecific type of society than with seeking toidentify the empirical conditions whichfacilitate and inhibit their development. Onthe other hand, European researchers havetypically focussed on the constitutivestructure and type of society in whichmodern movements emerge, the relation ofmovements to that society and their‘historical role’ therein.

15

There are three broad schools of thought inmovement research:

• Collective behaviour and social movementsresearch

• Resource mobilisation theory, and

• New social movements thinking.

4.1 Collective behaviour and socialmovement research (CBSM)

CBSM was the dominant school ofsociological thought during the 1940s toearly 1960s (cf. Smelser, Turner and Killian).This research took emotions and non-rationalbehaviour - ‘the imagery of the emotionalcrowd’ - as the central issues in socialmovement formation. From this startingpoint CBSM research portrayed movementemergence as a reflex response to‘grievances’, ‘deprivations’, ‘anomie’,‘structural strains’ or other such forms ofhardship (Crossley, 2002). Consequently,CBSM research naturally tended to focus onprotest movements. Collective behaviourtheorists thus believed that objectivehardships were both a necessary and asufficient cause of protest and movementformation. Shaped in part by Fascistmovements in Germany, Italy and Japan, thisschool stressed the irrational, deviant andvolatile dimensions of movements, andportrayed protests and movements asirrational psychological responses,manifestations of ‘mob psychology’ orcollective hysteria. CBSM research thuslumped social movements together withother assorted forms of ‘collectivebehaviour’, such as fashions, crazes andpanics, without any particular considerationfor their distinctness and properly ‘political’nature (Crossley, 2002).

Nevertheless, CBSM gave a prominence tothe emotional dimension that was to take afurther forty years before making itsappearance in organisation research,something which is only happening now(Fineman, 1994). Thus, for CBSM researchers:‘emotions and irrational methodologies were central

because movements occurred in highly chargedcontexts characterised by mass enthusiasm, collectiveexcitement, rumour, social contagion and masshysteria. Thus, social movements and movementparticipants were viewed as nonrational, given theunpredictability, and heavy emotional content ofmovements.’ (Morris, 2000: 445)

4.2 Resource mobilisation and politicalprocess theories (RM)

RM grew out of research that offered littleto no support for the suggested linkagebetween real or ‘felt’ deprivation and theoutbreak of movement phenomena and awillingness to participate in collective action.RM researchers in the 1970s and 1980s (cf.McCarthy, Zald, Gamson, Tilly) began toreject the earlier emotional bias and applieda new focus on ‘mobilising structures’1 andrational, calculative, opportunistic politicalaction.

RM theory does not deny the importance offeelings or the need for them to be presentin social movement action but merely assertsthat they will not produce a movementunless they are organised and properlyresourced. Edwards and McCarthy (2004)propose a five-fold typology of resources:moral (legitimacy, solidary support), cultural(artefacts and cultural products), social-organisational (infrastructures, socialnetworks), human (labour, experience, skills)and material resources (financial and physicalcapital). This is the concept of socialmovements as a form of organisation ratherthan a form of emotional expression orrelease; hence, building a social movement isnot dissimilar to building any otherorganisation2.1 ‘Mobilising structures’ are those ‘collective vehicles, informal aswell as formal, through which people mobilise and engage incollective action’ (McAdam et al, 1996: 3).2 There are of course differences. For example, a social movementorganisation has goals aimed at changing society and its members,whereas the full blown bureaucratic organisation does not(stability- rather than change-orientated), and members work forideological/purposive rather than instrumental/solidary reasons(Zald & Garner, 1986: 123). Nevertheless, they still both have goals,structures and resources, and survival, maintenance and growthneeds.

RM theories assume (a) a rational actormodel of the social agent along with aneconomistic focus upon exchange relations insocial life and the effects of the movementof resources between agents, and (b) astructural ‘network’ model of social relationsand social life. With these elementsmovement theorists from within the resourcemobilisation school were able to examinethe balance of costs, rewards and incentivesthat provided agents with the motivation tobecome involved in struggle, and they werealso able to focus upon the blockmobilisation of whole communities (Crossley,2002). By the 1980s this was added to by aconsideration of the ways in which politicalsystems and processes variously open up andclose down opportunities for protest,thereby affecting the flow of activism itself.

The RM perspective therefore focuses on thesocial and organisational structures withinwhich social movements form and grow (ornot); ‘structure’ includes organisation, roles,relationships, resources and politicalprocesses at the social, industrial andorganisational level. Obviously, the rationalactor model has attracted its critics whoobject that it is overly structural andrationalistic and precludes many importantissues from analysis, including the origin anddistribution of preferences, movementidentities and culture, and the role ofemotion (Crossley, 2002).

4.3 New Social Movements research (NSM)

In the 1990s NSM theorists (cf Habermas,Touraine, Melucci) began to ask a differentquestion to previous movement theorists.They took a step back from the usual batteryof questions regarding the dynamics ofmovement mobilisation and sought toidentify both the key movement clustersbelonging to any given era, and the mainstructural tensions which those movementsformed around. NSM research thereforerelocates our understanding of movementswithin an understanding of society moregenerally, providing a new focus on culturalissues and framing processes.

Culture (shared ideas, beliefs, meanings,interpretations, outlooks) is seen to play acentral role in generating and sustainingmovements; hence cultural forms such aslanguage (including stories and folklore),scripts, talk, rituals, ceremonies and rallies,dress, and symbols are central to movementformation, action and identity. Creating amovement is therefore regarded essentiallyas a cultural enterprise: an idea only ‘moves’a group if it has cultural resonance1. NSMrecognises that social movements are not somuch about emotions or structures butinteractive social processes within whichpeople talk, argue, debate, buildrelationships and, through these interactionsdevelop collective identity and purposes. Thisis the point at which new and lessmainstream sociological and organisationaltheories began to enter the field - symbolicinteractionism, dramaturgical analysis,culture and narrative - marking a shift awayfrom structure and rationality towards theexpressive, ideological, identity-shaping andconsciousness-raising dimensions ofmovements. This type of research alsoreaffirms the importance of strains andgrievances; whilst RM theorists (see above)argued that strains are not important tomovement analysis because they areconstants, NSM theorists argue that societieschange and with them so do the sources ofstrain. Thus strains are important becausethey are variable.

Bringing together these three schools ofsocial movement research in one overarchingperspective, Morris (2000: 452) describesmovements as ‘deep cultural and emotionalprocesses that inspire and produce collectiveaction.’ The key lies not in any one factor butin the dynamics and interrelationshipsbetween emotion, structure and culture andthe way the one reinforces or underminesthe other; each one is a lever formobilisation and collective action and incombination they add up to very powerfulcombined force2 but the way one might goabout ‘creating’ a movement depends uponwhichever theory one favours and chooses to

17

privilege, and/or exactly what type ofmovement one is striving to ‘create’.1 Snow et al’s (1986) concept of frame alignment is crucial in thisrespect (see page 50ff).2 One of the best examples of all of these working together isMartin Luther King and the black civil rights movement (Morris,2000: 448). The mobilising capacity of Montgomery’s African-American churches was the key; it was significant that it was theministers who endorsed the bus boycott after Rosa Park’s arrest.King remarked ‘I was filled with joy when I entered the church andfound so many of them there; for then I knew something unusualwas about to happen’. Morris (ibid) suggests ‘something unusualhappened because the church provided the emerging movementwith its vast communication network, its organised congregationsand its cultural and financial resources [authors’ note: i.e. resourcemobilisation] ... [the church also] contained the cultural frameworkthrough which the movement would be framed [authors’ note: i.e.new social movements] ... [and] collective behaviour theorists wereright to argue that movements often occur in the context of massenthusiasm and highly charged emotions [authors’ note: i.e.collective behaviour and social movements].

SECTION FIVE: MOBILISATIONAND MOVEMENTS

Key points for healthcareimprovement leaders

• In order to form a movement, peopleneed to be personally ‘moved’ ormobilised towards a shared goal; theyneed to want to join

• Large scale radical change, such as thatenvisaged in the NHS Plan, requires lots ofpeople to be mobilised

• There is huge variation in people’spotential for mobilisation

• This review examines the factors that mayeffect why an individual would join amovement which takes as its goal NHSimprovement. These factors are groupedhere into six categories: rational,emotional, social and normative,behavioural, organisational and leadershipfactors

Movements are made up of people, hence,no people, no movement. Huy (1999)suggests that at the individual level,mobilisation refers to the concrete actionstaken by a person in the direction of change.At the organisational level, mobilisationrefers to the process of rallying andpropelling segments of the organisation toundertake joint action with the purpose ofrealising common change goals.Klandermans (2004: 361) defines mobilisationas ‘the marketing mechanism of the socialmovement domain, and thus the study ofmobilisation concerns such matters as theeffectiveness of (persuasive) communication,the influence of social networks, and theperceived costs and benefits of participation’.Whatever, the particular nuances ofdefinition, mobilisation and movements aretwo sides of the same coin: without the onethere will not be the other.

The ability to mobilise hinges on theavailability of adequate resources (for

example, finances, time, human resources),support structures, and systems but, mostimportant, the necessary commitment andskill sets for co-operating during the changeprocess. Mobilisation during radical changerequires significant emotional energy. Incontrast to first-order change, such aschange in formal structures, which oftenrequires the action of a minority in thedominant coalition, radical change thatalters core perspectives and values oftenrequires widespread mobilisation1. Strongmotivations and commitments promotestrong efforts to complete the action in spiteof obstacles or great difficulties.1 Diani (2004: 341) discusses how mobilisation in social movementsoften occurs through mechanisms of ‘bloc recruitment’ (Oberschall,1973); cells, branches of simply significant groups of members ofexisting organisations are recruited as a whole to a new movement,or contribute to starting off new campaigns.

This leads us to our three core questions:

- Why do people join movements?

- Why do they stay in movements?

- Why do they leave movements?

The first question - ‘Why people join’ - isoften considered from the point of view ofreceptivity or readiness for change: howreceptive are individuals to membership andparticipation? In organisational development(OD) and change management terms it issuggested that receptivity is higher whenpeople (a) can perceive a degree of urgency,(b) perceive that there is a good chance ofsuccess and (c) can see the first steps. Bycontrast, theories of social movementrecruitment tend to deal with this questionunder the heading of incentives. Traditionaltheories have stressed the importance ofmaterial and ideological incentives, whereasmore recent theories have attached greaterimportance to microstructural social andorganisational incentives such as friendshipand organisational ties (Cohn et al, 2003).Other models provide different foci1.

In all of this we need to recognise that thereis huge variation in people’s potential formobilisation; some sign up straightaway,others remain unmoved or cynical.“It is highly unlikely that conversion can be explainedby any one theory ... There are simply too many

variables, both on the side of the transformationaltechniques employed ... and on the side of theassumptions, values and personalities of thoseattracted.” (Heelas, 1996: 197)

Recruitment into social movements has beenexplained by:

• Individual values (belonging, expression,affect)

• Concrete forms of involvement (supportfor the change program is stronglyconnected to the concrete personal-experience of involvement)

• Experience with related programmes

• Expectations about the program’s future

• The views of co-workers (driven byrelational and organisational context -presence of ties to other participants is arobust predictor of social movementmobilisation in many settings).

Klandermans (2004: 361) suggests three ‘dynamics ofmovement participation’, explaining the theoreticalbasis for each2 (see table 2):1 For example, Lazarus’s (1993) stress theory clarifies the relationshipbetween an individual’s receptivity to change and mobilisation.Individuals go through a two-stage appraisal process. Throughprimary appraisal they evaluate the significance of a new event fortheir own well-being. If change recipients evaluate the potentialconsequence as harmful (arousing negative emotions), they arelikely to be non-receptive to the proposed change, but if theyconstrue it as an opportunity or a challenge (positive emotions),they will be better attuned. Through secondary appraisalindividuals evaluate their own resources and capability for dealingwith the stressor. Thus, primary appraisal determines the extent towhich an individual is receptive to change, whereas secondaryappraisal determines the extent to which the individual mobilisesfor change.2 He also states that he knows of ‘no study that has attempted toassess the relative weight of all these motives in their effect onparticipation’ (362).

TABLE 2

Dynamic

Instrumentality

Identity

Ideology

Definition

Movementparticipation as anattempt to influencethe social andpolitical environment

Movementparticipation as amanifestation ofidentification as agroup

Movementparticipation as asearch for meaningand an expression ofone’s views

Theoretical basis

Resource mobilisationand political processtheories of socialmovements (andrational choice theoryand expectancy-valuetheory)

Sociologicalapproaches whichemphasise collectiveidentity componentof social movementparticipation and tothe social-psychological identitytheory

Approaches thatfocus on culture,meaning, narratives,moral reasoning andemotion, and totheories of socialcognition andemotions

19

Our own reading of the social movementsliterature points us towards six groups offactors which explain why an individual mayjoin a movement. These are discussed in turnbelow:

• Rational• Emotional• Social and normative• Behavioural• Organisational• Leadership.

SECTION SIX: RATIONALFACTORS

Key points for healthcareimprovement leaders

• Some people might join a NHSimprovement movement for rationalreasons; it seems a logical and reasonablething to do. For instance, they might bemotivated by self-interest (such as careerprogression)

• But rational reasons are not sufficient toexplain why large numbers of people joinand stay in movements. There are otherfactors that need to be considered

The first group of factors take an interest-based view consistent with the rationalchoice theory perspective (Rowley &Moloveanu, 2003). Individuals are assumedto have stable preferences based on (usuallyeconomic) utility maximization which guidetheir behaviours; the underlying notionbeing that individuals self-interests drivethem to mobilise. Thus, rational factorsinclude the notions that individuals’ haveinterests, mobilise to protect or enhancethose interests, and are more likely to actwhen there is a sense of urgency attached tothose interests. This interest-basedexplanation of individual mobilisation doesnot however explain the range of individualand group behaviours.

For instance, not all stakeholder groups witha high degree of discontent and access tothe necessary resources actually mobilise. Onthe other hand, groups may take action eventhough their members realise they arepursuing a lost cause (when the expectedrational benefits of the action are negligibleor negative). Yet again, some groups mayrefuse to terminate their action even afterthe focal organisation has satisfied theirclaims. None of these behaviours seems to beconsistent with the calculative theory ofmobilisation.

It therefore seems that, under certaincircumstances, a cost-benefit calculation ofgroup mobilisation is a less critical or even anirrelevant factor in predicting action. Groupsmay forego a rational assessment of netbenefits associated with collective action,because they are motivated to express andbe recognised for a particular identitygarnered to those participating as membersof the group. Not surprisingly, scholars haveraised: ‘... questions about the wisdom of continuing to use atheoretical framework that views movement memberssolely as rational actors. While this framework hasstimulated much important research and fundamentalinsights, it presents only a partial picture of humanbeings. Recent theorizing has highlighted theimportance of emotions as motivators of social action(Jasper, 1988), and it may well be that future researchon social movements will indicate that movementsmust offer members cultural and emotional incentivesin order to stimulate participation.’ (Cohn et al, 2003:334)

Clearly, people contemplating joining amovement will consider how far it will servetheir best interests to do so, and to thisextent reasoning and instrumentality docome into to it. However, reason and logicare just one component of a very complexbehaviour or choice-making process tocommit to participation in collective action.There are other factors at work that need tobe considered.

