Creating tomorrow today: how to (and how not to) help people build their agency at every level

Chief Transformation Officer | Innovation | Improvement | Mobilising | Large Scale Change
Mar. 3, 2022

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Creating tomorrow today: how to (and how not to) help people build their agency at every level

  1. NHS England and NHS Improvement Helen Bevan Göran Henriks @HelenBevanTweet @GoranHenriks Creating tomorrow today: how to (and how not to) help people build their agency at every level
  2. 2 | Agency: The power and ability to make choices and act on them  Individual agency: People get more power and control in their own lives: through thinking differently, self-efficacy (confidence and belief that I can make things happen) shared decision-making and/or self-care  Collective agency: People act together, united by a common purpose, harnessing the power and influence of the group and building mutual trust #qmicro @HelenBevanTweet @GoranHenriks
  3. 3 | 3 | • Agency is vital to improving the value of the contribution that health care services makes to health • Change efforts are far more likely to fail because of lack of agency, than because of lack of improvement skills, capability, resources or methodology About agency #qmicro @HelenBevanTweet @GoranHenriks
  4. 4 | I felt sad when I went home from the hospital, and disappointed that I had been treated so badly. I’m going to the ER because of kidney stones for the second time in a short period of time. At the doctor's appointment, I find an arrogant attitude. When asked how are you on the VAS scale? I answered 6-7. The doctor then says: You know that a severed foot is VAS 10. I didn't feel trusted. I've been in the emergency room for about 4 hours without anyone asking me how I'm doing. I go out into the hallway to ask staff when I'm going to be examined or what's going to happen. I ask two staff, one of whom replies: You know we have sicker patients who can't stand on their feet. When I'm in as much pain as I am, you can't be still. In connection with the discharge, the same doctor comes in who has talked to me before. I get a medicine bag with morphine tablets. I was not told how many, what kind or how often I would take them. The next day, I urinated out the kidney stones at home. Treatment
  5. 5 | Why didn't the doctor listen to me? Why did I have to suffer unnecessarily? My back had been hurting for many years. Last year I had a herniated disc. I was at the orthopedist when I felt something was not right in my back, but the doctor said that it will get better even though I repeatedly pointed out that I was in terrible pain and ignored how badly I walked. I was referred to primary care. I wanted a second opinion and got it and came to another hospital. They could immediately see that something was wrong. As soon as the doctor saw me, they said, "How are you doing?" It looks like you are struggling. X-rays were done. They could see that the pelvis has sunk and there was an immediate surgery. Communication and participation
  6. 6 | Source: @NHSChangeDay 6 #qmicro @HelenBevanTweet @GoranHenriks
  7. 7 | Well prepared team Co-production builds agency Active patient and relatives We become succesful together! #qmicro @HelenBevanTweet @GoranHenriks
  8. 8 | What do I need? What can I do myself? More knowledge Tools What help do I need? What help is available? Through healthcare Digital solutions Network Society What if the patient's process started from a place of agency? Photo by Sara Riggare
  9. 9 | #qmicro @HelenBevanTweet @GoranHenriks
  10. 10 | Agency applies at any age #qmicro @HelenBevanTweet @GoranHenriks
  11. 11 | Health visit for 3 year olds
  12. 12 | Hälsobesök med hälsosamtal i Barnhälsovården 10 mån 1 år föräldrar 18 mån 2,5 år 3 år 4 år 5 år Barnhälsovården 2021
  13. What we can learn about agency from a Ghanian bead partnership?  a non-governmental organisation (NGO) based in Ghana with a mission of alleviating poverty and  a Danish company that manufactured and sold bead jewellery made from recycled crushed glass Set up a“Business-NGO partnership” to make beads, aimed at alleviating poverty in villages in Eastern Ghana, with a worthy goal to break the poverty cycle through education and alternative livelihood opportunities • Viewed as successful by the NGO because it delivered on its promise in terms of providing resources and competences for the women it employed • But actually made the lives of the villagers worse • “Competency without agency” Cross sector partnerships as capitalism’s new development agents: reconceiving impact as empowerment #qmicro @HelenBevanTweet @GoranHenriks
  14. “Competency without agency” 1. Lack of co-production and power sharing 2. Hand-picking of employees 3. Unstable employment 4. Having to travel to work 5. Specialist nature of the skills 6. Lack of voice Cross sector partnerships as capitalism’s new development agents: reconceiving impact as empowerment The resources and competences, which the women acquired through the bead partnership (income, technical skills and new knowledge), did not help them to build their agency (the power and ability to make choices and act on them). It did not provide the women with better opportunities to live the lives they desired #qmicro @HelenBevanTweet @GoranHenriks
  15. Source of graphic: Lionel Francois Agency: the power and ability to make choices and act on them
  16. COMPETENCY AGENCY COMPETENCY- the quality of being competent; capacity and skills & AGENCY – the power and ability to make choices and act on them • Improvement skills • Project/programme management • Innovation and design methods • Analytics • Process facilitation skills • Influencing skills • Coaching skills • Self-efficacy • Collective action • Building belonging • Embracing diversity • Relationships • Connections • Social action #qmicro @HelenBevanTweet @GoranHenriks
  17. Agency How do we build the confidence, courage and power to manage our own health and /or challenge the way things are and get things changed? • Tactics that start with me, on the inside, to build my own self-efficacy - the confidence and belief that I can make things happen • Tactics that start with others, on the outside, collaborating to build the power to make things happen #qmicro @HelenBevanTweet @GoranHenriks
  18. Self-efficacy There is a positive, significant relationship between the self- efficacy beliefs of a change agent and their ability to facilitate change and get good outcomes “The ability to act is tied to a belief that it is possible to do so.” “Our sense of conviction that we can successfully execute a task to produce the result we want to see” Albert Bandura
  19. Mentalisation -theory of mind • The ability to understand one´s own and other´thoughts, desires, feelings and needs • Holding mind in mind • To see ourselves from the outside and others from the inside • Understanding misunderstanding • Know yourself as others know you but also know your subjective self (your own experience) Source: Bateman and Fogany #qmicro @HelenBevanTweet @GoranHenriks
  20. When leaders can cultivate both inner and outer skills, it increases their chances of success in large complex change by 52 percent. Deborah Rowland #qmicro @HelenBevanTweet @GoranHenriks
  21. SynEnergy: we are not outside of the change: we ARE the change Source of graphic: Adapted by Helen Bevan from Reos Partners Others I am a co-creator of the change I am part of (within) it I am leading or enabling the change I am helping others to change I am apart from (above or outside) it
  22. Change is inherently relational: it depends on our ability to work with others to enable it to happen. In a system Helen Bevan and Goran Henriks “ SynEnegy
  23. Ten ways to build self-efficacy & agency

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