How to Be a Great Change Agent - Minicourse M10

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Presentation from IHI National Forum on Quality and Safety

Minicourse M10 How to Be a Great Change Agent
It’s tough being a change agent, particularly when other people don’t want to change. Yet big change happens in health care organizations only because of heretics: passionate people who are willing to take responsibility for change. Such individuals support organizational goals, but also want to change existing thinking and practice and improve care for patients. This session provides a toolkit for surviving and thriving as a change agent.

After this session, participants will be able to:
Identify and practice tactics for being an effective change agent
Build a toolkit of powerful approaches to enable change
Connect with and learn from other change agents
Monday 9th December Crystal Ballroom, Salon D8.30am to 4.00pm

Helen Bevan @HelenBevan
Robert Varnam @RobertVarnam
Andrew Hasler @AndrewHasler

#IHI25Forum #ChangeAgents

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  • @TimBenson1 Thanks Tim for nice comment. It's hard to choose what to prioritise in a day. We have a section in the workshop on 'building alliances' which is all about practical tactics for getting people on board with your cause, using approaches based on narrative and calling others to action. I think this is in the same territory as 'followers'. best wishes Helen
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  • Fantastic slides.

    My only thought was that you missed out the problems of attracting followers (http://people-equation.com/following-its-the-new-leadership/) and crossing the chasm.
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  • These are the slides for a one day workshop on 'How to be a great change agent' that is taking place on 9th December 2013 at the Institute for Healthcare Improvement 25th National Forum on Quality in Healthcare. The workshop is aimed at people who support the mission of their organisations and who see the need for change but who often find that the way that their organisations go about change to be frustrating and challenging. This is a day of tactics for surviving and thriving as a change agent; how to rock the boat and stay in it. The workshop starts at 8.30am EST which is 1.30pm UK time. Please feel free to take part in real time virtually, wherever you are, using the hashtags #IHI25Forum and #ChangeAgents
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  • Examples of Social Movements: people doing something for a cause …The early psychosis declaration: Under the banner of IRIS a small group of people from around the UK gathered in Cheltenham in 2001 to discuss how they might generate a consensus on how services could be improved for young people with psychosis and their families. From those initial ideas the launch of the National Institute for Mental Health in England provided an ideal platform for further development.  40 people (service users, family members, and expert practitioners) met with representatives of the World Health Organisation (WHO), IRIS and Rethink to agree standards of care that those developing early psychosis and their families should expect. The IRA Hbloock/Armagh: IRA leaders detained in prison went on a dirty protest and refused to eat – Bobbly Sands was elected to the UK parliament whilst in prison and not allowed to take up his seat and died in prison. Greenpeace: surely everyone knows something about Greenpeace?100k lives campaign: in the USA from IHI, participating organizations agreed to provide monthly mortality statistics and adopt at least one of six interventions. These interventions included dispatching rapid response teams at the first sign of patient decline, following rigorous protocols to prevent infections caused by surgery, central venous catheters, and ventilators, giving heart attack patients recommended medications when they enter and leave the hospital, and checking to make sure all medications taken by a patient are appropriate. The 5 Million Lives Campaign calls for six additional interventions, including guidance on best practices to prevent pressure ulcers and to reduce Methicillin-Resistant Staphylococcus aureus (MRSA) infectionMarathon runners: City marathons for charity as well as elite athletes started in London on the 80s and have grown and spread all over the worldSuffragettesCND: peace marchers and peace camps against nuclear war British Heart Foundation – could have any number of charities
  • Large scale action - Not requiring large leadership team or compliance frameworkDefinition used in “The Power of One, the Power of Many” = a voluntary collective of individuals committed to promoting or resisting change through co-ordinated activity.