SECTION SEVEN: EMOTIONALFACTORS

Key points for healthcareimprovement leaders

• Strong, positive emotions can help to drivea movement forward

• Commitment-based movements aim tocreate a better future whereas grievance-based movements are centred on protestand anger.

• An NHS improvement movement is morelikely to be commitment- as opposed togrievance-based

• Feelings effect why people might join - aswell as leave - an NHS improvementmovement

Social movement organisations, like any othero rganisation, are ‘emotional are n a s ’ :“Feelings shape and lubricate socialtransactions. Feelings contribute to, andreflect, the stru c t u re and culture ofo rganisations. Ord e r, and control, the veryessence of the ‘organisation’ of work, concernwhat people ‘do’ with their feelings”(Fineman, 1994:9).

The general point from our second group offactors is that mobilisation re q u i res more thanrational cognition; it also re q u i res significantemotional energy - those strong positiveemotions that drive the movement forw a rd( H u y, 1999). We need to appreciate that‘being in a movement is a thoro u g h l yemotional experience’ (Adams, 2003: 85) andthat re c ruitment, emergence, longevity anddecline all rest on emotional decisions (Jasper,1998). Flam (1990) suggests that emotions areat least as important as rationality in socialmovements, and a recent empirical study ofthe Bread for the World movement by Cohnand others raised further doubt about “thewisdom of continuing to use a theore t i c a lframework that views members solely asrational actors”, adding that “re c e n ttheorising has highlighted the importance of

emotions as motivators of social action, and itmay well be that future re s e a rch on socialmovements will indicate that movementsmust offer members cultural and emotionalincentives in order to stimulate part i c i p a t i o n ”(2003: 334).

T h e re is an important distinction herebetween two quite diff e rent types ofmovements which is extremely pertinent tothe NHS context, and raising a fundamentalquestion about which type is mosta p p ropriate. In the case of ‘commitment’ orideologically-based movements, people join inthe hope or belief in a better or more joyfulf u t u re, this spirit being characterised byfeelings of caring and commitment, optimismand hope, joy, humility, awe and wonder, andemotional idealism. Such movements have anidea or ideal at their centre, which pro v i d ethe rallying point around which collectiveaction mobilises (Schon, 1971 cited in Van deVen, 1986).

H o w e v e r, in the context of ‘grievance’ orp rotest-based movements which are oftenc o n c e rned to correct an injustice1 p e o p l e ’sfeelings are more ones of injustice, outrage,hate, anger, blame, hostility, shame and guilt,t e m p e red by anxiety, fear, and feelings ofpowerlessness, futility, and isolation. If otherg roup processes have created sufficient gro u pidentification, the protesters will respond tot h reats as a powerful, angry group ratherthan as isolated, frightened individuals. Underthese circumstances, polarisation can have as t rong positive impact on participation. Thesense of crisis that develops in such conflictss t rengthens participants’ belief that their fateis tied to that of the group (Hirsch, 2003).C rossley (2002) goes as far to suggest that:‘neither resources nor networks, any more thangrievances or strains, are sufficient to explainmovement emergence, however necessary orimportant they may be. Sometimes either one ofthese factors may be the missing ingredient whoseemergence sets a movement in process but it is onlytoo obvious that many well-resourced and well-networked communities do not give rise tomovements most of the time. Well-resourced and

21

well-networked groups with no grievances will notmobilise...’ (p. 103)1 In such grievance-based movements the ‘evil’ must be dramatizedand personalized in a way that lastingly ties the crisis image andemotion to the cause. For example, publication of the vividlydescriptive and personalized account of slavery in ‘Uncle Tom’sCabin’ undoubtedly played an important part in translating slaveryfrom an ethical to moral issue and from a misfortune to an injustice(Turner, 1996).

Having joined a movement, people oftenstay because of feelings of affiliation,optimism, community, brother/sisterhoodand belongingness, escapism, attachment,pride, empathy, support, love, caring andaffection, intimacy, comradeship, solidarity,togetherness and exhilaration - what havebeen variously termed the ‘bonds ofcommitment and community’, “collectivelyexperienced emotion” and “collectiveeffervescence” (Adams, 2003).

An important change requires a leap of faithinto the unfamiliar (Kanter, 1983), and anemotionally unifying purpose serves tominimise large divergences among groups(Barnard, 1968). Radical change ofteninvolves a collective, interactional andemergent process of learning andsensemaking (Bartunek, 1984; Gioia &Chittipeddi, 1991). In this way, having peoplecommitted to realising a vision is moreimportant for its success than a well-thoughtstrategy (Pascale, 1984) becauseconcentration and passionate dedication arenecessary to achieve distinctive competenceand success (Miller, 1993). However, radicalchange often involves major uncertainty: theconsequences of different alternatives aredifficult to evaluate fully. During suchperiods, too much analysis may breedincreasing doubt and paralysis (whatMcAdam (1982) calls “a lessening ofconfidence in their ability to change thesituation”); warm emotionality has tosupersede cold rationality (see previoussection) to enable coherent collective action. ‘...much of the work that organisers and leaders do toanimate movements involves emotion work.Organisers reinforce group loyalties, inspire pride andcalm fears’ (Goodwin et al, 2004: 416)

People may also leave a movement becauseof feelings - in this case feelings ofdisillusionment, disappointment (let down),bitterness, betrayal, impotence, depression,disconnection, pessimism, fatalism, disgust,disaffection, boredom, exhaustion/burn out,failure, alienation and personal crisis (Gitlin,1987; Zolberg, 1972; Hirschman, 1982;Tarrow, 1988; Schneider, 1995). ‘Feelings’ canwork in either direction.

Goodwin et al (2004) discuss several types ofemotions and their relation to movementprocesses:

• Reflex (arise suddenly, for example, fear,or surprise)

• Affective bonds (persist over longer time(e.g. respect and trust)

• Moods, and

• Moral emotion (for example, pride orshame).

All of this implies a greater role for affect(feel) over cognition (perceive) in movementformation. Social movements are thereforeall about ‘movement sensibilities’ and‘structures of feeling’; the heart is the ‘heart’of a movement. All movements begin with aperson(s) deciding that he/she cannot carryon living a ‘divided life’ (Palmer, 1997) - theRosa Parks decision to act on her heart’sknowledge of her own humanity - or anuprising of the heart against the situation inwhich one finds oneself1. The first step isabout trying to bring one’s action intoharmony with one’s inner life; another wayof describing integrity or ‘deciding to livedivided no more.’ Others will join becausethey feel impelled to do the same. Hence,the action is not motivated (stimulus-response) but released (an ‘uprising’), inside-out not outside-in. One does not need to be‘encouraged’: the movement has the statusof an imperative so it must be donewhatever the cost or because ‘beliefs’ aremore powerful than the cost2. Given thecrucial role emotion plays in movementformation and growth it is paradoxical that,

‘scholarly attention to the role of emotionsin the realm of movement participation isonly in its infancy.’ (Klandermans, 2004: 369)1 See ‘The Heart Aroused’ (David Whyte).2 ‘No punishment anyone lays on you could be worse than thepunishment you lay on yourself by conspiring in your owndiminishment’ (Palmer, 1997: 171).

SECTION EIGHT: SOCIAL ANDNORMATIVE FACTORS

Key points for healthcareimprovement leaders

• An NHS improvement movement is morelikely to succeed if it’s stated aims andvalues are widely shared and supported bysociety as a whole

• Pre-existing networks of people within theNHS have a key role to play in mobilisingsufficient staff to join a movement

• Individuals are much more likely toengage in improvement activities if theircolleagues, friends and peers are alreadydoing so

• Finding those at the centre of thesenetworks who are committed toimprovement in the NHS is a critical firststep in developing the self-sustainingcommunities of practice that can providemass and energy to improvement activities

8 . 1 Historical and cultural conditions

Mobilisation and social movement gro w t ha re more likely to occur when there is (1) as t rong collective sentiment base (the numberof people who feel, like and share similargoals - see previous section), and (2) lowsocietal hostility towards the movement (theextent to which groups and org a n i s a t i o n saccept the legitimacy or value of themovement) (Zald & Garn e r, 1986). The bro a dpoint in this section is that situational contextis important. For example, it has been arg u e dthat the more a social movement thre a t e n sor perceives to threaten wider societal norm sand power bases the more it will be re s i s t e d .On the other hand, if the views put forw a rdresonate with current cultural narr a t i o n s(Snow and Benford call this ‘narr a t i v e

fidelity’) then they will be more effective inmobilising support (D’Anjou and van Male,1 9 9 8 ) .

McAdam and Paulson (1993) suggest that theultimate decision to participate in amovement depends, in part, on the absenceof strong opposition from others on whomother salient identities depend1. The decisionto join, support and remain in a socialmovement is there f o re greatly affected bysocial factors, either immediate ones likeo n e ’s peer group or much wider ones re l a t e dto prevailing views2 within a society at thet i m e :‘the modern social movement is not only a stru c t u r a lphenomenon - a complex of network actors andinteractions - but a cultural phenomenon as well ... thei n t e r p retative packages they put forw a rd re p re s e n tviews that are by definition against the grain, as theyc o n c e rn the cause of the socially marg i n a l i s e d .Packages have to resonate with current culturaln a rrations to be effective in mobilising support ... Theymust also be resonant or culturally credible becauseo t h e rwise they would not convince authorities or thegeneral public that their diagnosis is accurate and thep roposed changes are needed.’ (D’Anjou and vanMale, 1998)1 So, for example, prior to passage of the Nineteenth amendmentwomen’s groups in the United States were more likely to winsuffrage rights at the level of state government when they arguedthat women would use their voting rights to protect children,homes and families. In other words, they were more successfulwhen they framed their demands in ways that convinced peoplethat granting women the right to vote would reinforce rather thanundermine women’s traditional identity and gender roles(McCammon et al, 2001, cited in Campbell, 2002).2 The negative effect of social disapproval is more marked in‘exclusive’ (require active membership, training) rather than‘inclusive’ (only needs approval, pledge of support, no activism)movements.

8 . 2 Social networks

In conjunction with historical and culturalconditions that legitimate movementn a rratives, social networks and ties play a keyrole in re c ruiting, mobilising and re t a i n i n gp a rticipants (Passy, 2001)1; networks to al a rge extent determine who becomes at a rget of mobilisation attempts( K l a n d e rmans, 2004: 311). Alliances andnetworks lie at the heart of mobilisation, andmay cross formal organisational, pro f e s s i o n a land social boundaries (Zald et al, 2002: 11).These ‘mobilising stru c t u res’ (as RM theoristst e rm them - see page 23) enable movementsto re c ruit members, obtain re s o u rces and

23

disseminate information. Oberschall (1973, ascited in Cro s s l e y, 2002 pp. 93ff) proposes thatthe networks of everyday life harbour amultitude of re s o u rces which can be tappedinto for the purposes of struggle. Wi t hnetworks and communities come leaders,places of association, communicative channelsand means, and a stock of organisational andadministrative materials. Without these, thes p read of system-critical framings to theminimum number of people re q u i red toa ff o rd a basis for collective action would bep revented (McAdam et al, 1996).

This naturally leads to the hypothesis thatmany movements will grow out of pre -established networks, communities ando rganisations, and that movement form a t i o nwill be more common among tightlynetworked groups than in situations of highsocial atomisation. These networks pro v i d ethe bonds of solidarity out of which amovement could gro w. They provide pre -existing lines of communication, not tomention places of assembly and basico rganisational and administrative re s o u rc e s2.

As Campbell (2002) and others (Davis andMcAdam, 2000) point out, org a n i s a t i o ntheorists also understand that networksp rovide the foundation for all sorts ofo rganisational innovation and activity3; socialmovement activities are usually embedded indense relational settings (Diani, 2004: 339).This is borne out in a great deal of empiricalnetwork re s e a rch in both the org a n i s a t i o n a land social movement literatures. Manystudies have shown that individuals who havefriends or acquaintances who are alre a d yinvolved in a movement are more inclined top a rt i c i p a t e5. In his classic study of whitecollege students going to the American southin 1964 to help in voter registration drives,McAdam found three factors (see annex 1)i m p o rtant in explaining who comes forw a rdto join a movement (biographical availability,ideological compatibility and social-networkties) but in explaining those who showed upand those who did not, the first two factorsd rop out and the third factor - social networkties - becomes cru c i a l6.

‘If we have learned anything from the last twenty fiveyears of social movement re s e a rch, it is thatmovements do not depend on interest or opport u n i t yalone, but build on indigenous social networks indomestic societies ... it is more due to networks ofpeople who are linked to each other by a specificinterpersonal bond than to formal organisation orindividual incentives that collective action isa g g regated.’ (McAdam, Ta rrow and Ti l l y, 1995)2 See Freeman (1973) and D’Emilio (1998) for specific examples (inregard to the women’s liberation movement and militant gay andlesbian movements respectively) of the critical importance of socialnetworks for mobilizing people. Indeed, D’Emilio notes that manylesbians and gay men had already been radicalized and educated inthe movements then current among American youth (including thefeminist and antiwar movements). (Goodwin & Jasper, 2003)3 For example, black churches were crucial to the Southern civilrights movement in the 1950s, fundamentalist churches helpeddefeat the Equal Rights Amendment and mosques facilitated theIranian Revolution (Goodwin & Jasper, 2003: 51).4 See Granovetter’s (1973, 1985) classic discussions of networkembeddedness and strong and weak ties.5 Diani (2004: 341) cites Snow et al (1980) as showing socialnetworks accounting for the adhesion of a large share (60-90%) ofmembers of various religious and political groups, with HareKrishna being the only exception. Diani & Iodi (1988) found 78% ofenvironmental activists in Milan to have been recruited throughprivate or associational networks.6 Three further important insights from ‘Freedom Summer’ were: (a)a clear emphasis upon emotion, culture, identity (individual andcollective - see earlier section) and the sense of ‘shock’ which oftenprompts an individual to join collective action; (b) participation hada significant effect both at the level of personal and political lives;and (c) involvement in the activity disposes the agent both towardsfurther involvement and towards the forms of belief and identitywhich correspond with and reinforce it. McAdam postulated aprocess of circular reinforcement and amplification in the processwhereby each successive act of involvement commits the agenttowards more costly and risky forms of activism: ‘...each succeedingforay into safe forms of activism increases the recruit’s networkintegration, ideological affinity with the movement, andcommitment to an activist identity, as well as his receptivity to morecostly forms of participation.’ (McAdam, 1986: 70)

Social networks socialise and build collectivei d e n t i t y, provide participation opport u n i t i e sand shape individual pre f e rences in thedecision to join a movement. Kitts (2000)d i ff e rentiated between information, identityand exchange mechanisms. Information re f e r sto the capacity of networks to cre a t eo p p o rtunities for participation; identity tothe fact that social ties to significant othersc reate and re p roduce solidarity; exchange tothe informal circulation of social appro v a l ,re w a rd and sanctions through networks. Theyalso discourage leaving, and supportcontinued participation (Diani, 2004: 342).

