@helenbevan
Being a leader of change:how to rock the boat and stay in it
Helen BevanChief Transformation Officer,
NHS Horizons Team@helenbevan
@helenbevan #NHSChangeDay
Emerging themes in large scale change
Organisation Community
Power through hierarchy Power through connection
Mission and vision Shared purpose
Making sense through rational argument
Making sense through emotional connection
Leadership-driven (top down) innovation
Viral (grass-roots driven) creativity
Tried and tested, based on experience
“ Open” approaches , sharing ideas & data, co-creating change
Transactions Relationships
Dominantapproach
Emerging direction
@helenbevan #NHSChangeDay
John Kotter: “Accelerate!”• Dual operating systems: the hierarchy AND the network•Many change agents, not just the usual few •A “want-to” - not just a “have-to” - mind-set
The spirit of volunteerism - the desire to work with others for a shared purpose – creates the energy to power the network
•Head and heart, not just headPeople won’t want to do a day job in the hierarchy and a night job in the network if we appeal only to logic with numbers, contracts and business cases
@helenbevan #NHSChangeDay
Place in the networkBridge networks
versus cohesive networks
As a change agent, my centrality in the informal network is a far more important factor than my position in the formal hierarchy
Change agents who bridge disconnected
groups/individuals more likely to deliver big change
Change agents with cohesive networks more likely to deliver
minor incremental changes
The Network Secrets of Great Change AgentsJulie Battilana andTiziana Casciaro
@HelenBevan
We need three kinds of people to transform healthcare
• Professionals• Patients• Pirates
Source: Lucien Engelen
@HelenBevan
Valuing radicals
• “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)
• big things only happen in organisations because of heretics and radicals
@HelenBevan
We need to be boatrockers!
• Walk the fine line between difference and fit, inside and outside, rock the boat but manage to stay in it
• Able to challenge the status quo when we see that there could be a better way
• Conform AND rebel• Capable of working with others
to create success NOT a destructive troublemaker
Source: Debra Meyerson
@HelenBevan Source : Lois Kelly www.foghound.com
Sometimes leaders see radicals as troublemakers
@HelenBevan
Four tactics for change agents
1. Start with myself2. Build alliances3. Work out what might help others to
change4. Don't be a martyr
"There’s only one corner of the universe you can be certain of
improving, and that’s your own self." Aldous Huxley
@HelenBevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice
Source: adapted from Debra E Meyerson
@HelenBevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice we surrender a part of ourselves, and silence
our commitment, in order to survive
Source: adapted from Debra E Meyerson
@HelenBevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice we surrender a part of ourselves, and silence
our commitment, in order to survive2. leave the organisation
Source: adapted from Debra E Meyerson
@HelenBevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice we surrender a part of ourselves, and silence
our commitment, in order to survive2. leave the organisation
we cannot find a way to be true to our values and commitments and still survive
Source: adapted from Debra E Meyerson
@HelenBevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice we surrender a part of ourselves, and silence
our commitment, in order to survive2. leave the organisation
we cannot find a way to be true to our values and commitments and still survive
3. stridently challenge the status quo in a manner which is increasingly radical and self-defeating
Source: adapted from Debra E Meyerson
@HelenBevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice we surrender a part of ourselves, and silence
our commitment, in order to survive2. leave the organisation
we cannot find a way to be true to our values and commitments and still survive
3. stridently challenge the status quo in a manner which is increasingly radical and self-defeating this just confirms what we already know – that
we don’t belongSource: adapted from Debra E Meyerson
@HelenBevan
They:1.are driven by values2.have a strong belief that they are personally able to make change happen3.are able to build alliances
ignite collective action with others mobilising others, inspiring change
4.are able to achieve small wins which create a sense of hope, possibility and confidence5.are good corporate citizens
Often, the most effective change agents in organisations are the ones with the least positional authority
What do we know about successful boat rockers?