  • Examples form the NHS of social movements often called a call to action
  • 3min. Reflect & write it down
  • So that we believe that this is creating contagious commitment to deliver pretty challenging results across the challenging times. We use our shared purpose to connect with others, through shared values and commitment around a collective vision. A narrative creates contagious commitment by connecting people to our values, purpose and vision. So when thinking about engagement we are best placed if we strike a balance in our engagement
  • Connection is made with individuals by connecting with their values
  • Removed all the builds and let the presenter speak to this using narrative to connecting with peoples values, emotions which then connects with action.Ask delegates to turn to page 6 and write a few words reflecting on the change they are seeking
  • LIST some emotions
  • Where has it been used?
  • Count how many times each element is used.How did it make you feel? Did you notice the elements? What do you remember? What else did he include?
  • Try to include a challenge , choice and outcome in your story when you write it.We will ask you to provide feedback to your colleagues as they tell their stories later on whether these are obvious to you.
  • Remember the power of “Killer Facts”Have one that really illustrates this for you.JG – I often use one from Kath Evans. If we had the health care system in England that matched the best in Europe 1500 children a year, would not die in our care.
  • How does this make you feel?
  • there are three roles and a set of role cards for each triad
  • RV Stories of our process with CCGs & partners & practices

Transcript

  • 1. IHI National Forum on Quality and Safety Minicourse M10 How to Be a Great Change Agent Monday 9th December Crystal Ballroom, Salon D 8.30am to 4.00pm Helen Bevan @HelenBevan Robert Varnam @RobertVarnam Andrew Hasler @AndrewHasler #IHI25Forum #ChangeAgents @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 2. What it says in the brochure…. It’s tough being a change agent, particularly when other people don’t want to change. Yet big change happens in health care organizations only because of heretics: passionate people who are willing to take responsibility for change. Such individuals support organizational goals, but also want to change existing thinking and practice and improve care for patients. This session provides a toolkit for surviving and thriving as a change agent. After this session, participants will be able to: • Identify and practice tactics for being an effective change agent • Build a toolkit of powerful approaches to enable change • Connect with and learn from other change agents @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 3. Today we are part of a global community of change agents • We will monitor and synthesise tweets all day, including those from fellow change agents who are connecting virtually • We will produce summaries of the minicourse: • Storify • Pinterest • Please use both hashtags #IHI25Forum and #ChangeAgents @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 4. @helenbevan #1000LivesPlus
  • 5. What happens to heretics/radicals/rebels/mavericks in organisations? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 6. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 7. “There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who profit by the new” Niccolo Machiavelli 15th century @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 8. Task We are going to talk to others on our table about our experiences of being a change agent and challenging the status quo • Pick a picture card from the pack that reflects your experience • In turn each person at the table should take turns to: • Introduce yourself to others • talk about your experience (and why you picked the picture) Time allowed (for whole table): 15 minutes @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 9. 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 @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 10. Sometimes people see us radicals as troublemakers Source : Lois Kelly www.foghound.com @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 11. Task • Talk to others at your table about your experiences around “radicals” and “troublemakers” • Which have you been and why? • What moves people from being “radical” to “troublemaker”? • How do we protect against this? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 12. First they ignore you, then they laugh at you, then they fight you, then you win Gandhi @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 13. 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 @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 14. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Source: Foghound
  • 15. Emerging themes in large scale change Dominant Organisation approach Power through hierarchy Emerging direction Community 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 @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Relationships Source: @HelenBevan
  • 16. John Kotter: “Accelerate!” • We won’t create big change through hierarchy on its own • We need hierarchy AND network • Many change agents, not just the usual few • Changing our mindset • From “have to” to “want to” • Head and heart, not just head and @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 17. The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro 1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy 2. If you want to create small scale change, work through a cohesive network If you want to create big change, create bridge networks between disconnected groups @helenbevan
  • 18. Across the world, the change agent movement is exploding! @chagww Changeagentsworldwide.com @rebelsatwork rebelsatwork.com @corprebels Corporaterebelsunited.com @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 19. Source: @NHSChangeDay @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 20. Source: @NHSChangeDay www.changeday.nhs.uk/healthcare radicals @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 21. Five tactics for change agents 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Create energy for change 5. Don't be a martyr @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 22. Five tactics for change agents 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Create energy for change 5. Don't be a martyr @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 23. 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 @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 24. 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 @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 25. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Source: Foghound