H o w e v e r, we have to decide whethercollective actions are more likely to thrivew h e re a small number of people know manyothers (while most know no-one) or wheremany people each know some others, but no-one knows a large number. There areadvantages and disadvantages in both: asmall number of people who know each

other well will have a greater potential forc o - o rdination but if any one of them dro p sout or shows no interest in collective action,no-one else has much chance of gettingthings going. Meyer and Rowan (1977) arg u ethat dense ties among a group of socialactors facilitate the diffusion of norms andexpectations. As the number of ties among ag roup of actors increases, the actors cancommunicate more efficiently with eachother and can establish a share dunderstanding of how to address theirdissatisfaction (Rowley, 1997). Altern a t i v e l y,re s e a rch by Marwell et al (1988) stro n g l yfavours the network centralisation thesis:that mobilisation is a qualitative not aquantitative thing; what matters is not somuch the number of ties that organisers areinvolved in, as their selectivity, that is, thequantity of re s o u rces controlled by potentialp a rticipants they are connected to:‘Collective action happens when a critical mass ofi n t e rested and re s o u rceful individuals can co-ord i n a t etheir eff o rts ... successful organising is more a matterof whom you can mobilise than of how many you canm o b i l i s e . ’

This re s e a rch suggests an import a n ta l t e rnative lesson: one needs to find andt a rget an ‘org a n i s e r’ with a large personalnetwork rather than try and reach the wholenetwork. Marwell & Oliver (1993)emphasised the crucial role of a critical massof people (‘organisers’) pre p a red to face thecosts of starting collective action, re g a rd l e s sof the size of the group as a whole (Diani,2004: 346).

Oberschall (1973) also introduces the notionof ‘segmentation’: segmented communitiesa re those that are well integrated intern a l l ybut are cut off from other groups and,s p e c i f i c a l l y, from social elites. Thesecommunities are important for two re a s o n s :

• The distance between groups means thatless intensive forms of social control holdbetween them. Aggrieved groups haverelatively few channels by which toinfluence elite groups, other than overt

p rotest, and elite groups have littleleverage by which to prevent such pro t e s tor uprising

• The lack of mobility between gro u p smeans that the more talented andmotivated members of the aggrievedg roup - whom Oberschall believes maybecome its movement leaders - are notdrawn out of the oppressed group andinto the elite. Their re s o u rces orre s o u rcefulness remain within theaggrieved group, and at its disposal.

8.3 Communities of practice

As Campbell (2002) points outnetworks/mobilising stru c t u res can becultivated deliberately in order to obtaincritical re s o u rces, new organisational modelsand the like1. This is similar to the‘communities of practice’ (CoP) notion( Wenger et al, 2002; Bate & Robert, 2002),which may manifest itself as the equivalentof collective action in the workplace. Palmer(1997) uses the phrase ‘communities ofc o n g ruence’ but these seem little diff e rent toa CoP. These ‘offer mutual support ando p p o rtunities to develop a shared vision’.They are gathering places for people whofeel shaky about what they are doing, andlook to others for reassurance and stre n g t h .In the movement sparked by Rosa Parks,these communities of congruence found ahome in black churches. Although they havenow been recognised as such CoPs may beone of, if not the most import a n t ,mobilisation mechanisms for an impro v e m e n tmovement. 1 This is of particular relevance to the NHS Modernisation Agency’sAssociates scheme which is an example of network cultivation inthe NHS context. For instance, the work of those ‘leading’ thescheme sounds a lot like the ‘agitators’ or ‘travelling activists’described in the literature who create a macro-network betweenotherwise disjointed groups of actors and regions.

Gabbay et al (2003) define a CoP as a ‘gro u pof people who may not normally workt o g e t h e r, but who are acting and learn i n gtogether in order collectively to achieve acommon task whilst acquiring andnegotiating appropriate knowledge’. A CoP isthe place where individual identity (andpersonal stories) is forged into collective

25

identity (collective narrative), where ‘my’belief and ‘my’ struggle becomes ‘our’ beliefand ‘our’ struggle. Klandermans (1984) callsthis group process, in which group membersdevelop a collective identity that art i c u l a t e stheir shared interests and goals,‘consciousness mobilisation’ (as cited inRowley & Moldoveanu, 2003). Such collectiveidentity serves as an alternative basis formobilisation since it creates individualcommitment and feelings of solidarity.F i reman and Gamson (1979) argue that thefeeling of solidarity, which emerges amongindividuals through group affiliation, acts asa powerful catalyst for collective action.Despite the lack of material or pecuniarybenefits, individuals may still participate ing roup action toward the focal org a n i s a t i o n ,because they have become ‘linked togetherin a number of ways that generate a sense ofcommon identity, shared fate, and generalcommitment to defend the group’ (Fire m a n& Gamson, 1979: 21)1. It is interesting thatmany of the larger private sector companiessuch as Xerox and Shell have abandonedf o rmal programmatic approaches to change,which they claim have achieved little, infavour of an informal, communities ofpractice approach, based upon natural,v o l u n t a ry groupings. It would thus appearthat the particular qualities of a communityof practice - its informality and voluntarism,and its ethic of equality and co-operation,make it well suited to creating the ‘collectivecontagion’ that all large scale change re q u i re s .

8.4 Summary

Diani (2004: 350-1) identifies some re c u rr i n gthemes related to the question of ‘whatnetworks account for what type ofp a rticipation in a movement’?

• The role of networks seems to vary,depending on the costs attached to theaction that they are supposed to facilitate.M o re demanding forms of action haveusually been backed by stronger and morespecific networks. A central position in thenetwork, linking prospective part i c i p a n t s ,has also been identified as an import a n tp redictor of actual part i c i p a t i o n

• The extent to which the mobilisingmessages and the cultural orientation of amovement differ from, and are at oddswith, the dominant orientation in societyalso seems to make certain networks moree ffective than others

• Networks perf o rm diff e rent functionsranging from socialisation to the cre a t i o nof concrete opportunities to becomeinvolved, and to influencing pro s p e c t i v ep a rticipants decisions at crucial points int i m e

• Modelling simulations have suggested thatm o re centralised networks are more likelyto overcome ‘free-riding’ problems andgenerate higher amounts of collectiveaction; degree of network hetero g e n e i t yand homogeneity have also been found toplay a ro l e

• Flows of communication and the linksbetween diff e rent territorial areas haveillustrated how levels of collectivep e rf o rmance in one area depend on levelsof perf o rmance in other areas and howd i ffusion of new forms of collective actiona re also facilitated by previous connectionsbetween diff e rent territorial locations.1 In this way, McAdam (1989) argues that the consequences ofinvolvement in the Mississippi Freedom Summer projectincluded a strong affiliation with a particular social identity andthe tendency to participate in subsequent activism, whichallowed the participants to strengthen their affiliation with thatcollective identity (as cited in Rowley & Moldoveanu, 2003).

SECTION NINE: BEHAVIOURAL FACTORS

Key points for healthcareimprovement leaders

• Once individuals have decided to join amovement, their personal experiences ofparticipating in that movement play animportant role in determining how long,and how much they personally contribute,to its activities

• Participating in formal and informalmovement-related activities helpsreinforce the shared values andcommitments that attracted individuals tojoin initially

• In terms of a NHS improvementmovement, there is a need to focusspecifically on how to get people to join;the social processes around activism meanthat once they get involved, it is easier tokeep them involved

The fourth group of factors are behavioural:what people do in itself generates andstrengthens emotions and commitments. Soacts of joining, staying and the level ofactivism within a movement are alsodetermined by what people ‘do’ within themovement - ‘enactment’ and participationtie them in. For example, recruitment andfund-raising activities, voting (collectivedecision-making often plays an importantrole in motivating continuing commitment)and holding office, lobbying (‘phoning,writing letters to members and officials), andprotesting/rallies all enhance solidarity(Fendrich, 2003: 346). Cultural practices are aparticular form of collective behaviour, andespecially powerful because they build andreinforce the cultural identity of themovement. Examples of such culturalpractices would be certain kinds of meetings(e.g. prayer meetings), celebrations, festivalsand rallies, ceremonials, music and rituals.Language1 and appearance2 are alsoimportant, providing the visible ‘glue’ for themovement. There is also an important link

here between cultural practices and theearlier section on emotion. As Cohn andothers (2003: 334) have pointed out recenthistorical and ethnographic studies of socialmovement dynamics have pointed to theimportance of cultural practices in sustainingemotional commitments. 1 For example, Rasta ‘soul language’ or ‘dread talk’ reflects andexpresses every aspect of Rasta philosophy about life, politics andnature, so ‘I, a Rasta’ confirms he or she is an active subject ofhistory as opposed to an individual who has lost his or herpersonhood.2 As used to delineate symbolic boundaries between socialmovements and others, for example, Rastafari dreadlocks whichdemarcate in-group and out-group distinctions, establish identityand symbolise defiance and resistance (Kebede et al, 2000: 323).

So, whilst participation in the externalmission of social movements is clearlyimportant to movement success, as Knoke(1988) indicates many voluntary associationscannot persist unless members alsoparticipate in what Knoke terms internalactivities - the ‘pragmatic actions’, such asvoting in organisational elections, recruitingnew members and doing work that arenecessary for organisational maintenanceand continuity. As discussed in section 7,participation in social movements issustained by values, beliefs and emotionalcommitments but these are, in turn, fosteredand nourished by active participation in awide range of cultural practices such as thoselisted above. All this needs props andaccessories to support such participation andto animate and ‘bring it all alive’ for theaudience: backdrops, images, artefacts,wardrobe. Setting is also significant: all ofthese backstage and frontstage thingsconvey meaning.

‘Concrete forms of involvement’ (Strang & Il-Jung, 2002) - and their impact in forging acollective identity - is a theme that comesout in many social movement writings(Castell, 1983; Hunt et al, 1994; Taylor &Raeburn, 1997 as cited in Kebede et al, 2000:316).‘New Social Movement analysts argue that collectiveidentity is both the product and the cause ofcollective action, stating that collective identities arecreated in the midst of collective actions, and theprocess of maintaining them stimulates furthercollective action.’ (Kebede et al, 2000: 316)

27

Just as early studies in employeeparticipation showed, workers did not have ahigh propensity to participate prior to theirexperience of participation; this came afternot before the experience. Put idiomatically,people can’t want ‘it’ until they have tried it,and once they have they may want more ofit (the salted-nut paradox of motivation!).The concrete experience of participating in amovement is crucial, meanings and valuebeing formed after the experience notbefore it. The challenge is to get them in toMcAdam’s circle (annex 1) - hence theimportance of the recruitment agent -because once in it will be easier to keepthem in. Here they will find like-mindedpeople, shared values and outlooks, and aclimate of mutual support that makes themwish to continue their association.

SECTION TEN:ORGANISATIONAL FACTORS

Key points for healthcareimprovement leaders

• Movements do need some organisationand structure

• The concept of a Social MovementOrganisation (SMO) is a relevant one inthe context of NHS improvement

• The notion of a federated NHSimprovement movement, balancing theroles and responsibilities of the ‘local’ andthe ‘national’, may be particularly helpful

• NHS improvement needs financial, timeand human resources. Many movementslack one or more of these. However, theavailability of such resources is animportant mobiliser that influencesindividuals to join a movement

• One of the most important organisationalfactors for movement activists is theavailability of “havens” or free spaceswhere people can openly express theirhopes and concerns. This needs to beconsidered in the context of the NHSimprovement movement

The concept of the social movementorganisation (SMO) - the focus of theResource Mobilisation theorists (see page 23)who rooted their theory in the structuralrather than the social psychological - definesa fifth group of factors. Focal concerns hereare resources, structures and relationships (toother organisations and the wider politicaland state organisations). ‘SMO’s operatemuch like other organisations’ (McCarthy &Zald, 1977), and like all organisations theSMO is all about efficiency, effectiveness andfitness for purpose.

8.1 Organisational structure

There is much debate in the literature aboutwhether movements need ‘enabling’structures (dedicated roles, authority

positions, leadership, target goals). Somecommentators argue that while informalstructureless groups can be useful for earlyconscious- and energy-raising, after thisthere is a strong case for more formalstructure and structuring of the movement(Freeman & Levine, 1984)1. Others, like Rucht(1999) take the opposite line, pointing outthe dangers of formalised movementsbecoming more centralised-bureaucratic andmore moderate in their actions over time2.For example, in social movements we findexamples of ‘goal displacement’, where thegoal becomes survival, stability, maintenanceand conservative respectability rather thanmajor change (Zald & Garner, 1986) .‘whatever the form of goal transformation, it isalways in the direction of greater conservatism (theaccommodation of organisational goals to thedominant social consensus). Organisationalmaintenance is a special form of goal transformationin which the primary activity of the organisationbecomes the maintenance of membership, funds, andother requirements of organisational existence. It,too, is accompanied by conservatism, for the originalgoals must be accommodated to societal norms inorder to avoid conflicts that could threaten theorganisation’s viability.’ (ibid., 121)1 A strong case example would be Bread for the World (BFW), aleading professional SMO in the contemporary antihungermovement, which has required a high level of organisation inorder to sustain its external Congressional lobbying activities inrelation to hunger legislation (Barkan, Cohn & Whitaker (1993).2 Crossley (2002; p.92) cites Robert Michels (1949) on the dangers offormal organisations to political struggle. Organisations tendinevitably towards oligarchy, and the demands of organisation andspecialisation tend to cut the ruling elite off from the rank and fileand lead them to focus on their own agendas. Hence, theorganisation, or more precisely its survival, becomes an end in itself,to the detriment of the wider change agenda of the movement.

These routinisation and goal-displacementprocesses explain why SMO organisationsage, and begin to slow down and lose theirfire. Structure may therefore bring its ownproblems and requires certain leadershipactions (see section 11) to correct these.

Freeman (Freeman & Levine, 1984), however,exposes the ‘myth of structurelessness’ - theidea that movements are emergent and donot need organisation and central co-ordination - and argues that they do need itbecause it provides resources1, professionalsupport and co-ordination, and cruciallyhelps prevent factional disputes (what Knoke(1988) refers to collectively as the SMO’s

‘internal maintenance activities’). As with anyorganisation structure there are levels and inMintzberg’s terms (1979) this would bestrategic apex, operating core,technostructure and support structure.However, in social movement terms it isusually the ordinary members who give timeor money as organisational ‘constituents’ or‘workers’ (operating core), the people whohave control over decision-making as the‘cadre’ (strategic apex), and full-timeprofessionals who do not have involvementin decision-making as ‘professional staff’(support and technostructure):‘Similar to a piece played in the theatre, collectiveprotest requires a veritable production structure toenable the best performance to be offered to thepublic. In particular, protests which are large and/orare part of a broader campaign are preceded by thecollection and management of resources, definition ofroles and calls for action.’ (Rucht, 1999)

On the other hand, Levine says more rulesand structures are not needed, certainly notones that take away local spontaneity, powerand initiative. The literature tends to inclinetowards the alternative view.

