Organisational Radicals

@helenbevan #Quality2013 #Qradicals#Quality2013 #Quality5
M12
A half day school for
organisational radicals
Helen Bevan
Delivery Team
NHS Improving Quality
@HelenBevan
#Quality2013
#Quality5

A half day school for organisational radicals
Big change only happens in healthcare organisations because of heretics
and radicals; the passionate people who are willing to take responsibility
for change, who support their organisation in its patient-centred mission
but also challenge the status quo. It's tough being an organisational
radical so we invite you to spend an inspiring half day with people of like
minds. We will explore how we can apply the thinking and practice of
other radical leaders to achieve a "revolution in healthcare quality" in our
own organisations
Session Objectives
• Learn the survival and success tactics of other organisational radicals and
increase your effectiveness as a leader of change
• Build a toolkit of alternative/additional approaches to supporting change
• Ignite a movement of organisational radicals in your own organisation

We are a learning community!
• We want to work together this
afternoon with a philosophy of
“all teach, all learn”
• We will use the Twitter hashtags
#Quality2013 and #Quality5

Film: Apple commercial on rebels

You have come to this minicourse today as
an “organisational radical”
Draw a quick picture of what this means to you (5
minutes)
Introduce yourself to other people at your table by
sharing your pictures (10 minutes for everyone to share)
15 minute total
We will revisit the pictures at the end of the minicourse

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

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

@helenbevan #Quality2013 #Qradicals
“Bad” Rebels/Radicals “Good” Rebels/Radicals
Break rules Change rules
Complain Create
Assertions Questions
Me-focused Mission-focused
Anger Passion
Pessimist Optimist
Energy-sapping Energy-generating
Alienate Attract
Problems Possibilities
Vocalize problems Socialize opportunities
Worry that......... Wonder if...........
Point fingers Pinpoint causes
Doubt Believe
Social loner Social
Source :
Lois Kelly
www.foghound.com

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

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

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

The contrarians and rebels, the people on the
fringes of organizations who question and
deviate from the status quo, which so often
leads to inertia and inflexibility, are huge
assets for any organization
Tim Leberecht

Radicals provide to significant help to organisations
Source: Foghorn survey http://www.slideshare.net/Foghound/corporate-rebel-ebook#btnNext

The 90/30 conundrum
90% senior leaders
say to improve a
corporate culture
involve radicals/
rebels in finding ways
to improve
90% senior leaders
say to create more
innovation, activate
the radicals/rebels
37% senior leaders
very satisfied that
radicals/rebels can
provide this value in
their organisations
http://www.slideshare.net/Foghound/corporate-rebel-ebook#btnNext
90%90%
37%

@helenbevan #Quality2013 #Qradicals#Quality2013 #Quality5 Source: Foghound

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

“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

“Great spirits have always
encountered violent opposition
from mediocre minds. The
mediocre mind is incapable of
understanding the man who
refuses to bow blindly to
conventional prejudices and
chooses instead to express his
opinions courageously and
honestly.”
Albert Einstein

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

‘I do not think you can really deal with change
without a person asking real questions about
who they are and how they belong in the
world.’
(David Whyte,
The Heart Aroused, 1994)

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

 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

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

What is the “Stockdale
Paradox”?

Advice for senior leaders on how to encourage the
true mavericks who can help you:
• give them a long tether – they need space to soar
• put them in charge of something they can really own
• listen to their ideas and give them time to grow
• let them work on their own it they wish
• leave them alone and give them time to blossom
Source: Hanz Finzel

How to stifle the mavericks in your midst:
• create as many layers of management as possible for
decision-making
• keep looking over their shoulder
• make your policy manual as thick as possible
• send everything to committees for deliberation
• make them wait
Source: Hanz Finzel

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

Tactics for change agents
2. Build alliances
3. Work out what might help others to change

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

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

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
action
values
emotion
Source: Marshall Ganz

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

1. Tell a story
2. Make it personal

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

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

1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us”
is)
5. Build in a call for urgent action

Film: James Croft’s Public Narrative

Watch James Croft
• How does he make his talk authentic?
• How does he use detail?
• How does he create a sense of “us” (and who
is part of his “us”)?
• How does he build in a call for urgent action?

Tactics for change agents
2. Build alliances
3. Work out what might help others to
change

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

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

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!

“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

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

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

Case study:
Call to action for shared decision
making for people with end stage
kidney disease

The Case For Change
50, 000 people living with end stage renal failure
in England
61% of people on dialysis regretted their
decision

People with end stage kidney disease
• around half are treated with a kidney transplant
• around 4 out of 10 are treated with
haemodialysis
• around 1 out of 10 are treated with peritoneal
dialysis
• conservative treatment is another alternative
Source NHS Choices

Film: call to action for people with end
stage kidney disease

Our call to action
• We set things up as though our clinical
community was at stage 4 – ACTION
• Reality was that most people were at stage 1
or 2
• We made huge assumptions in respect of
commitment and motivation – and read
signals in the way that we wanted to read
them

“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

So what do we TEND to do?
• Lower our ambitions for improvement
• Focus our energies on those who are already in
the “action” stage
• Put negative labels on those who are not yet at
the action stage such as “blocker” or “resister” or
“laggard”
• Blame the leadership for not enforcing change
• Overestimate the motivation of those who say
they’re ready to change and underestimate the
motivation of those who indicate no interest in
change (Lundberg)

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

Task
You are acting as a change agent for an initiative that is about
shared decision making.
How would you know which stage people are at?
What actions would you take to support them with change?
Patients Clinicians
Precontemplation
Contemplation
Preparation
Action
Maintenance

What did we learn?
• The need to listen to and understand all our
stakeholders – not misunderstand signs in the
first stages of change
• The need to build strong foundations of
commitment – and work out whether
commitment was compliance
• Take time to really build the shared purpose with
the whole community
• Use resistance as an opportunity to understand
and build commitment

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

Discussion
What might you do to:
• enhance your own role as an
organisational/system maverick, radical or
heretic?
• Support other mavericks, radicals or rebels in
your organisation or system?

Are you ready to do what hasn’t been
done before?
Corporate Rebels United
http://www.corporaterebelsunited.com

Corporate Rebels United
We are architects and scouts into the future, and we want to
guide our organisations in navigating a safe path from now to
then:
Relentlessly
Challenging the status quo
Changing the rules
Saying the unsaid
Spreading the innovation virus
Seeding tribal energy
With no fear
With a cause to do good
Leading by being from our true selves
Going after the un-named quality
Relentlessly

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

Organisational Radicals

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