  • 26. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 27. 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 2. leave the organisation Source: adapted from Debra E Meyerson @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 28. 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 2. 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 @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 29. 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 2. 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 @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 30. 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 2. 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 belong Source: adapted from Debra E Meyerson @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 31. "There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 32. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 33. What do we know about successful boat rockers? 1. convictions and values-driven 2. strong sense of “self-efficacy”   belief that I am personally able to create change belief in others 3. action orientated   ignite collective action mobilising others, inspiring change 4. able to join forces with others  work as a collective body for commonly valued changes 5. able to achieve small wins which create a sense of hope, selfefficacy and confidence 6. optimistic in the face of challenge   see opportunities take account of obstacles Source: adapted from Debra E Meyerson @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 34. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 35. Three assumptions for change agents 1. Assume that everyone has a noble intention 2. When people “resist” change is it more likely to be a result of their interpersonal interaction with the change process than their innate character traits (“a bad change process not a difficult person”) 3. My role as a change agent is about alignment, not judgement @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 36. Being a great change agent is about knowing, doing, living and being improvement @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 37. Task Talk to others at your table about moving beyond skills and knowledge of improvement to live and be improvement • What are some of the ways that we already do this? • How could we do this more? • What are the implications for the way we work? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 38. Five tactics for change agents 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Create energy for change 5. Don't be a martyr @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 39. The easiest way to thrive as an outlier ...is to avoid being one Seth Goodin @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 40. “if you want to go fast, go alone. If you want to go far, go together” African proverb quoted by Al Gore @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 41. @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 42. What’s the financial incentive? What’s the project plan? Who is performance managing? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 43. or “I have some KPIs for your” “I have a dream” @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 44. Call to Action @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 45. What do you want to achieve? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 46. @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 47. Framing Is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action Snow D A and Benford R D (1992) @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 48. A good narrative motivates others by: • achieving common purpose through shared values and commitment • uniting us around a collective vision ,focusing our energy towards a specific and real change • creating contagious commitment @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 49. @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 50. Values Emotion Source: Marshall Ganz @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 51. But not all emotions are equal......... urgency anger hope solidarity you can make a difference Action inhibitors Overcomes Action motivators @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents inertia apathy fear isolation Self-doubt Source: Marshall Ganz
  • 52. Developing your narrative Individually: • Using the narrative worksheet on pages 7 and 8 of your workbook please consider the questions raised • This prompt sheet will help you to capture key points into one area without the need for writing a script @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 53. Public narrative a skill to motivate others to join you in action Source: Marshall Ganz @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 54. Made in Dagenham @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 55. Made in Dagenham @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 56. story of self story of PURPOSE call to leadership now strategy & action story of us shared values & experience @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Source: Marshall Ganz
  • 57. story of self story of PURPOSE call to leadership Why I am called to do this work now strategy & action story of us shared values & experience @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Source: Marshall Ganz
  • 58. story of self story of PURPOSE call to leadership now strategy & action story of us shared values & experience @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Our shared experience reveals our shared values Source: Marshall Ganz
  • 59. Frame the urgency & hopefulness necessary to secure commitment & build momentum towards our shared goal story of self story of PURPOSE call to leadership now strategy & action story of us shared values & experience @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Source: Marshall Ganz