Reger and Staggenborg (2003) propose themodel of a federated SMO combiningnational and local structures which may beparticularly relevant to the NHSimprovement context; while the nationalorganisation provides guidelines and policiesand initiates action campaigns, local chaptersmobilise participants and deviseorganisational forms and strategies to suitlocal conditions2. In this way, local chaptersand national level organisations are mutuallybeneficial, with the national levelmaintaining the organisation and thechapter drawing on the opportunities withinthe local field.1 Proponents of a formal organisational structure argue thatmobilisation of money and mobilisation of labour, are heavilycontingent upon the creation of movement structures, ororganisation building. This is true because, in general, the mostimportant factor in accounting for whether individuals willcontribute money or time and effort to collective enterprises iswhether or not they are asked to (Edwards & McCarthy, 2004).2 What Clemens & Minkoff (2004) term ‘meso-mobilisationstructures’ for generating and co-ordinating movement campaigns.

29

Formal organisations are by no meansnecessary to sustain strong campaigns: thereare many different ways in which protestactivities and even sustained campaigns canbe organized. However, protest requiressome degree of organisation and co-ordination (or piggy-backing on a pre-existing infrastructure) otherwise it will nothappen1. But too much organisation of theformal variety can lead to oligarchy andbureaucratisation, and indeed to political co-optation, such that movements ultimatelybecome incorporated and lose their criticaledge. Most successful movements passsomewhere between these two extremes, orperhaps counter-balance the tendencies ofone against the other, thus avoiding theworse excesses of either (Crossley, 2002). 1 For example, Rowley & Moldoveanu (2003) cite the example of thepro-life movement in the US abortion debate which was able to co-ordinate grassroots collective action immediately and effectively.Much of this success has been attributed to the existinginfrastructure linking people through the Catholic Church (Zald &McCarthy, 1987). Many members of the pro-life group wereinvolved in other Church-sponsored activism and had pre-existingrelationships with other pro-life members from a broad array ofpast activism. Because the costs of forming these relationships, aswell as norms of co-operation, had been incurred previously, thepro-life group had an initial advantage over its pro-choiceopponent.

8.2 Organisational resources

Even if social movements did not needorganisation they would still need resourcesand resource availability; adequate resources(financial, time, human) need to be presentin order to fuel and feed the movement.Movements may - indeed invariably do -experience resource problems. For exampleof the three types of resources that Etzioni(1975) identifies: coercion, utilitarianincentives appealing to the self-interest ofmembers, and normative incentivesappealing to members’ values, SMOs usuallylack the first two types. Typically they do notcoerce their members or provide them withmoney or other material benefits. All theyhave to offer are normative or ideologicalincentives, which may not be enough (Cohnet al, 2003: 314).

But there is a subjective motivational as wellas an objective aspect to this issue ofresources, as the literature also shows thatpeople are more likely to respond to the callto join if they believe there are adequate

resources to deal with the events at hand(Huy, 1999) - the so-called ‘secondaryappraisal’ that goes on after people havedecided that change is a ‘good thing’(Lazarus, 1993). Resources are therefore animportant mobiliser. As Weston (1985) putsit, individuals are motivated to act only ifthey perceive they can bridge thediscrepancy between goals and performance- and that is largely an issue of resources.

The issue here is that level of motivation tojoin, take part or stay is very muchdetermined by what people perceive asfeasible and possible, and this calculus is verymuch based upon what they see as availableby way of tangible (money, knowledge, time)and intangible resources (support, help,endorsement). The vision is what makespeople ‘up’ for change (receptivity) but it isresources that actually get them moving(activity).

Social movement theory also talks about‘free spaces’ (Polletta, 1999) and ‘opportunitystructures’ - neutral, meaning-free areaswhere people can begin to engage, free ofprevious baggage; a place of escape, a placethat gives ‘cognitive liberation’ for all thosewho enter, and therefore the opportunity toexperience and feel something different.Hirsch (1989) similarly suggests thatconsciousness-raising is facilitated in non-hierarchical, loosely structured, face-to-facesettings isolated from the people in power,where people can speak freely about theirhopes and concerns; in such ‘havens’ peoplecan more easily express their concerns,become aware of common problems andbegin to question the legitimacy ofinstitutions that deny them the means forresolving those problems.

SECTION ELEVEN:LEADERSHIP FACTORS

Key points for healthcareimprovement leaders

• Leaders of movements do make ad i ff e re n c e

• T h e re are diff e rent types of movementleadership, and single heroic leaders havean important role to play, but it is thep rocess of leadership of a movement that isi m p o rt a n t

• Multiple, multi-level, dispersed andnetworked leadership, including ‘every d a yleadership’ by frontline staff, is needed ifan NHS improvement movement is to bringabout large-scale change

• The way in which any movement isdescribed, discussed and presented by itsleaders to both internal and extern a laudiences is crucial.

• The greater the alignment between thelanguage and meanings used and ani n d i v i d u a l ’s own beliefs and values then theg reater the likelihood that individual willjoin a movement and stay within in.

• Such ‘framing’ plays a number of import a n troles: it provides unifying stories, acompelling case and an irre s i s t i b l eemotional and logical argument; it ignitescollective action, mobilises others andi n s p i res change; and it can fostercommitment and build community and‘collective identity’

• Leaders of an NHS improvement movementmust be able to frame its objectives andvalues in such a way that the great majorityof staff working in the NHS can identifywith, and personally commit to, them

• The leaders of the future NHS impro v e m e n tmovement need to be willing to make apersonal stand, to challenge the status quoand tackle the tough issues; they need tobe able to do this within the existingsystem; they need to be able to pre s e rv eoptimism, often against the odds

‘Leadership’ is one of the understudied are a sof social movements re s e a rch, having madelittle connection with the large corpus ofre s e a rch on leadership in organisation andmanagement studies. Leadership comes underthe broader heading of, what Morris (2000)refers to, as ‘agency’: the intervention by keyindividuals to shape the context, organise andd i rect the movement. In general, the balanceof the literature is in favour of the view thatleaders do have a role to play but - if there isa criticism of the literature - it is that thei m p o rtance of leadership has not beenemphasised nearly strongly enough. Cert a i n l yjudging by the evidence leaders do indeed‘make a diff e rence’ and there seems to be awide range of functions that they can pro v i d ein relation to movement growth anddevelopment (Morris, 2000: 450). Forexample, Morris & Staggenborg (2004)suggest that leaders are critical to socialmovements because ‘they inspirecommitment, mobilise re s o u rces, create andrecognise opportunities, devise strategies,frame demands and influence outcomes’(171). McCarthy and Zald (1977) also talkabout the role of leaders in the ‘manufactureof discontent’ whilst Campbell (2002) furt h e rdescribes leaders as ‘the ones oftenresponsible for cultivating networks for theiro rganisations or movements’ (22).

11.1 Types of movement leadership

Tu rn b u l l ’s (1997) work1 shows that peopleoften do need, and welcome, hero i c ,charismatic leaders whom they can follow.Nadler & Tushman (1990) talk about the‘Magic Leader,’ the person who serves as thefocal point for the movement, whose pre s e n c ehas some special ‘feel’ or ‘magic.’ This is activeand visible leadership that serves to art i c u l a t ethe change and to capture and mobilise theh e a rts and minds of people in theo rganisation. These individual leaders displaythe following characteristics and behaviour:

• They exhibit elements of three distinctivebehaviours: envisioning (creating anengaging and inspirational vision of anideal irresistible future state - this is the‘moving’ people aspect of the movement);

31

e n e rgising (creating or stimulating energ yt h rough personal demonstration, re w a rd s ,punishments and setting high standard s ) ;enabling (helping to create pro c e s s e s ,re s o u rces or stru c t u res that enablesfollowers to do what they feel moved to do).

• The ability to create a sense of urg e n c y ;successful reorientations involve thec reation of a sense of urgency right at thelimits of tolerance and just at the pointw h e re responses border on the defensive.

• G u a rdianship of themes: the leader is theg u a rdian of the themes of change; he/she isthe embodiment of the change he or shewants to see

• A mix of styles: directive andu n c o m p romising (autocratic) but alsoinclusive and participative (democratic).

Single leaders with special qualities - charisma,courage, intelligence, resilience, vision - areclearly an important ingredient of movements(for example, Martin Luther King, NelsonMandela) but there is always the problem ofthe ‘cult of personality’ which may lead topeople to over attribute the results to a singleperson. In most cases of movements ‘the ideaof a single leader is sociologically unsound’.R a t h e r, behind the figurehead one finds aconfiguration of leaders acting behind thescenes to mobilise and guide the movementand to give it its collective or institutionalisedc h a r i s m a2.1 Whilst research has suggested that organisational members arenot easily convinced by evangelistic corporate rhetoric and religiousimagery, Turnbull’s (1997) research at ‘Aeroco’ suggested that it didwin converts. There was ‘much evidence of quasi-religiousexperiences amongst managers’ (26): “Instead of overt resistance to the manipulative tenor of the[change] programme, I found that whilst some of the managerswere clearly disengaged or ‘agnostic’ in their views, many of themappeared to be engaging with it on a deep level, apparentlyconverting to its values, and welcoming the opportunity itappeared to offer them to find purpose and meaning in theirwork” (5).

She suggest this may reflect the growing secularisation of our timesand an increasing number of people who are re-enchanted byreligion in various forms - particularly ‘religions of humanity’(Heelas & Woodhead, 2000) which have a humanitarian focus onaction in the service of humanity, offering a dual appeal to self andmoral values. In this regard, it has been suggested that the growthof interest in the spiritual has started to spread into organisations,that there is a great untapped quest for meaning andtranscendence

2 Morris & Staggenborg (2004: 175) suggest that to be successful,social movements require that a myriad of intellectual tasks beperformed extremely well. A host of social movement activities -framing grievances and formulating ideologies, debating,interfacing with media, writing, orating, devising strategies andtactics, creatively synthesising information gleaned from local,national and international venues, dialoguing with internal andexternal elites, improvising and innovating, developing rationalesfor coalition building and channelling emotions - suggest a cadre ofleaders doing different things at different times and at differentlocations within the movement.

Such leaders may even belong to diff e re n to rganisations such as the church, politicalp a rties, trade unions or, in the case of the NHS,Royal Colleges, Department of Health, andlocal NHS organisations. There are also theleaders who sit at various nodal points in theirf o rmal and informal networks and who usesuch networks to exert leverage and influence.Another type of leader may be what Robnett(1997) calls ‘bridge leadership’1, ‘ani n t e rmediate layer of leadership whose tasksinclude bridging potential constituents anda d h e rents, as well as potential formal leaders,to the movement’.1 Building on Robnett, Goldstone (2001) writes ‘bridge leaders arethose neighbourhood and community organisers who mediatebetween top leadership and the vast bulk of followers, turningdreams and grand plans into on-the-ground realities’ (as cited byMorris & Staggenborg, 2004: 188).

In his work on changing culture - one of thep re - requisites for movement emergence -Bate (1994) puts the emphasis somewhereelse, suggesting that social movements need‘aesthetic’ and ‘political’ leaders, the first toc o n s t ruct the new framework of ideas, thesecond to persuade others to buy in to thoseideas and to mobilise support around them(Bate, 1994: 13). Single leaders may embodyboth or they may be shared between anumber of leaders, the stress being onleadership as a process rather than a singleperson. The whole point about the socialmovement perspective is that any or manyo rganisation members can take on leadershipfunctions, such that leadership is no longerthe privilege of a minority elite but of themasses who see themselves leading themovement forw a rd together (see Meyerson’s‘ t e m p e red radicals’ on next page).

Even if leadership is ‘crucial in determ i n i n gmovement success’, we still need to ask, ist h e re an appropriate model of leadership fora movement?

‘a major task of movement theory is to unpack the‘black box’ of movement leadership so that we candevelop more robust models of how collective actione m e rges and is sustained’ (Morris, 2000: 451).

The literature strongly favours multiple, multi-level, dispersed and networked leadershipp rocesses. Within this one can distinguishbetween (Morris & Staggenborg, 2004) fourtypes of leaders:

• Leaders who occupy the top form a lleadership positions of SMOs

• Leaders who make up the top team of them o v e m e n t

• ‘Bridge leaders’ who (laterally) connectd i ff e rent parts of the movement together

• those organisers who, in addition tobuilding connections between members ofa challenging group and helping them todevelop, also, ro u t i n e l y, engage inleadership activity.

Movement agency is contained in leadershipconfigurations where pre-existing leadershave the capacity to mobilise social networksbecause of their nodal position. What we aredescribing here is ‘network leadership’. Rao etal (2000) use the term ‘institutionale n t re p reneurs’ whom they identify as leading:‘... eff o rts to identify political opportunities, frameissues and problems, and mobilise constituencies. Bydoing so, they spearhead collective attempts to infusenew beliefs, norms and values into social stru c t u re s ,thus creating discontinuities in the world ofo rg a n i s a t i o n s . ’

Coining the term ‘tempered radical’,Meyerson (2001) suggests that in ano rganisational context movement leadershave needed to learn how to oppose andc o n f o rm at the same time1. Such people,Meyerson says, can be found at any and everylevel of the organisation, leadership being aset of actions not a position. These are the‘ e v e ryday leaders’, people who wouldp robably not consider themselves radical orleading a movement, or do not realise. Theya re convictions- and values- driven, holding

fast to their own self-definition. Such peopledo not want change for change’s sake but abetter place and, import a n t l y, they want torock the boat, at the same time as wanting tostay in it. Such people thus walk the fine linebetween diff e rence and fit, balancingc o n f o rmity and rebellion (notions of ‘insider-outsiders’; ‘double-consciousness’ and ‘bi-polarity’) working within systems notnecessarily against them.‘ Te m p e red radicals bear no banners: they sound not rumpets. Their ends are sweeping, but their means aremundane. They are firm in their commitments, yetflexible in the ways they fulfil them. Their actions maybe small but can spread like a virus. They yearn forrapid change but trust in patience. They often workindividually yet pull people together. Instead ofstridently pressing their agendas, they startconversation ... to do all this, tempered radicalsunderstand re v o l u t i o n a ry change for what it is - aphenomenon that can occur suddenly but more oftenthan not re q u i res time, commitment and the patienceto endure.’ (Meyerson, 2001: 40)

C o n t r a ry to the ‘charismatic school ofleadership’ leaders do not simply cre a t emovements by enthralling followers (Morris &S t a g g e n b o rg (2004: 18). Rather, the earlystages of a movement are typically an ‘orgy ofp a rticipation and of talk’ in which part i c i p a n t ss h a re stories, socially construct meaning ande x p l o re new ideas. To mobilise movementsout of these early interactions, leaders off e rframes, tactics and organisational vehiclesthat allow participants to construct acollective identity and participate in collectiveaction at various levels (Bate, 2004). It ist h rough the collective narratives and scriptsthen that leaders weave and make meaningfor others (Morgan and Smircick, 1980).1 Tempered in two senses: a) having the elements mixed insatisfying proportions; moderated b) toughened by heating andcooling (like steel); Radical: marked by a considerable departurefrom the usual or traditional

1 1 . 2 Framing

The role of movement leaders is not to ‘dire c t ’but orchestrate, facilitate and enable amovement to grow by creating the ‘re c e p t i v econtext’ for its formation. ‘Framing’2, as abehaviour by which people make sense ofboth daily life and the grievances thatc o n f ront them (Oliver & Johnston, 2000), is a

33

key concept for social movement re s e a rc h e r sin this re g a rd3:2 Gregory Bateson (1954) introduced the notion of a frame as ametacommunicative device that sets parameters for ‘what is goingon.’ Twenty years later frame analysis was introduced to sociologicalresearch by Erving Goffman. In ‘Frame Analysis’ (1974) and ‘Formsof Talk’ (1981) Goffman explored types and levels of framingactivities.3 Snow et al (1986) remain the key reference point in themovements literature for collective framing. More recently, Snow(2004) has presented a review of 15 studies on collective actionframes and framing processes.

Snow and Benford (1988) usefully distinguishbetween three types of framing:

• Diagnostic: a problem needs to bea d d ressed: ‘this is a problem that has to bedealt with’

• P rognostic: appropriate strategies, tacticsand targets: ‘this is what things could belike, these should be the targets, and this isthe direction in which we should bem o v i n g ’

• Motivational: arousing the right emotion:‘this is new and exciting and should re a l l yappeal to your inner needs and passions’

They have argued that frames are more likelyto be accepted if they (a) fit well with theexisting beliefs of potential re c ruits, (b)involve empirically credible claims, (c) arecompatible with the life experiences of theaudiences, and (d) fit with the stories orn a rratives the audiences currently tell abouttheir lives.

For frames read ‘springboards for mobilisings u p p o rt ’1. Frames are shaping metaphors,symbols and cognitive cues that cast issues ina particular light and define ‘reality’ for selfand others (situational definition). Framing asan activity involves the creation andmanipulation of shared understandings andi n t e r p retations of the world, its problems andviable courses of action. It affects how actorsp e rceive their interests, identities andpossibilities for change2 and ultimately howand in what way they act (and re a c t ) .1 From an organisational theory perspective, the notion is thatchanges in organisational structures and strategy are driven by alogic where proposed changes are only likely to ‘catch hold’ - oreven be recognised as viable possibilities in the first place - if theyare consistent with local customs, habits, schema and routines(Campbell, 2002). Alternatively, frames can be thought of as the‘voice’ - the question being how does the ‘sender’ get that voiceheard. Not everyone hears (variations in personal receptivity), buthow does one increase the likelihood of them hearing, especiallythose out there who might want to hear? Think of it in terms of a‘sender’ and a ‘receiver’; the sender has to have a message to send

and it has to be embedded in a form where it will be picked up bythose you wish to target (no different from politics and politicianslooking for people to vote for them!). Much of it depends uponhow it is presented - Campbell’s (2002) ‘cognitive framing:’ it mustresonate with ideologies, identities and understandings ofsupporters and potential recruits.2 Indeed, framing is often about establishing discursive oppositions.For example, in France when the characteristics of classical andnouvelle cuisine were juxtaposed by renegade chefs seeking toestablish an identity and niche for the latter within the profession(Rao et al, 2001, as cited in Campbell, 2002).

At a group or community level, framingp rocesses are ‘the collective processes ofi n t e r p retation, attribution and socialc o n s t ruction that mediate betweeno p p o rtunity and action’ (McAdam & Scott,2002: 17). Snow et al (1996) emphasise thei m p o rtance of framing processes inmobilisation eff o rts with re g a rd to changingframes, logics, alignments and stru c t u res. Theysuggest there are four alternative framingp rocesses: bridging1, amplification, extensionand transformation, with each havingassociated ‘micromobilization tasks’ (thedevices, cogs, processes and mechanisms) but,of these, ‘frame bridging appears to be thep r i m a ry form of alignment’ (468).‘By frame alignment, we refer to the linkage ofindividual and Social Movement Organisations (SMO)i n t e r p retative orientations, such that some set ofindividual interests, values and beliefs and SMOactivities, goals and ideology are congruent andc o m p l e m e n t a ry. The term ‘frame’ (and framework) isb o rrowed from Goffman to denote ‘schemata ofi n t e r p retation’ that enable individuals ‘to locate,p e rceive, identify, and ‘label’ occurrences within theirlife space and the world at large. By rendering eventsor occurrences meaningful, frames function to org a n i s eexperience and guide action, whether individual orcollective. So conceptualised, it follows that framealignment is a necessary condition for movementp a rticipation, whatever its nature or intensity’ (Snow etal, 1986: 464). 1 A social movement requires some kind of frame bridging or framebending experience. This is another way of talking about changingthe ‘institutional logics’. ‘Frame bending’ is said to be the basis oflarge-scale organisational change/’reorientation,’ (this beingdistinguished from ‘frame-breaking’ change which involves a sharpbreak with the past: social movements spread rather than breakfrom the past - a process of accelerated evolution). If it doesn’toverlap or fit, the next step - arguably the role for the leader - is totry and bend or stretch the frame to accommodate it.

In the context of the question, ‘why dopeople join movements?’, frame alignmentt h e o ry suggests the more my meanings,values, aspirations, identity and personalbiography align with those of the movement,the more likely I am to join and stay.T h e re f o re, the extent of mobilisation is a

function of the degree of consonance orc o n g ruence. The greater the degree ofoverlap/alignment between the individual(psychological) and the collective (cultural) int e rms of ideas, interests, and above allsentiments, the greater the likelihood ofs u p p o rt and participation.

The factors at work here include the extent tow h i c h :

• The ‘movement’ is perceived to address agrievance, problem or moral imperative.‘Felt’ is better than ‘perceived’: Snow et altalk about the mobilisation of sentimentpools, people’s inner feelings1.

• People believe the situation is actuallychangeable/mutable (i.e. worth doing/canactually be done/will make a diff e rence; thecomplete opposite to the mentality of‘ l e a rned helplessness’ ),

• It is seen to serve an intere s t( i n s t rumentality) or rationale, and

• It is perceived to carry risk and cost(calculus).

Such ‘frame alignment’ along these variousdimensions is there f o re key to enlistings u p p o rt and participation in a movement:

Framing will there f o re only succeed in gettingp e o p l e ’s attention and commitment if itresonates with existing aspirations and logics(‘the belief systems and associated practicesthat predominate in an organisational field’(Scott et al, 2000)). In this re g a rd, getting theright labels on the ‘package’ is crucial: 1 Movement membership has been described by Kling (1995) as a‘personal search for embedded belief’,

‘Labelling is an indispensable part ofp e rception and interpretation. It is the firstprinciple of language, and is essential to allf o rms of discourse and communication (Miller& Johnson 1976: 222). Before people canchange a culture, they must first be able tothink about it within their own minds andthen be able to talk about it with others. Theyneed a set of labelling routines for culturalphenomena. Labelling is indeed a skill:finding a word that serves as a catalyst for

some kind of ‘inner cultural form’ or semanticunity is by no means a straightforw a rdbusiness.’ (Bate, 1990)

We discuss ‘framing’ below in terms of thecontext of the three sets of activities thatmovement leaders have to manage in ord e rto get the attention and support re q u i red:

• Strategising: provide unifying stories, acompelling case and an irre s i s t i b l eemotional and logical arg u m e n t

• Mobilising: ignite collective action, mobiliseothers and inspire change, and

• Uniting: foster commitment and buildcommunity and ‘collective identity’.

1 1 . 2 . 1 S t r a t e g i s i n g

Movements often fail because of poorlythought out strategies and tactics and, to putit rather cru d e l y, bad decisions and wro n gc h o i c e s2 (Fendrich, 2003: 341). Hence, thel e a d e r’s role is to articulate and express astrategy that gives direction and purpose tothe movement and to which people canidentify and commit. 2 For example, Ganz’s (2003) case study of mobilisation offarmworkers by two unions in the US explained differences in theiroutcomes in terms of their strategy relating to the targeting, timingand tactics through which resources were mobilised and deployed.One union reframed its efforts as a farmworker movement. This ledto the development of a dual strategy based on mobilisation ofworkers (without whom there would have been no people, nocause and no movement) along with the mobilisation of urbansupporters (without whom there would have been no financial,political and economic resources).

The ‘strategic leadership’ of a movementrefers to two overlapping clusters ofleadership activities: strategic framing andstrategic choice:

Strategic framing: The movement leader(s)need to decide how best to frame andp resent the movement to pro s p e c t i v ep a rticipants, knowing that such ‘frames mustresonate with the salient beliefs of potentialre c ruits’ if their attention and involvement isto be secured (Snow & Benford, 1988). Bystrategically framing movement positions ina c c o rdance with dominant values and folktheories, the leadership is thus able to elicitg reater participation (Oliver & Johnston, 35

2000). Effective framing is very much alinguistic and dramaturgical skill, theleadership challenge being one of coming upwith a ‘unifying narrative’ for the movement,a ‘springboard story’ (Denning, 2000) or scriptthat will get people’s commitment andinvolvement, and allow the movement to‘take off’ (hence ‘springboard’).

Language and dramaturgy bring a theatricalmetaphor to movements thinking and to theframing literature in respect of the leadershipdimension (Hunt & Benford, 1997). From thisperspective, leaders search for what Stro n g(1979) calls a ‘plausible story,’ defined simplyas practical reasoning that convinces others.Not unlike the techniques of impre s s i o nmanagement, the leader(s) works toc o n s t ruct, foster and shape a compelling,convincing and irresistible image thro u g hw o rds, words in this case being the‘messenger of meaning.’. Dramaturgists tell usthat this involves four main framing tasks:

• S c r i p t i n g : c o n s t ructing a script that definesthe rationale behind the action and off e r sjustification and legitimisation of the actionbeing proposed. The script contains the‘hook’ that pulls people in.

• S t a g i n g : putting on the show in such a waythat it attracts the sponsors who ‘put upthe money’ and the audience whoseresponse will determine whether or not the‘play’ is a hit. Issues here also includes c e n e ry, setting, costumes and props. Maleleaders in organised hate movements mayemploy ostentatious titles such as GrandDragon or Imperial Wi z a rd (Taylor & Va nDyke, 2004: 269), which would not be outof place in a grand opera.

• P e rf o rm i n g : this is the ‘acting out’ part ofthe play which involves the actorsemploying various dramatic techniquessuch as ‘dramaturgical loyalty’ to create then e c e s s a ry air of reality (conveying a senseof being loyal to the values and beliefs ofthe target audience and an integrity to thescript). Taylor and Van Dyke (2004) talkabout collective actors choosing among

‘tactical re p e rt o i res’, many of thesedeliberately intended as spectacles thatshock and grab people’s attention (whatTa rrow (1993) terms ‘moments ofmadness’). Recent novel examples of whate l s e w h e re Taylor and Van Dyke call‘ g u e rrilla theatre actions’ would be womenlying down naked in the rain to spell out‘PEACE’, bra-burning, and crowning asheep Miss America in order to get themessage to the intended audience.

• I n t e r p re t i n g : i n t e r p reting the script in away that, on the one hand, resonates withthe feelings, cognitions and values of theaudience, and, on the other hand deepensand extends their interpretations andinsights into the issues being dealt with.The leader acts as ‘interlocutor,’ linking themovement ideal to the target group

F rom this perspective, strategic leadership andframing are about manipulation,confabulation, and fictionalism, not in thesense of something deliberately dishonest oru n t rue but in the Geertzian sense of‘something made, something constru c t e d ’( f rom the Latin original, ‘fictio.’)

Strategic choice. Strategic leadership is aboutdecision-making but, perhaps morei m p o rt a n t l y, it is also about choice making.The choices the movement leader makesbetween diff e rent strategies, tactics andcourse of action will have a major impactupon the direction, and success or otherw i s eof the movement. Strategic choice and‘agency’ are no strangers to movementswritings (see for example, Gamson, 1975), butas Jasper (2004) has recently pointed out, thel i t e r a t u re has been far from clear about whatleaders in a movement setting are supposedto be choosing between.

J a s p e r’s approach to this unanswered questionis to pose the issue of choice in the form ofdilemmas which need to be resolved by thel e a d e r’s application of superior skill,knowledge and judgement (since there isr a rely the luxury of an obvious best or right

choice). In the context of leadership of amovement these dilemmas include:

• The organisational dilemma: c h o i c e sa round manner and degree to which themovement needs to be organised, whichinvolves complex and difficult issues such asn a t u re and degree of form a l i s a t i o n ,c e n t r a l i s a t i o n - d e c e n t r a l i s a t i o n ,incentivisation and motivation,p rofessionalisation, and efficiency versusdemocracy concern s

• The extension dilemma: issues around theoptimum size and scale of the movement.As size increases, so does potential powerand influence, yet at the same time themovement becomes susceptible tofactionalism and conflict, dilution, andp roblems of co-ordination and contro l .M o re o v e r, in explaining re c ruitment, socialmovement theory has emphasised the ro l eof existing friendship and org a n i s a t i o n a lties and the possibility that joiningmovements will lead to new friendships( s o l i d a ry incentives) (Oegema &K l a n d e rmans, 1994). Here large SMOs withnational or international memberships havea serious hurdle to overcome, as theirmembers typically have little to do witheach other and usually do not even knoweach other (McCarthy & Zald, 1977).

Choice is not only about size and scale, butalso extends to whether membership isopen or restricted: “Does your power lie insheer numbers of members, no matter whothey are, or in the kind of people they are ?You may wish to restrict your mobilisationto those with special re s o u rces, skills orreputations to increase your eff e c t i v e n e s s .You may wish to exclude those especiallystigmatised by other audiences ... On theother hand, sheer numbers may be thes o u rce of the movement’s power ...’ (Jasper,2004: 8)

• Shifting goals: do you stick tenaciously toyour original values and goals, or do youreact flexibly and opportunistically to thee m e rging situation? Grasping newo p p o rtunities (such as unexpected alliances)can lead to greater movement growth and

success, but it can also lead to compro m i s eand limited victories at the cost of moresweeping, ambitious ones.

• Naughty or nice?: To what extent do youwork with or against the system? Are youlikely to gain more by having people lovingyou or fearing you?

Jasper offers a further nineteen dilemmas/-strategic choices for the movement leader andthese are included in annex 2 of this re v i e w.

Behind each of these difficult strategicchallenges lies a set of equally difficult tacticalchallenges. For example, in the context of theabove naughty or nice? dilemma, one istactically choosing between disru p t i o n ,stealth, coercion, aggression and sabotage onthe one hand, and collusion, co-operation,openness, and moderation on the other, andr a rely will this be a simple either-or matter.

M o rris (2000: 449) talks about ‘tacticalb re a k t h roughs’, inspired tactics thato u t m a n o e u v re the opposition and generatecollective action.‘ Wi d e s p read and sustainable collective action is notlikely to develop if potential movement leaders fail tomeet the tactical challenge. Such leaders must selectand then execute appropriate tactics that will generates u fficient disorder and be attractive to theirc o n s t i t u e n c y. If they fail to meet this challenge,collective action will not develop.’ (ibid.)