Source: adapted from Debra E Meyerson
@helenbevan #IQTGOLD
Three assumptions for change agents
1. Assume that everyone has a good intention2. When people “resist” change is it more likely
to be a result of their interpersonal interaction with the change process than their character traits (“a bad change process not a difficult person”)
3. My role as a change agent is about alignment, not judgement
@HelenBevan
Four tactics for change agents
1. Start with myself2. Build alliances3. Work out what might help others to
change4. Don't be a martyr
@HelenBevan
“if you want to go fast, go alone. If you want to go far, go together”African proverb quoted by Al Gore
@HelenBevan
Framing Is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action
Snow D A and Benford R D (1992)
If we want people to take action, we have to connect with their emotions through values
actionaction
valuesvalues
emotionemotion
Source: Marshall Ganz
@HelenBevan
What do we need to do?1. Tell a story2. Make it personal3. Be authentic4. Create a sense of “us” (and be clear who the “us”
is)
@HelenBevan
What do we need to do?1. Tell a story2. Make it personal3. Be authentic4. Create a sense of “us” (and be clear who the “us”
is)5. Link your story to the change you want to see
@HelenBevan
Task
• Talk to the person next to you• In one minute, tell them a story from your life
which illustrates why you are committed to improving healthcare
@HelenBevan
Four tactics for change agents
1. Start with myself2. Build alliances3. Work out what might help others to
change4. Don't be a martyr
@HelenBevan
“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
@HelenBevan
The model is mostly used around health-related behaviours
• smoking cessation • exercise adoption• alcohol and drug use• weight control • fruit and vegetable intake• domestic violence• HIV prevention• use of sunscreens to prevent skin cancer • medication compliance • mammography screening
@HelenBevan
The model is mostly used around health-related behaviours
• smoking cessation • exercise adoption• alcohol and drug use• weight control • fruit and vegetable intake• domestic violence• HIV prevention• use of sunscreens to prevent skin cancer • medication compliance • mammography screening
It works for organisational and
service change too!
@helenbevan #stuconf
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my smoking is a
problem – I have no intention to quit
@helenbevan #stuconf
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
@helenbevan #stuconf
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
@helenbevan #stuconf
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped
smoking!
@helenbevan #stuconf
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped
smoking!
I am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
@helenbevan #stuconf
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped
smoking!
I am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
@helenbevan #stuconf
“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
@HelenBevan
90% of our change efforts are aimed at the “action” stage
• Our tools are often not effective at the stage of change that most people we work with are at
• It’s hard to engage people in change• It’s hard to get people to make the changes
we want them to make• People get irritated, defensive, irrational• We feel powerless in our ability to make the
change happen
@HelenBevan
Example - Surgical Checklist
• Designed for Stage 4 – ACTION!
• Mandated it through targets
• Despite compelling case for change – people resisted it – no values connection
• People did the task and missed the point
@HelenBevan
“One key issue is that many doctors already feel that they are delivering patient centred care – unfortunately that is not what patients report.”Dr Nigel Mathers, Vice Chair, Royal College of General Practice
@HelenBevan
So what do we TEND to do?• Lower our ambitions for improvement• Put negative labels on those who are not
yet at the action stage such as “blocker” or “resister” or “laggard”
• Blame “the management” for not enforcing change
@HelenBevan
So what SHOULD we do
• Listen and understand• appreciate others’ starting point for change
• Recognise that the people who are resisting might have a point• Don’t argue against it• Understand why people are resisting the change
• What makes it so hard?• What would help?
• Build shared purpose based on what we want for our patients
NHS Change Day 2014
• Increase the reach to 500,000 pledges• Pledge, share, do and inspire framework• Inaugurate School for Healthcare Radicals• Kickstarter challenge• Mobile first approach underpinned by social media
and industrial-strength infrastructure• Discussions with colleagues in 16 territories globally• Launch on 6th November 2013
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@HelenBevan
Probably the only winner of a global challenge
to develop leaders in the
corporate world that names Saul
Alinsky and Marshall Ganz
as major influencers
@HelenBevan
....the last era of management was about how much performance we could extract from people
.....the next is all about how much humanity we can inspire
Dov Speidman