  • 60. Frame the urgency & hopefulness necessary to secure commitment & build momentum towards our shared goal story of self story of PURPOSE call to leadership Why I am called to do this work now strategy & action story of us Our shared experience reveals our shared values shared values & experience @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Marshall Ganz
  • 61. www.youtube.com/watch?v=LM-fxPrSZZ8 @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 62. Storytelling elements o shared experience – shared values o emotion o plot o vivid detail o key touch points Source: Marshall Ganz @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 63. Creating a plot • Challenge: What was the challenge? Why was it a challenge? • Choice: What were the choices? Why did you make the choice you did? Where did you get the courage or hope? How did it feel? • Outcome: How did the outcome feel? Why did it feel that way? What do you want us to feel? Source: Marshall Ganz @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 64. Vivid details @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Source: Marshall Ganz
  • 65. The power of stories What did it achieve? How does this make you feel? How did it achieve it? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 66. Frame the urgency & hopefulness necessary to secure commitment & build momentum towards our shared goal story of self call to leadership Why I am called to do this work story of PURPOSE Your turn now strategy & action story of us shared values & experience @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Our shared experience reveals our shared values Source: Marshall Ganz
  • 67. Working in trios • Storyteller • Listener • Observer @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 68. Storyteller • Tells story of self • Reflects taking notes, what did I do well what might I do differently next time? • Receives feedback from the listener and observer @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 69. Listener • Reflects upon how the story makes them feel, did it connect with them and why? • What were the key touch points for you? • Was there use of vivid detail or data? • In listener role the story will build each time you hear it, is there a plot, character, challenges and choices • @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 70. Observer • Manages the process, timing is important as is ensuring that each group member has an opportunity to give and receive feedback. • Allows about 3-4 minutes for the story teller to tell their story of self • 1 minute for writing down reflections • Allows about 3 minutes for feedback from the group starting with the story teller, listener and observer • Change roles and repeat. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 71. Giving feedback • Was the – challenge – choice – Outcome explicit? • Could you identify with their values? Where did they come from? • Were the details vivid in ways that helped you to identify what she/he was feeling? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 72. Frame the urgency & hopefulness necessary to secure commitment & build momentum towards our shared goal story of self story of PURPOSE call to leadership Why I am called to do this work now strategy & action story of us Our shared experience reveals our shared values shared values & experience @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Marshall Ganz
  • 73. “If people give to a cause, they expect a relationship, not a transaction” Nilofer Merchant @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 74. “A cynic, after all, is a passionate person who does not want to be disappointed again” Zander R and Zander B (2000) The art of possibility. Harvard Business School Press. As quoted by Steve Onyett @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 75. Case study: people with dementia and antipsychotic drugs @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 76. “short-term treatment (up to six weeks) of persistent aggression in patients with moderate to severe Alzheimer’s dementia, unresponsive to non-pharmacological approaches & when there is a risk of harm to self or others”. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 77. The reality was • Estimated 180,000 people in England with dementia were getting antipsychotics • Only 36,000 get any clinical benefit from the drugs • Negatives far outweigh the positives Source: Bannerjee report @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 78. It doesn’t have to be that way! @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 79. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 80. Our goal By 31st March 2012, all people with dementia who are receiving antipsychotic drugs will have undergone a clinical review to ensure that if they are receiving these drugs they are doing so appropriately & that alternatives to their prescription have been considered & a shared decision has been agreed regarding their future care @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 81. Priority groups to call to action • The clinical decision makers who prescribe & review therapeutic interventions • Those who we want to shift power to (e.g., people with dementia & their carers) • Those who can give voice & advocacy to people with dementia & their carers • Those with authority who can promote & ensure best practice @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 82. Call to action for pharmacists I (we) commit to: reviewing the people under my care to identify those who are prescribed antipsychotic medication & working in partnership with my prescribing & other healthcare colleagues to review each individual by 31st March 2012 @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 83. What has happened? 51% reduction in the prescription of antipsychotic drugs for people with dementia across England Learning study: Mobilising and organising for large scale change in healthcare ‘The Right Prescription: A Call to Action’ Manchester Business School NHS Improving Quality http://www.nhsiq.nhs.uk/media/2414209/dementia_report_nov _2013.pdf @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 84. The largest simultaneous improvement initiative in the history of the NHS @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 85. It started with a tweet! Trainee doctors and improvement leaders started to talk about how they could build a social movement to improve care Damian Roland Stuart Sutton Helen Bevan Source: @NHSChangeDay @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 86. A 189,000 pledge mountain! 