Such strategies and tactics do not just‘happen’: they have to be carefully craftedand constru c t e d :‘For mass-based movements to emerge leaders mustdevelop tactics that are congruent both with thecultural framework of the challenging community andtheir main organisational vehicles ... The developmentof a tactical solution is one of the central factors inmovement causation. Such tactical solutions are notinevitable and do not occur by happenstance. It is thischallenge that leaders must meet if collective action isto occur.’ (ibid.)1

1 Morris (2000) cites the example of Martin Luther King: ‘...to linkthe boycott tactic directly to the mass-based church, King situated itin the context of love and evil - familiar themes in the African-American religious community ... King added the theme of evil byarguing that non-cooperation was a tactic whose ‘attack is directedagainst forces of evil rather than against persons who happen to bedoing the evil.’ By imbuing the tactic with love and identifying theJim Crow social order as an evil force, the leaders successfullyrooted the protest in the moral frame of the African-Americanchurch. The result was a marriage in which culture, tactics andorganisational capacity were linked so that collective action couldbe produced ...’ (449)

37

The tactical and strategic decisions andchoices leaders make and the actions theytake are there f o re cru c i a l :‘What is usually ignored is that leaders of SMOs mustchoose from a number of options. The choices theymake affect the mobilising capacity and outcomes ofmovements. If King had chosen to adopt an aggre s s i v emilitant tactic that included the use of violence, themasses and their churches would not have supported it.M o re o v e r, chances are great that the state would haveviolently crushed such protest in its infancy. Ta c t i c a lchoices that leaders make matter.’ (ibid.: 450)

Ta rrow (1998) suggests that strategic andtactical framing needs to focus on gettingalignment with the cultural symbols andvalues which mediate agents’ perceptions andunderstandings of the world. ‘Out of the cultural re s e rvoir of possible symbols,movement entre p reneurs choose those that they hopewill mediate amongst the cultural understandings ofthe groups they wish to appeal to, their own beliefsand aspirations, and their situations of stru g g l e ’( Ta rro w, 1998: 109)

Ta rrow adds that emotions also have a centralrole to play in collective mobilisation andaction, the role of the leader being to channeland manage these towards the desire dobjectives. Frames are precisely about this -they give sense to emotions and direct ani n d i v i d u a l ’s course of action in such a way asto channel that emotion. Emotions are ac rucial source of energy fuelling movementactivism and engagement (see section 7).C o n s e q u e n t l y, the processes in relation toframe alignment must seek to tap into thesesymbols which are so invested into emotionalmeaning and significance.

1 1 . 2 . 2 M o b i l i s i n g

‘Movement success depends on org a n i s e r spersuading others of the need to engage incollective action to solve a problem’ (Adams,2003: 85). Such persuasion may involveevocative new words and scripts. Emotionalstories are an important part of this2:‘Social movements ... are created by the stories peopletell to themselves and one another. They reflect thedeepest ways in which people understand who theya re and to whom they are connected. Whatever theya re, and whatever historical sources of theirdevelopment, they are constructed from the

i n t e rmeaning of personal and social biographies - fro mthe narratives people rehearse to themselves about then a t u re of their lives.’ (Kling, 1995: 1)

F ryer (2003) suggests that stories are the basisof any framing activity and whilstconventional managerial rhetoric is based onan intellectual process - quotes fro mauthorities, data, statistics, evidence - thep roblem is that even if people are persuaded,this is not sufficient as ‘people are noti n s p i red to act by reason alone’ (52). Better to‘unite an idea with an emotion’, ‘to tell acompelling story [and] arouse the listener’semotions and energy’ as ‘stories are how weremember; we tend to forget lists and bulletp o i n t s . ’‘Leadership through storytelling emphasises the moreempowering parts of an org a n i s a t i o n ’s past and bringsthem into the present for all members of theenterprise. Storytelling is an act of creating futureo p p o rtunities. Communicating through teachingparables, that serve life as it is configured today, yeta re grounded in the org a n i s a t i o n ’s foundingexperiences ... is part of leading cre a t i v e l y. In this sensethe stories are not old, but take an experience from thepast ... and create a living ‘collective memory’ of thelessons learned, even for newcomers. The storiesp rovide a continuous thread to bond all in theo rganisation with the energy and learnings derivedf rom invigorating experiences ... The role of topmanagement is to invent and give form to at r a n s f o rmational story for the organisation.’ (Butler &Zein 1996: 405)2 For instance, research on the Polish Solidarity movement showsthat the ‘emotional-volitional tone’ of people’s acts and speecheswas an essential element of the sense they made of situations.

1 1 . 2 . 3 U n i t i n g

O rganisations are characterised by extre m efactionalism: the challenge for leaders is toframe things in a way that finds space in thetent for all and help to foster ‘collective’identity and commitment.‘An organisational frame too narrowly constru c t e dmakes broad mobilisation more difficult since it re d u c e sthe number of sympathetic people ... an org a n i s a t i o n a lframe that is too broad makes it difficult for theo rganisation to communicate a distinct org a n i s a t i o n a lidentity and agenda.’ (Croteau & Hicks, 2003: 253)

Framing is not a static activity but a constantand dynamic process in which leadership skillsa re deployed in negotiating, fitting,

c o n s t ructing and aligning diff e rent frames,building coalitions of purpose and re s o l v i n gongoing frame disputes between the part i e s .A sense of unity or collective identity issynonymous with ‘solidarity’ (Kebede et al,2 0 0 0 ) :‘ We argue that a movement’s endurance depends onits ability to develop and sustain a strong sense ofcollective identity.’ (ibid.: 313)

As a movement develops, if it is successful itmay become increasingly fragmented andpluralistic. Hence the uniting role of centralleadership becomes even more important as itgoes on. Again, in all these aspects, storiesseem central to that process of maintainingunity and continuity.

1 1 . 3 S t o rytelling: movements as narr a t i v e

Social movements are forms of narrative andn a rratives are framing devices. The chosenn a rrative will determine who and how manywill ‘sign up’ to the movement, how thesituation is defined and what action is taken:if people define a situation to be real it willbe real in its consequences

A movement must have its own text/form ofn a rrative which acts as the ‘hook’ for newre c ruits, for example, people will join a peacemovement or religious group when theyunderstand, accept and agree with its basics t o ry/stories. The story has to grab them,make sense, re i n f o rce one’s sense of one’sown self identity and personal biography.Stories situate people and provide them withcontext and identity: “It is to stories thatpeople turn to make the incoherences of theirlives coherent” (Culverson, cited in Kling,1995). “Social movements are ... a set of textsput together by social groupings ... thosestories help people make sense of thate v e ryday life” (ibid.).

N a rrative thus holds the key to meaningmaking and to this extent is the entry pointinto the practices through which people makechoices, shape action, and form into socialmovements. ‘Social movements ... are constituted by the stories

people tell to themselves and to one another. Theyreflect the deepest ways in which people understandwho they are and to whom they are connected ... theya re constructed from the interweaving of personal andsocial biographies - from the narratives people re h e a r s eto themselves about the nature of their lives.’ (Kling,1 9 9 5 ) .

The role of leaders, there f o re is to assemble,craft and hone the script for the movement.The dramaturgical perspective (Mangham &Overington, 1987) asks what makes a goodscript in this re g a rd? The stress is on crafting:this is more ‘bricolage’ than Shakespeare, acut and paste job using scraps from diff e re n tperspectives to build up the script. ‘Scripts’assemble individual meanings into a cohere n twhole and carry the message to the masses. Itis there f o re important to get the script right.A c t u a l l y, here, one is talking more about‘ rhetoric’ than ‘language.’ The primarypurpose of language is to communicatew h e reas the primary purpose of rhetoric is topersuade. Features of a persuasive script - the‘ rhetorical devices’ used - are many. Forexample, careful choice of metaphor isessential. A movement often needs a fre s h ,e m e rgent metaphor to hang it all on: ‘Metaphors are integral to our language. It is thro u g hmetaphors that we communicate. Often we are nota w a re of using them because we take them forgranted and have begun to treat them as literal ...Metaphors have the effect of both describing andc o n s t ructing our organisational realities. By naming asituation through a metaphor, we not only give it a richidentity but also engender actions that actually cre a t ethe reality’. (Karl Weick coins the term enactment toname this process) (Akin and Palmer, 2000).

The choice of metaphor can make or break achange pro c e s s1. If it is a ‘good’ metaphor, itcan cast reality in a new light (i.e. re f r a m e ) ,get people out of thinking traps, and ignitee n e rgy; the creative and energising power ofmetaphor is immense. But it needs ap a rticular kind of metaphor: ‘Its evocativei m a g e ry produces an effect that touches ac h o rd of comprehension in individuals. If thisis missing, the metaphor will not take.’ (ibid.)The skill of movement leaders like Mart i nLuther King often lies in assembling a rich

39

a rray of diff e rent metaphors into a singlec o h e rent utopian vision that people will findi rresistible. Thus it is words not arms that arethe messengers of meaning and the ‘wings’ ofthe movement. The diff e rence between asuccessful movement and an unsuccessful onemay simply be a case of choosing the rightw o rds and the right story, and the part playedby leaders in this re g a rd is cru c i a l .1 An example the above authors give is a change leader talkingabout change in terms of ‘building on past successes’ and the needfor ‘further development,’ when what was wanted was a breakfrom the past, something new and different; a transformationalchange. The language was first order whereas the aspiration wassecond order. The language needed to start to embrace more‘second order metaphors.’

SECTION TWELVE: TOWARDSA THEORY OF LARGE SCALECHANGE IN HEALTHCARE?

Can social movement thinking contribute tothe transformation of healthcare services inEngland? Can models and frameworksdeveloped through the study of emergentsocial movements provide perspective to aNHS change process that is essentiallyorganisationally bounded?

12.1 Limitations of social movement theoryand research in NHS context

Firstly - and the largest question concernedwith applying social movements thinking tothe NHS - is that many observers believe thatwe cannot predict the emergence of animprovement movement, we cannot make ithappen or consciously construct them, andwe certainly cannot control its direction andimpact. In short, social movements areunpredictable and difficult to control:‘Social change exhibits varied moments and istransported by many carriers. It may result in thetransformation of existing organisations or thecreation of new and hybrid forms. It is advanced byinstitutionalised processes as well as by tumultuousbattles. Settlements are realised but, they in turn giverise to different struggles among contending interestsand logics.’ (McAdam & Scott, 2002: 46)

Secondly, whilst social movement theory andresearch have long addressed differentialrecruitment, little research has examineddifferential participation after recruitment,even though an active and committedmembership is critical for the success of manysocial movements (Cohn et al, 2003). Somestudies of social movements have found thatonly a few of the many people who mayagree with the goals of the movement everparticipate in its activities; some peopleparticipate a lot while most participate littleor not at all (Knoke, 1988).

Finally, as McAdam & Scott (2002) suggest,social movement researchers have tended tolimit their scope to ‘transgressive contention’

(change efforts that require the consciousmobilisation of marginalised ordisenfranchised elements) whereas in theNHS context, the focus is more on ‘prescribedpolitics’ (the activation and reproduction ofinstitutionalised authority).

However, Clemens & Minkoff (2004: 162)claim that movements inside organisationsprovide a ‘fertile site’ for the application anddevelopment of social movement theories.The impetus for insider mobilisations comesfrom mass-based social movements, but,once movement ideas and identities hit theworkplace, organisational context, cultureand relationships to the environment presentactivists with both distinctive opportunitiesand constraints. Palmer (1977) suggest thatsocial movement thinking can give impetusto organisational change:“The genius of social movements is paradoxical: theyabandon the logic of organisations so they can gatherthe momentum necessary to alter the logic oforganisations” (page 166).

Scully & Segal (2002) suggest that workplaceactivists - such as those in the NHS - areadvantaged by a relatively transparent viewof how the system works and access toresources and strategies that give them locallegitimacy and leverage. Still, suchadvantages carry the risk of incorporationand reutilization in ways that potentiallydiminish the grass-roots energy to sustainthem. It should also not be overlooked,however, that - relative to other countries -the NHS is in a relatively strong position interms of movement formation anddurability1:‘if the medical profession in the UK could be

convinced of the need for fundamental breakthroughin quality improvement and adopts the approachesfor doing do, the chance for more rapidimplementation and diffusion appears far greaterthan in the more loosely organised physiciancommunity in the US’ ((Ferlie & Shortell, 2002: 288).1 Although note the interesting counterview from Pope’s analysis ofclinicians’ reactions to the Evidence Based Medicine movement inthe UK (Pope, 2003).Social movements and large scale change

12.2 ‘Moving’ people: the ‘animating vision’.

People will only be animated and moved ifthe message has ‘cultural resonance’ - it ringsbells with people’s beliefs, values, ethics andcommitments (see Morris (2000) and NSM).Wide acceptance of the proposed visionaccelerates the change process (Larwood etal, 1995). Having people committed torealising a vision is more important for itssuccess than a well thought-out strategy(Pascale, 1984): the vision is what makespeople ‘up’ for mobilisation and change.

Over the past period, a number of NHSorganisations have started to focus theirimprovement strategies around a ‘theoreticalidea’ (Bevan, 2003). This means movingbeyond the limits of the performance targetsset out in the NHS Plan to aspire to standardsof healthcare delivery previously notdreamed of. An example vision statement,from the Luton and South Bedfordshirehealth community is shown below (table 4)

• There are no avoidable deaths

• There is no feeling of helplessness by thepublic, staff and patients

• Care is given in the right place at the righttime

• We do the right things (based onevidence)

• Clinicians practice in an interdependentsystem not an institution

• Different organisations’ leaders trust eachother

• Health inequalities are tooted out andremoved

Source: Luton and South Bedfordshire Health Community, 2003

TABLE 4: GOALS FOR IMPROVEMENT FROM THELUTON AND SOUTH BEDFORDSHIRE HEALTH

COMMUNITY

This represents evidence of leadership‘framing’ to envision a future state thatconnects with core values and aims to inspireand produce collective action.

41

12.3 Planned programme or mobilisation?

The social movements perspective may helpto shed new light on large scale change inthe NHS by offering a new butcomplementary approach to currenthealthcare improvement thinking. The“programmatic” and social movementsperspective on change are contrasted belowin table 5:

Source: Bate et al, 2004: 63

TABLE 5

The paradoxical nature of social movementthinking (Palmer, 1997) fits well with afuture model of healthcare improvementthat combines planned programmaticapproaches with actions to ignite energy andpassion around deeply held beliefs andvalues. This is not “either/or” (pragmatic ormobilisation approach) but “both/and” - thesocial movement perspective adds thetension and energy that enables change tooccur and be sustained.

12.4 Towards theoretical constructs for largescale change

In general, improvement activities in the NHSis under conceptualised (Bevan, 2004).Research has identified that, even in NHSorganisations with a strong track record ofimprovement, there is typically littlereflection, hypothesising or consideration ofalternative actions before embarking onchange processes. Rather, teams decide on aspecific course of action and jump straight into making changes (Matrix RHA, 2003a).

There is a need to strengthen theunderpinning theoretical base of NHSimprovement work, particularly focussing ontheories for large system change. Socialmovement theory may not necessarily be the‘right’ theory of the predomination theoryfor the nest stage of the NHS improvementjourney. It may not be an exact ‘fit’ with theorganisational and cultural context of theNHS. However, the lens of social movementtheory provides insight into ways to mobiliseand liberate NHS around the goal of betterpatient care, with a perspective that isunavailable through the prevalentOrganisational Studies paradigm.

Social movement theory has the potential tomake a significant contribution to thedevelopment of explicit theories formotivation for large scale change. This areais a critical component for the future yet islargely absent from current thinking. Perhapsthis is an appropriate starting point for thenext stage in the NHS improvement journey

Project / programmeapproach

A planned programme ofchange with goals andmilestones (centrally led)

‘Motivating’ people

Change is driven by anappeal to the ‘what’s in itfor me’

Talks about ‘overcomingresistance’

Change is done ‘to’people or ‘with’ them -leaders and followers

Driven by formal systemschange: structures (roles,institutions) lead thechange process

Social movementsapproach

Change is about releasingenergy and is largely self-directing (bottom up)

‘Moving’ people

There may well bepersonal costs involved

insists change needsopposition - it is thefriend not enemy ofchange

People change themselvesand each other - peer topeer

Driven by informalsystems: structuresconsolidate, stabilise andinstitutionalise emergentdirection

REFERENCESAdams, J. (2003) ‘The bitter end: emotions at a movement’sconclusion’, Sociological Inquiry, 73(1): 84-113

Akin G and Palmer I. (2000). ‘Putting metaphors to work forchange in organizations’, Organizational Dynamics, 28,67-79.

B a rn a rd CI. (1968) The function of the executive. Boston;H a rv a rd University Pre s s

B a rtunek JM. (1984) ‘Changing interpretative schema ando rganisational re s t ructuring: an example of a religious ord e r’ ,Administrative Sciences Quart e r l y, 29: 355-372

Bate SP. (1990) ‘Using the culture concept in an org a n i s a t i o ndevelopment setting’, Journal of Applied Behavourial Science,26(1): 83-106

Bate SP. (1994) Strategies for Cultural Change, Butterw o rt hHeinemann: Oxford

Bate SP. (2004) ‘The role of stories and storytelling ino rganizational change eff o rts: the anthropology of ani n t e rvention within a UK hospital’, Intervention, intern a t i o n a lj o u rnal on Culture, Organization and Management, 1(1)

Bate SP and Robert G. (2002) ‘Knowledge Management andcommunities of practice in the private sector: lessons form o d e rnising the National Health Service in England andWales,’ Public Administration, 80(4): 643-663

Bate SP, Robert G and Bevan H. (2004) ‘The next phase ofhealth care improvement: what can we learn from socialmovements?’ Quality & Safety in Health Care, 13(1): 62-66

B e rnstein, M. (2003) ‘Celebration and suppression: thestrategic uses of identity by the Lesbian and Gay movement’,in Goodwin J and Jasper J (eds.), The Social MovementsR e a d e r. Cases and Concepts, Oxford; Blackwell

B e rwick, D. (2003) ‘Improvement, trust and the healthcarew o r k f o rce’, Quality & Safety in Health Care, 12(6) 448-452

Bevan H. (2004) ‘On the power of theory’, Health Serv i c eJ o u rnal, 8th April 2004

Blumer H. (1969) Symbolic Interactionism, Englewood Cliff s ,NJ; Tr a n s i t i o n

B u c k l e r, S.A. and Zein K.A. (1996) ‘From experience: Thespirituality of innovation: learning from stories,’ Journal ofP roduction Innovation Management, 13, pp. 391-405

Campbell JL. (2002) ‘Where do we stand? Commonmechanisms in organisations and social movements re s e a rc h ’ ,Paper presented at conference on ‘Social Movements andO rganisation theory’, Ann Arbor, Michigan

Castell, M. (1983) The city and the grassroots: a cro s s - c u l t u r a lt h e o ry of urban social movements, Berkeley; University ofC a l i f o rnia Pre s s

Clemens ES and Minkoff DC. (2004) ‘Beyond the Iron Law:rethinking the place of organisation in social movementre s e a rch’, in Snow DA, Soule SA and Kriesi H (eds.), TheBlackwell Companion to Social Movements, Oxford; Blackwell

Cohn SF, Barkan SE and Halteman WA. (2003) ‘Dimensions ofp a rticipation in a professional social movement org a n i s a t i o n ’ ,Sociological Inquiry, 73(3): 311-337

C rossley N. (2002) Making sense of social movements,Buckingham: Open University Pre s s

C roteau D and Hicks L. (2003) ‘Coalition framing and thechallenge of a consonant frame pyramid: the case of acollaborative response to homelessness,’ Social Pro b l e m s ,50(2): 251-272.

Culverson, D, Neisser PT, Schram SF and Vaughan L. ‘The Stateof Tales: Why These Tales For This State?’

Davis, GF and McAdam, D. (2000) ‘Corporations, classes andsocial movements after managerialism’, Research inO rganisational Behaviour, 22: 193-236

D’Anjou L and van Male J. (1998) ‘Between old and new:social movements and cultural change’, Mobilisation, 3(2):2 0 7 - 2 2 6

D’Emilio J. (1998) Sexual politics, sexual communities: themaking of a homosexual minority in the United States, 1940-1970, 2nd edition. Chicago; University of Chicago Pre s s

Della Porta D and Diani M. (1999) Social movements: ani n t roduction, Oxford; Blackwell

D e p a rtment of Health. (2000) The NHS Plan: a plan forinvestment, a plan for re f o rm, Issued by the Department ofHealth, July 2000

Diani M. (2004) ‘Networks and participation’, in Snow DA,Soule SA and Kriesi H (eds.), The Blackwell Companion toSocial Movements, Oxford; Blackwell

Diani M and Lodi G. (1988) ‘Three in One: currents in theMilan Ecology movement’, in Klandermans B, Kriesi H andTa rrow S (eds.), From Stru c t u re to Action, Greenwich, CT; JAI,1 0 3 - 1 2 4

Donaldson MS and Mohr JJ. (2000) Exploring Innovation andQuality Improvement in Health Care Micro-Systems. A Cro s s -Case Analysis. A Technical Report for the Institute of MedicineCommittee on the Quality of Health Care in America,Washington; Institute of Medicine

E d w a rds B and McCarthy JD. (2004) ‘Resources and socialmovements mobilisation’, in Snow DA, Soule SA and Kriesi H(eds.), The Blackwell Companion to Social Movements,O x f o rd; Blackwell

E y e rman R and Jamison A. (1991) Social movements: acognitive approach, Oxford; Polity

Fendrich, JM. (2003) ‘The forgotten movement: the Vi e t n a mantiwar movement’, Sociological Inquiry, 73(3): 338-358

F i reman B and Gamson WA. (1979) ‘Utilitarian logic in there s o u rce mobilisation perspective’, in Zald MN and McCart h yJD (eds.), The dynamics of social movements, Cambridge, MA;Wi n t h rop, 8-45

Flam, H. (1990) ‘Emotional Man’. Part 1: The Emotional ‘Man’and the problem of collective action. International Sociology,5: 39-56

Franklin, HB. (2000) ‘The antiwar movement we are supposedto forget’, The Chronicle Review, 20 October: 1-10

F reeman J. (1973) ‘The Origins of the Wo m e n ’s LiberationMovement’, American Journal of Sociology, 78(1973): 792-8 1 1 .

F reeman J and Levine C. (1984) Untying the knot. Feminism,43

a n a rchism and organisation, Dark Star Rebel pre s s

F ryer B. (2003) ‘Storytelling that moves people. Aconversation with screenwriting coach Robert McKee’,H a rv a rd Business Review, June: 51-55

Gabbay J., le May A, Jefferson H, Webb D, Lovelock R, PowellJ, Lathlean J. (2003) ‘A case study of knowledge managementin multi-agency consumer- i n f o rmed “communities ofpractice”: implications for evidence-based policy developmentin health and social services’, Health. An interd i s c i p l i n a ryJ o u rnal for the Social Study of Health, Illness and Medicine, 7:2 8 3 - 3 1 0

Ganz, M. (2003) ‘Resources and re s o u rcefulness’, in Goodwin Jand Jasper J (eds.), The Social Movements Reader. Cases andConcepts, Oxford; Blackwell

Gioia DA and Chittipeddi K. (1991) ‘Sensemaking andsensegiving in strategic change initiation’, StrategicManagement Journal, 12: 433-448

Gitlin, T. (1987) The Sixties: Years of hope, Days of rage. NewYork; Bantam Books

G o ffman, E. (1962) Asylums: Essays on the social situation ofmental patients and other inmates, Garden City, New Yo r k :Anchor Books

G o ffman, E. (1974) Frame analysis: an essay on theo rganisation of experience. New York; Harper Colophon

G o ffman, E. (1981) Forms of Talk, Philadelphia: University ofPennsylvania Pre s s

Goodwin J and Jasper JM (eds.). (2003) The social movementsre a d e r. Cases and concepts, Oxford: Blackwell Publishing

Goodwin J, Jasper JM and Polletta F. (2004) ‘Emotionaldimensions of social movements’, in Snow DA, Soule SA andKriesi H (eds.), The Blackwell Companion to SocialMovements, Oxford; Blackwell

Granovetter M. (1973) ‘The strength of weak ties’, AmericanJ o u rnal of Sociology, 78: 1360-80

Heelas, P. (1996) The New Age Movement: The Celebration ofthe Self and the Sacralization of Modern i t y. Malden, MA:Blackwell.

Heelas, P. and Woodhead, L. (2000) Religion in modern times:an anthology, Blackwell publishers; Oxford

Hirsch, E.L. (1989) Urban revolt: ethnic politics in thenineteenth century Chicago labour movement. Berkeley, CA:University of California Press.

Hirsch, EL. (1990) ‘Sacrifice for the cause: Group pro c e s s e s ,re c ruitment and commitment in a student social movement’,American Sociological Review, 55 (Apr.): 243-54

Hirsch, EL. (2003) ‘Generating commitment among students’,in Goodwin J and Jasper J (eds.), The Social MovementsR e a d e r. Cases and Concepts, Oxford; Blackwell

Hirschmann AO. (1982) Shifting involvements: private intere s tand public action, Princeton, New Jersey: Princeton UniversityP re s s

Hunt SA, Benford RD and Snow DA. (1994) ‘Identity fields:framing processes and the social construction of movementidentities’, in Larana E, Johnston H and Gusfield JR (eds.) New

Social Movements: From ideology to identity, Philadelphia,PA; Temple University Press, 185-208

Hunt SA and Benford RD. (2004) ‘Collective identity, solidarityand commitment’, in Snow DA, Soule SA and Kriesi H (eds.),The Blackwell Companion to Social Movements, Oxford ;B l a c k w e l l

H u y, QN. (1999) ‘Emotional capability, emotional intelligenceand radical change’, Academy of Management Review, 24(2):3 2 5 - 3 4 5

Jasper JM. (1998) The emotions of protest: affective andreactive emotions in and around social movements,Sociological Forum, 13: 397-424

Jasper JM. (2004) ‘A strategic approach to collective action:looking for agency in social-movement choices’, Mobilisation,9(1): 1-16

Kanter R. (1983) The change masters. Corporatee n t re p reneurs at work, London; Unwin

Kebede A, Shriver TE and Knottnerus JD. (2000) ‘Socialmovement endurance: collective identity and the rastafari’,Sociological Inquiry, 70(3): 313-337

Kitts J. (2000) ‘Mobilzing in black boxes: social networks andSMO participation’, Mobilisation, 5: 241-257

K l a n d e rmans B. (1984) ‘Mobilisation and participation. Social-psychological expansions of re s o u rce mobilisation theory ’ ,American Sociological Review, 49: 583-600

K l a n d e rmans B. (2004) ‘The demand and supply ofp a rticipation: social-psychological correlates of part i c i p a t i o nin social movements’, in Snow DA, Soule SA and Kriesi H(eds.), The Blackwell Companion to Social Movements,O x f o rd; Blackwell

Kling J. (1995) ‘Narratives of possibility: social movements,collective stories and the dilemmas of practice.’ Paperp resented at the ‘New Social Movement and CommunityO rganising Conference’, University of Washington School ofSocial Work, November 1-3, 1995

Knoke, D. (1988) ‘Incentives in collective action org a n i s a t i o n s ’ ,American Sociological Review, 53: 311-329

Koopmans R. (1993) ‘The dynamics of protest waves: We s tG e rm a n y, 1965 to 1989’, American Sociological Review, 58:6 3 7 - 5 8

Koopmans R. (2004) ‘Protest in time and space: the evolutionof waves of contention’, in Snow DA, Soule SA and Kriesi H(eds.), The Blackwell Companion to Social Movements,O x f o rd; Blackwell

K o t t e r, JP and Cohen, DS. (2002) ‘The Heart of Change’,H a rv a rd Business Press, 2002

L a z a rus RS. (1993) ‘From psychological stress to emotion: ah i s t o ry of changing outlooks’, Annual Review of Psychology,44: 1-21

L e a t h e rman S and Sutherland K. (2003) The quest for qualityin the NHS: a mid term evaluation of the ten year qualityagenda, London; The Nuffield Tru s t

McAdam D. (1982) Political process and the development ofblack insurg e n c y, 1930-1970, Chicago: University of ChicagoP re s s

McAdam D. (1986) ‘Recruitment to high-risk activism: the caseof Freedom Summer’, American Journal of Sociology, 92: 64-90

McAdam, D. (1989) ‘The biographical consequences ofactivism’, American Sociological Review, 54: 744-760

McAdam D and Paulson R. (1993) ‘Specifying the re l a t i o n s h i pbetween social ties and activism’, American Journal ofS o c i o l o g y, 99: 640-667

McAdam D. (1994) ‘Culture and social movements’, in LaranaE, Johnston H and Gusfield JR (eds) New Social Movements:F rom Ideology to Identity, Philadelphia, PA: Temple UniversityP ress, 36-57

McAdam D, McCarthy JD and Zald MN. (eds). (1996)Comparative perspectives on social movements: politicalo p p o rtunities, mobilising stru c t u res and cultural framings.Cambridge: Cambridge University Press, 1996

McAdam D and Scott RW. (2002) ‘Organisations andmovements’, Paper presented at conference on ‘Socialmovement and organisation theory’, Ann Arbor, Michigan

McAdam D and Snow DA. (1997) Social movements: re a d i n g son their emergence, mobilisation and dynamics, Los Angeles:R o x b u ry

McAdam D, Ta rrow S and Tilly C. (1995) ‘To map contentiouspolitics’, Mobilisation, 1(1): 17-34

McCammon H, Campbell K, Granberg E and Mowery C. (2001)‘How movements win: gendered opportunity stru c t u res andUS women’s suffrage movements, 1866 to 1919’, AmericanSociological Review, 66(1): 49-70

M c C a rthy JD and Zald MN. (1977) ‘Resource mobilisation andsocial movements: a partial theory’, American Journal ofS o c i o l o g y, 82(6): 1212-1241

Mangham, I. & Overington, M. A. (1987). Organizations ast h e a t re. Chichester, NY: Wi l e y.

M a rwell G, Oliver PE and Prahl R. (1988) ‘Social networks andcollective action: a theory of the critical mass. III’, AmericanJ o u rnal of Sociology, 94: 502-534

Matrix RHA. (2003a) Rapid review of Modernisation: FullR e p o rt

Matrix RHA. (2003b) NHS Modernisation : Making itm a i n s t re a m

Melucci A. (1996) Challenging codes: collective action in thei n f o rmation age, New York: Cambridge University Pre s s

Meyer J and Rowan B. (1977) ‘Institutionalised org a n i s a t i o n s :f o rmal stru c t u re as myth ceremony’, American Journal ofS o c i o l o g y, 83: 340-363

Meyerson DE. (2001) ‘Radical change, the quiet way’, Harv a rdBusiness Review, October: 32-40

Michels, R. (194) Political Parties, Glencoe, IL: Free Pre s s

M i l l e r, GA and Johnson-Laird, PN. (1976) Language andp e rception, Cambridge University Press; Cambridge

Miller MAL. (1993) ‘The rastafarian in Jamaican politicalc u l t u re: the marginalisation of a change agent’, The We s t e rnJ o u rnal of Black Studies, 17: 112-117

M i n t z b e rg H. (1979) The structuring of organizations. A

synthesis of the re s e a rch, Englewood Cliffs, NJ: Pre n t i c e - H a l l

Mohr JJ and Batalden PB. (2002) ‘Improving safety on thef ront lines: the role of clinical microsystems’, Quality & Safetyin Health Care, 11: 45-50

M o rgan G and Smircich L. (1980) ‘The Case for QualitativeR e s e a rch,’ Academy of Management Review, 5: 491-500, 1980

M o rrill C, Zald MN and Rao H. (2003) ‘Covert political conflictin organisations: challenges from below’, Annu. Rev. Sociol,29: 391-415

M o rris A. (2000) ‘Charting futures for sociology: socialo rganisation. Reflections on Social Movement Theory :criticisms and proposals’. Contemporary Sociology. A Journ a lof Reviews, 29(3): 445-454

M o rris AD and Staggenborg S. (2004) ‘Leadership in socialmovements’. in Snow DA, Soule SA and Kriesi H (eds.), TheBlackwell Companion to Social Movements, Oxford; Blackwell

Nadler DA and Tushman ML. (1990) ‘Beyond the charismaticleader: leadership and organisational change’, Californ i a nManagement Review, 32(2): 77-97

NHS Modernisation Agency (2004) How do we get a NHS thatis continuously improving: a concept paper for the next phaseof NHS impro v e m e n t

NHS Modernisation Agency (2004) A review of re s e a rch andevaluation activities, Unpublished.

Oberschall A. (1973) Social conflict and social movements,Englewood Cliffs, New Jersey: Pre n t i c e - H a l l

Oliver PE and Johnston H. (2000) ‘What a good idea!Ideologies and frames in social movements re s e a rc h ’ ,Mobilisation, 4(1): 37-54

Palmer P. (1997) The Courage to Teach: Exploring the InnerLandscape of a Te a c h e r’s Life, Jossey-Bass, San Francisco

Pascale RT. (1994) ‘Perspectives on strategy: the real storybeyond Honda’s success’, California Management Review, 28(summer): 47-72

Passy F. (2001) ‘Socialization, connection and thes t ru c t u re/agency gap: a specification of the impact ofnetworks on participation in social movements’, Mobilisation,6(2): 173-192

P e t t i g re w, A.M. (1998) Success and failure in corporatet r a n s f o rmation initiatives, in R.D. Galliers and W.R.J. Baets(eds) Information Technology and Org a n i s a t i o n a lTr a n s f o rmation, pp. 271-289. Chichester:Wi l e y

Piven FF and Cloward RA. (1979) Poor people’s movements,New York: Vi n t a g e

Polletta F. (1999) ‘Free spaces in collective action’, Theory andS o c i e t y, 28: 1-38

Pope, C. (2003) ‘Resisting evidence: the study of evidence-based medicine as a contemporary social movement’, Health:An Interd i s c i p l i n a ry Journal for the Social Study of Health,Illness and Medicine, 7(3): 267-282

Rao H, Morrill C and Zald MN. (2000) ‘Power plays: how socialmovements and collective action create new org a n i s a t i o n a lf o rms’, Research in Organisational Behaviour, 22: 239-282

Rao H, Monin, P and Durand R. (2001) Identity movements

45

and the redefinition of social identity: why French chefsabandoned classical cuisine for nouvelle cuisine, Unpublishedm a n u s c r i p t

R a s l e r, K. (1996) ‘Concessions, re p ression and political pro t e s tin the Iranian Revolution’, American Sociological Review, 61:1 3 2 - 1 5 2

Reger J and Staggenborg S. (2003) ‘Grassroots organizing in afederated stru c t u re: NOW chapters in four local fields’, Paperp resented at the American Sociological Association,[location], August 2003

Robnett B. (1997) How long? How long? African-Americanwomen in the struggle for civil rights, New York; OxfordUniversity Pre s s

R o w l e y, TJ. ‘Moving beyond dyadic ties: a network theory ofstakeholder influences’, Academy of Management Review, 22:8 8 7 - 9 1 0

Rowley TJ and Moldoveanu M. (2003) ‘When will stakeholderg roups act? An interest- and identity-based model ofstakeholder group mobilisation’, Academy of ManagementR e v i e w, 28(2): 204-219

Rucht D. (1999) ‘Linking organisation and mobilisation:M i c h e l ’s iron law of oligarchy re c o n s i d e red’, Mobilisation,4(2): 151-169

Schneider CL. (1995) Shantytown protest in Pinochet’s Chile,Philadelphia, PA: Temple University Pre s s

Schon, D. (1971) Beyond the stable state, Norton; New Yo r k

Scott RW, Ruef M, Mendel PJ and Caronna CA. (2000)Institutional change and healthcare organisations, Chicago;University of Chicago Pre s s

S m e l s e r, N. (1962) Theory of Collective Behaviour, London:Routledge and Kegan Paul

Smith R. (2003) ‘Is the NHS getting better or worse?’, BritishMedical Journal, 327: 1239-41

S n o w, D. (1976) The Nichiren Shoshu Buddhist Movement inAmerica: a sociological examination of its value orientation,re c ruitment eff o rts and spread, Ann Arbor, Michigan:University Microfilms

Snow D, Zurcher L and Ekland-Olson S. (1980) ‘Socialnetworks and social movements: a micro s t ructural appro a c hto diff e rential re c ruitment’, American Sociological Review, 45:7 8 7 - 8 0 1

Snow DA. (2004) ‘Framing processes, ideology and discursivefields’, in Snow DA, Soule SA and Kriesi H (eds.), TheBlackwell Companion to Social Movements, Oxford; Blackwell

S n o w, D.A. and Benford, R.D. 1988. ‘Ideology, FrameResonance, and Participant Mobilization’, International SocialMovement Research, 1:197-217

Snow DA, Burke Rochford E, Wo rden SK and Benford RD.(1986) ‘Frame alignment processes, micromobilization andmovement participation’, American Sociological Review, 51:4 6 4 - 8 9

Snow DA, Soule SA and Kriesi H. (2004) ‘Mapping the terr a i n ’ ,in Snow DA, Soule SA and Kriesi H (eds.), The BlackwellCompanion to Social Movements, Oxford; Blackwell

Strang D and Jung D-Il. (2002) ‘Organisational change as ano rchestrated social movement; determinants and implicationsof re c ruitment to a ‘quality initiative’’, Paper presented atc o n f e rence on ‘Social Movement and organisation theory ’ ,Ann Arbor, Michigan

Ta rrow S. (1988) ‘The oldest new movement’, in Klanderm a n sB, Kriesi H and Ta rrow S (eds.), From stru c t u re to action:comparing social movements across cultures, Intern a t i o n a lsocial movement re s e a rch, volume 1, Greenwich, CT: JAI

Ta rrow S. (1998) Power in movement: social movements,collective action and politics, 2nd edition, New Yo r k :Cambridge University Pre s s

Taylor V and van Dyke N. (2004) ‘Get up, stand up’: tacticalre p e rt o i res of social movements, in Snow DA, Soule SA andKriesi H (eds.), The Blackwell Companion to SocialMovements, Oxford; Blackwell

Ti l l y, C. (1978) From mobilisation to revolution. Reading, MA:A d d i s o n - We s l e y

Tu rnbull S. (1997) Quasi-religious experiences in a corporatechange programme - the roles of conversion and theconfessional in corporate evangelism. Manuscript.

Tu rn e r, RH. (1996) ‘The moral issue in collective behaviour andcollective action’, Mobilisation, 1(1): 1-15

Van de Ven AH. (1986) ‘Central problems in the managementof innovation’, Management Science, 32: 590-607

Watzlawick P, Weakland JH and Fisch R. (1974) Change.Principles of problem formation and problem resolution, NewYork; WW Nort o n

Wenger E, McDermott RA, Snyder W. (2002) CultivatingCommunities of Practice: A Guide to Managing Knowledge,H a rv a rd Business School Pre s s .

Westen D. (1985) Self and society: narcissism, collectivism andthe development of morals. Cambridge, MA; CambridgeUniversity Pre s s

Williams RH. (2004) ‘The cultural contexts of collective action:constraints, opportunities and the symbolic life of socialmovements’, in Snow DA, Soule SA and Kriesi H (eds.), TheBlackwell Companion to Social Movements, Oxford; Blackwell

Zald MN and Berger MA. (1978) ‘Social movements ino rganizations: coup d’etat, insurgency and mass movements’,American Journal of Sociology, 83: 823-861

Zald MN and McCarthy JD. (1987) Social movements in ano rganisational society: collected essays, New Brunswick, NJ:Tr a n s a c t i o n

Zald MN and Garner RA. (1987) ‘Social movemento rganisations: growth, decay and change’ in Zald MN andM c C a rthy JD, Social Movements in an Organisational Society,New Brunswick: Transaction Publishers

Zald MN, Morrill C and Rao H. (2002) ‘How do socialmovements penetrate organisations? Environmental impactand organisation response’, Paper presented at conference on‘Social Movement and organisation theory’, Ann Arbor,M i c h i g a n

Z o l b e rg AR. (1972) ‘Moments of madness’, Politics andS o c i e t y, 2: 183-207

ANNEX 2Additional dilemmas

1. The dilemma of inevitability; an ideologythat suggests you must eventually winoffers confidence but makes collectiveaction less critical

2. The band-of-brothers dilemma: affectiveloyalties to the broader group areessential, but there is a risk they willcome to rest only a single fellow memberor a handful at the expense of the largercollectivity

3. Leadership distance: will a leader bemore appealing if lofty and unique, akind of superhuman saint, or if a regulartype, one of the guys?

4. The ambitious leader (a twist on theextension dilemma): we want strong andcompetent leaders, but if they are too

ambitious they may substitute their owngoals for those of the group

5. Direct or indirect moves? Attention canbe devoted to direct confrontations withopponents, or to indirect moves such aspersuading third parties, gatheringresources, building networks and so on

6. Plan versus opportunity: you caninitiatives of your own, or you can watchand wait for opponents to makemistakes

7. The basket dilemma: do you aim for onedecisive engagement, winner-takes-all,or do you spread your risk over manysmaller engagements?

8. The dilemma of false arenas:representation in certain areas, forinstance blue-ribbon commissions, maytake a lot of time without advancingyour cause

ANNEX 1

47

9. The dilemma of cultural innovation: toappeal to your various audiences youmust use the meanings they alreadyhold, and pushing too far may cause youto lose them

10. Victim or hero? Do you portray yourselfas wronged victim in need of help or asstrong, avenging hero?

11. Villain or clown? Do you portrayopponents as a strong and dangerous oras silly and contemptible?

12. The engagement dilemma: moving fromlatency and community into activeengagement and visibility brings anumber of risks, such as externalrepression or misrepresentation andinternal conflicts over strategy

13. Dirty hands: some goals are only - ormore easily - attained through unsavourymeans

14. Money’s curse: money is often seen asdirtying your hands, yet evenorganizations that are ‘above’ suchmundane issues nonetheless depend onfinancial resources

15. The radical-flank dilemma: extremewords and action get attention, andoften take opponents by surprise, butthey usually play poorly with bystandersand authorities

16. The media dilemma: new media can getyour message to broad audiences but -like all powerful allies - they are likely todistort it in doing so

17. The bridge-builder’s dilemma: individualswho can mediate between groups, ordifferent sides in a conflict, often losethe trust of their own groups by doingso - caught on the horns of reaching outor reaching in

18. The familiar and the new: new tacticssurprise opponents and authorities but itis typically hard for your own group topull them off, and

19. Segregating audiences: you would like tosend different messages to differentplayers, especially internal versusexternal ones but spillover across the

boundaries can be used to make youlook duplicitous.

Source: Jasper JM. (2004) ‘A strategic approach tocollective action: looking for agency in social-movement choices’, Mobilisation, 9(1): 1-16

ANNEX 3Some questions for the next stage ofthinking about Social Movement Theory andthe NHS

• Is there an existing social movementorganisation (SMO) for the NHS? Is it theNHS Modernisation Agency?

• Why would people join an improvementmovement in the NHS? Why wouldn’tthey? And to what extent have they?

• Who are these activists in the NHS? Or asSenge would put it, who are the local lineleaders or franchisees for improvement?

• Do these people oversee a cluster of localgrassroots NHS movements, or do theycome together in a bigger network orforum? In McAdam’s (1986) terms are welooking for ‘a merger or coalition ofexisting groups rather than anorganisational offshoot of a single group’?

• Where might these communities ofcongruence be found or created withinthe NHS? What are the nearestequivalents?

• What type of ‘association’ (‘radical grassroots’ or ‘public interest groups’) isrelevant to the NHS?

• Who we might say has joined themovement to date? Why? Have theyjoined a movement to change something,and if so what? Are they the right people?Management trainees, clinicians, nursesand/or senior managers? Who is on the‘bandwagon’ and are they the people onewould want/need?

• Where are the gathering places in the NHSthat provide or might provide the physicaland emotional space for people to meet

and think the unthinkable?

• What are the current metaphors-in-usewithin NHS improvement communities ofpractice? Are there currently anydominant or dominating metaphors forimprovement to be found in documentsand speeches, and are they the right ones?

• Who are the ‘institutional entrepreneurs’and ‘tempered radicals’ in the NHS?

• Is ‘improvement’ the right label?

• What is the core narrative for the NHSmovement?

• So who should be the movement leadersin NHS healthcare organisations - and howshould they be mobilised and assisted?

• How do leaders and leadership teamscreate effective strategies and frames?

• Does the NHS improvement movementhave available ‘mobilising’ structures ofsufficient strength to get the movementoff the ground?

50