86 Source: @NHSChangeDay @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 87. Example pledges “We pledge to introduce a test for values and behaviour for recruitment into our universities and into employment.” Health Education England, West Yorkshire “As Director of Safety and Risk, my pledge is to spend more time listening to patients and staff and to act upon their concerns.” Moira Durbridge “We pledge to invite all individuals who make a complaint about our services to be involved in one of our 15 Steps Quality Challenge panels.” Bradford District Care Trust, Yorkshire, 3001 “I pledge each month to contact a front line staff member within my team who demonstrates inspirational clinical practice.” East of England Ambulance Service NHS Trust “I pledge to visit an elderly gentleman with dementia in his own home to help him build his life story on our Digital Reminiscence Therapy Software.” Jo Samuels. “I pledge to make sure every person with a learning disability at Turning Point has a health action plan.” Fiona Ritchie @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 88. People took action all over the country @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 89. 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 @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 90. Change Day 2013 was an extraordinary moment in the history of the NHS. It taught us that large-scale improvement is possible in the NHS and that the best way to do it is through collective commitment, action and by keeping it simple. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 91. 3rd March 2014 www.changeday.nhs.uk @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 92. Five tactics for change agents 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Create energy for change 5. Don't be a martyr @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 93. @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 94. “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992) @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 95. 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 @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 96. The model is mostly used around health-related behaviours • • • • • • • • • • smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake It works for organisational and domestic violence HIV prevention service change too! use of sunscreens to prevent skin cancer medication compliance mammography screening @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 97. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit Prochaska, DiClemente & Norcross (1992) @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 98. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet Prochaska, DiClemente & Norcross (1992) @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 99. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. Prochaska, DiClemente & Norcross (1992) @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 100. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! Prochaska, DiClemente & Norcross (1992) @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 101. “Stages of change” Smoking I am continuing to not smoke. I sometimes miss it – but I am still not smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! Prochaska, DiClemente & Norcross (1992) @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 102. “Stages of change” Smoking I am continuing to not smoke. I sometimes miss it – but I am still not smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! Prochaska, DiClemente & Norcross (1992) @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 103. “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992) @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 104. 90% of the tools available for healthcare change agents are designed for the “action” stage The reality of our change situation • Our tools are often not effective at the stage of change that most people we work with are at • It’s hard to engage people in change • It’s hard to get people to make the changes we want them to make • People get irritated, defensive, irrational • We feel powerless in our ability to lead or facilitate the change @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 105. 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 @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 106. So what do we TEND to do? • Lower our ambitions for improvement • Focus our energies on those who are already in the “action” stage • Put negative labels on those who are not yet at the action stage such as “blocker” or “resister” or “laggard” • Blame “the management” for not enforcing change @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 107. So what SHOULD we do? • Listen and understand • appreciate the starting point • elaborate interests • Build meaning and conviction in the change • Roll with resistance (Singh) • Don’t argue against it • Encourage elaboration of resistance • What makes it so hard? • What would help? • Build shared purpose @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 108. Task Using the sheet that shows tactics at the different stages of change, consider one or more of the improvement initiatives that people at our table are involved in: • Who are the key people we need to get on board? • What stage of change are they at? • How can I help them move to the next stage of change? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 109. Five tactics for change agents 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Create energy for change 5. Don't be a martyr @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 110. What happens to large scale change efforts in reality? In order of frequency: 1. the effort effectively “runs out of energy” and simply fades away 2. the change hits a plateau at some level and no longer attracts new supporters 3. the change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way Source: Leading Large Scale Change: a practical guide (2011), NHS Institute @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 111. Does fear motivate people to change? @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 112. burning platform versus burning ambition @PeterFuda @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 113. Lessons for transformational change 1. In order to sustain transformational change we need to move from a burning platform (fear based urgency) to a burning ambition (shared purpose for a better future) 2. We need to articulate personal reasons for change as well as organisational reasons 3. If the fire (the compelling reason) goes out, all other factors are redundant @PeterFuda @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 114. Task Talk to the person next to you • What is “my burning ambition” for my service, my community and /or my patients? • Try to make it personal: link it with your earlier narrative; tell others why this ambition connects with your personal motivations @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 115. Bruch and Vogel research Organisations with HIGH productive energy scored higher on: • overall performance - 14% higher • productivity – 17% • efficiency – 14% • customer satisfaction – 6% • customer loyalty – 12% @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 116. Download for free at www.changemodel.nhs.uk @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 117. Energy for change is: Spiritual the capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals Social Psychological Physical @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Intellectual
  • 118. Five energies for change Energy Definition Social Energy of relationships and connections between people: people feel a sense of “us and us” rather than “us and them” Spiritual Energy of commitment to a common vision for the future: gives people the confidence to move towards a different future that is more compelling than the status quo Psychological Energy of courage, resilience and feeling safe to do things differently: People feel confident to make a change and trust in leadership and direction Physical Energy of action, getting things done and making progress: the flexible, responsive drive to make things happen Intellectual energy of analysis, planning and thinking: Planning and supporting processes, evaluation, arguing a case on the basis of logic/ evidence @helenbevan
  • 119. High and low ends of each energy domain Low High Social isolated solidarity Spiritual uncommitted higher purpose Psychological risky safe Physical fatigue vitality Intellectual Illogical reason @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 120. Some questions • Which group is likely to have higher spiritual energy scores  clinicians?  non clinicians? • The nearer I am in the hierarchy to the CEO, is my overall energy score likely to be  higher  lower? @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 121. Energy for change profile Social 5 4 3 Intellectual 2 1 Physical • Are particular energy domains more dominant than others for Spiritual our team at the moment? • Is this the optimal energy profile to help us achieve our Psychological improvement goals? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 122. Energy for change profile Social 5 4 3 Intellectual 2 1 Physical • Are particular energy domains more dominant than others for Spiritual our team at the moment? • Is this the optimal energy profile to help us achieve our Psychological improvement goals? @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 123. Energy for Change A case study Michele Upton is responsible for strategic improvement across 17 neonatal units in the East of England region. A care bundle aimed at reducing rates of Necrotising Enterocolitis (NEC) in premature babies was implemented across the 17 units. One unit has been struggling to maintain compliance with the interventions. Attempts to improve compliance have been ongoing for two years. @helenbevan Spiritual Social Psychological Intellectual Physical Michelle received training on the 5-Energy model. The unit completed the Energy for Change online self-assessment which revealed low physical and spiritual energy for the change within the team. They also clarified their shared purpose: for the MDT to work together better and use evidence based practice. The team discussed what was depleting their energy – and created an action plan to build energy for the change – based on building commitment to the change.
  • 124. Team 1: what’s your assessment of their energy for change? Social 5 4 3 Intellectual Spiritual 2 1 Physical Psychological @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 125. Team 1: what’s your assessment of their energy for change? This energy profile is Social 5 4 3 Intellectual 2 Spiritual 1 Physical Psychological @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents characterised by an environment that has harnessed people’s interest and momentum for change, but which has failed to engage people fully. This imbalance results in their feeling some uncertainty regarding how they can contribute fully to the change, and therefore a sense of risk and lack of hope for the future. We can build energy by building team solidarity and developing shared purpose
  • 126. Team 2: what’s your assessment of their energy for change? Social 5 4 3 Intellectual Spiritual 2 1 Physical Psychological @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 127. Team 2: what’s your assessment of their energy for change? This energy profile shows Social 5 4 3 Intellectual 2 Spiritual 1 Physical Psychological @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents strong connections between people, a true sense of solidarity, which gives them enough hope for the future, but this energy is undirected, because the rational argument and shared purpose has not been agreed. We can build energy by agreeing shared goals for change and using systematic approaches to thinking through and planning the change
  • 128. Where does team 1 go for help? Roadmap of resources for building energy for change
  • 129. Task Using the template, make an assessment of the energy for change in the project you are working on at present: • Where are the opportunities to build a more balanced set of energies? • How might you go about doing this?
  • 130. “You can’t impose anything on anyone and expect them to be committed to it” Edgar Schein, Professor Emeritus MIT Sloan School @helenbevan @PowerNHS @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 131. What is our approach to change? Compliance Commitment States a minimum performance standard that everyone must achieve States a collective goal that everyone can aspire to Uses hierarchy, systems and standard procedures for coordination and control Based on shared goals, values and sense of purpose for coordination and control Threat of penalties/ sanctions/ shame creates momentum for delivery Commitment to a common purpose creates energy for delivery @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Source: Helen Bevan
  • 132. “ The source of energy at work is not in control, it is in connection to purpose” Don Berwick, 28th February 2012 @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 133. Shared purpose aligns..... Shared purpose allows many communities to engage with us without us having to invest resources in controlling their actions Nilofer Merchant @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 134. [Shared] purpose goes way deeper than vision and mission; it goes right into your gut and taps some part of your primal self. I believe that if you can bring people with similar primal-purposes together and get them all marching in the same direction, amazing things can be achieved. Seth Carguilo @helenbevan @PowerNHS @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 135. A three word concept @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 136. Change agent as “signal generator” “As a leader, think of yourself as a “signal generator” whose words and actions are constantly being scrutinised and interpreted, especially by those below you *in the hierarchy+” “Signal generators reduce uncertainty and ambiguity about what is important and how to act” Charles O’Reilly, Leaders in Difficult Times, 2009 @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 137. Avoiding “de facto” purpose • What leaders pay attention to matters to staff, and consequently staff pay attention to that too • Shared purpose can easily be displaced by a “de facto” purpose:  hitting a target  reducing costs  reducing length of stay  eliminating waste  completing activities within a timescale  complying with an inspection regime • If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 138. @SimonJGuilfoyle Police Inspector and systems thinker @helenbevan@RobertVarnam #IHI25Forum #ChangeAgents @HelenBevan #Staffschange
  • 139. @SimonJGuilfoyle Police Inspector and systems thinker @helenbevan@RobertVarnam #IHI25Forum #ChangeAgents @HelenBevan #Staffschange
  • 140. Police @SimonJGuilfoyle Police Inspector and systems thinker @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 141. Education @SimonJGuilfoyle Police Inspector and systems thinker @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 142. Healthcare @SimonJGuilfoyle Police Inspector and systems thinker @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 143. @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents 143
  • 144. How do we create shared purpose? Create a safe space Look for commonalities & understand differences @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents Create a statement of purpose
  • 145. Task In the context of your own change initiative: • Who needs to be part of our shared purpose? • What unites us? • What is our actual shared purpose (ie, the reason WHY we are undertaking the change) @helenbevan #Staffschange @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 146. Outwitted He drew a circle that shut me out Heretic, rebel, a thing to flout. But Love and I had the wit to win: We drew a circle that took him in. Edward Markham @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 147. @helenbevan #IQTGOLD @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 148. ....the last era of management was about how much performance we could extract from people .....the next is all about how much humanity we can inspire Dov Seidman @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
  • 149. We have a choice “This is the true joy of life, the being used up for a purpose recognised by yourself as a mighty one, being a force of nature instead of a feverish, selfish little clot of ailments and grievances, complaining that the world will not devote itself to making you happy” George Bernard Shaw @helenbevan @HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents