1.
@HelenBevan
In the near future, the edges
will be where almost all high-
value work will be done…..
http://www.jarche.com/2014/01/movi
ng-to-the-edges/
Leading from the edge
“

2.
@HelenBevan
For those of you who attended the
Greater Manchester Graduate Xchange
20th November 2015
Some learning reinforcement after a short
space of time helps to retain learning
Casebourne I (2015)
Spaced Learning: An Approach to Minimize the Forgetting Curve
https://www.td.org/Publications/Blogs/Science-of-Learning-Blog/2015/01/Spaced-
Learning-an-Approach-to-Minimize-the-Forgetting-Curve

3.
@HelenBevan
These ideas come from
theedge.nhsiq.nhs.uk/school
New term started 4.2.16

4.
@HelenBevan
The School has been formally evaluated by the Chartered
Institute for Personnel & Development
http://theedge.nhsiq.
nhs.uk/school/school-
evaluation/
How has the School for Health and Care
Radicals made a difference?

5.
@HelenBevan
The School has been formally evaluated by the Chartered
Institute for Personnel & Development
• Change knowledge
• Sense of purpose & motivation to improve practice
• Ability to challenge the status quo
• Rocking the boat & staying in it
• Connecting with others to build support for change
Statistically significant positive effect on
EVERY dimension of impact at both individual
and organisational level

6.
@HelenBevan
The Fundamental Law of Conventional
Conferences
The sum of the
expertise of the
people in the
audience is greater
than the sum of
expertise of the
people on stage
Dave Winer
“
“
Source of image: www.citynet.com

7.
@HelenBevan
Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

8.
@HelenBevan
Source: @NHSChangeDay

9.
@HelenBevan
“New truths begin as heresies”
(Huxley, defending Darwin’s theory of natural selection)
Source of image:
installation by the
artist Adam Katz
www.thisiscolossal.com
Via @NeilPerkin

10.
@HelenBevan

11.
@HelenBevan
Starts on the fringe
(at the edge)
Starts with the activists
Gary Hamel
always

12.
@HelenBevan
Tomorrow belongs to those
who can hear it coming
David Bowie
“

13.
@HelenBevan
If I put my ear down on the
railroad track, I can hear the train
coming, and we ain’t ready
Ray Smith, former Chairman and CEO of
Bell Atlantic
Source of image: cubimention.net
“

14.
@HelenBevan
The Five Year Forward View
Mentions
“radical”
12 times
“transformation/transformational”
13 times
“change”
42 times

15.
@HelenBevan

16.
@HelenBevan
What is happening with change?

17.
@HelenBevan
What is happening with change?

18.
@HelenBevan
What is happening with change?

19.
@HelenBevan
What is happening with change?

20.
@HelenBevan
Change from the edge
What is happening with change?

21.
@HelenBevan
Moving to the edge
“ Traditional R&D is no longer sufficient. Big
companies invest in innovation centers; some aim
to act like start ups, others set out to partner with
or acquire them.
Either way, innovation centers spark new ideas,
experiment faster, fail faster and gain momentum to
affect HQ and force change from the outside in”
Disruptive technology trends 2016-2018

22.
@HelenBevan
Why go to the edge?
“ Leading from the edge brings us
into contact with a far wider range
of relationships, and in turn, this
increases our potential for diversity
in terms of thought, experience
and background. Diversity leads to
more disruptive thinking, faster
change and better outcomes
Aylet Baron

23.
@HelenBevan
Jeremy Heimens TED talk “What new power looks like”
https://www.youtube.com/watch?v=j-S03JfgHEA
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship

24.
@HelenBevan
The Network Secrets of Great Change Agents
Julie Battilana &Tiziana Casciaro
As a change agent, my centrality in the
informal network is more important
than my position in the formal
hierarchy

25.
@HelenBevan
People who are highly connected
have twice as much power to
influence change as people with
hierarchical power
Leandro Herrero
http://t.co/Du6zCbrDBC

26.
@HelenBevan
People at every level recognise that things
aren’t right
“Legacy constructs that enforce
bureaucracy through command-
and-control structures …with gated
handovers between organizational
silos are pervasive across large
organisations. These processes
were built to mitigate risk for an
environment that doesn’t exist
today.
“With this in mind, many
organisations are looking for
ways to improve employee
participation in the
organisation’s strategy and in
turn, increase retention rates
and hold on to the great
people they’ve already
invested in. This results in a
radical shift in the existing
work constructs……”
Thoughtworks, The unfinished business of organizational transformation

27.
@HelenBevan
Success….depends on having an open, engaging,
and iterative process that harnesses the energies of
clinicians, patients, carers, citizens, and local
community partners including the independent and
voluntary sectors, and local government
Sustainability and Transformation Plans

28.
@HelenBevan
“Tomorrow’s management systems
will need to value diversity, dissent
and divergence as highly as
conformance, consensus and
cohesion.”
Gary Hamel
Image by neilperkin.typepad.com
“The single biggest mistake to
avoid? Creating disruption at work.
Focus on developing relationships,
not disrupting and alienating
people. Peter Vander Awera on
learning from setbacks and failures
is the new normal!

29.
@HelenBevan
We need rebels!
•The principal champion of a change initiative, cause
or action
•Rebels don’t wait for permission to lead, innovate,
strategise
•They are responsible; they do what is right
•They name things that others don’t
see yet
•They point to new horizons
•Without rebels, the storyline never
changes
Source : @PeterVan http://t.co/6CQtA4wUv1

30.
@HelenBevan
If you put fences around people, you
get sheep. Give people the room they
need
William L McKnight

31.
@HelenBevan
What happens to
heretics/radicals/rebels/mavericks
in organisations?

32.
@HelenBevan

33.
@HelenBevanSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

34.
@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

35.
@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

36.
@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

37.
@HelenBevan
Research shows the psychological distress
that comes with inauthentic behaviour
"Staying true to yourself matters, even if it is
difficult, because we notice that there is a cost
involved in straying too far from your personal
values.”
“It seems to be true that to act in accordance
with one’s own self, emotions, and values is a
fundamental aspect of well-being,”
F. Gino, Maryam Kouchaki and Adam D. Galinsky (2015) The moral virtue of
authenticity: how inauthenticity produces feelings of immorality and impurity
Psychological Science July 2015

38.
@HelenBevan

39.
@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
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 self-defeating
 this just confirms what we already know – that
we don’t belong Source: adapted from Debra E Meyerson

40.
@HelenBevan
Research shows the psychological distress
that comes with inauthentic behaviour
“it is important to note that a threat to someone’s
moral self-concept is different from other negative
states of mind such as feeling confused, disrespected,
or overwhelmed. Clear instructions, positive
feedback, and flexible hours are all undoubtedly
appreciated, but for leaders who want to keep their
employees engaged for as long as possible,
understanding their need for a positive moral self-
concept might be key”
F. Gino, Maryam Kouchaki and Adam D. Galinsky (2015) The moral
virtue of authenticity: how inauthenticity produces feelings of
immorality and impurity Psychological Science July 2015

41.
@HelenBevan
Source : Lois Kelly www.foghound.com
There’s a big difference between a rebel
and a troublemaker
Rebel

42.
@HelenBevan

43.
@HelenBevan
Reflection
• What are your insights around “rebels” and
“troublemakers”?
• What moves people from being “rebel” to
“troublemaker”?
• How do we protect against this?

44.
@HelenBevan
Source : Lois Kelly www.rebelsatwork.com
There’s a big difference between a
rebel and a troublemaker
Rebel

45.
@HelenBevan
Peter Fuda’s Transformational Change Agent
framework
Skills and methods for creating
change
Ability to make sense of, and reshape
perceptions of ‘reality’
Personal characteristics and
qualities

46.
@HelenBevan
Peter Fuda’s Transformational Change Agent
framework: my perspective
“Doing”
• Where most change agents
in health and care put most
of their effort and emphasis
• What others typically judge
us on
• What we often perceive we
need to do to add value
• What most change and
improvement courses focus
on

47.
@HelenBevan
Peter Fuda’s Transformational Change Agent
framework: my perspective
“Seeing ” and “Being”
• We can only do effective
“doing” if we build on strong
foundations of “seeing and
being”
• Change begins with me
• Hopeful futures, creative
opportunities and potential
• Multiple lenses for change
• See myself in the context of
my higher purpose

48.
@HelenBevan
“Being” as a change agent
Personal characteristics and
qualities

49.
@HelenBevan
Change starts with me
Source of image: jasonkeath.com

50.
@HelenBevan
"There’s only one
corner of the
universe you can
be certain of
improving, and
that’s your own
self."
Aldous Huxley
Source of image: timcoffeyart.wordpress.com

51.
@HelenBevan
“The success of our actions as change-
makers does not depend on what we do or
how we do it, but on the inner place from
which we operate”
Otto Scharmer
Leading from the emerging future

52.
@HelenBevan
1. able to join forces with others to create action
2. able to achieve small wins which create a sense
of hope, possibility and confidence
3. More likely to view obstacles as challenges to
overcome
4. strong sense of “self-efficacy”
 belief that I am personally able to create the change
Four things we know about successful
boat rockers
Source: adapted from Debra E Meyerson
CHANGE
me
BEGINS WITH

53.
@HelenBevan
Self-efficacy
There is a positive, significant
relationship between the
self-efficacy beliefs of a
change agent and her/his
ability to facilitate change
and get good outcomes
Source of image:www.h3daily.com

54.
@HelenBevan
What’s the difference between
self efficacy
and
self esteem,
self belief,
self-confidence?

55.
@HelenBevan
Source: @NHSChangeDay

56.
@HelenBevan
Source: @NHSChangeDay
What is the issue here?
“permission” ?
(externally generated)
or
Self efficacy ?
(internally generated)

57.
@HelenBevan
Building self-efficacy: some tactics
1. Create change one small step at a time
2. Reframe your thinking:
• failed attempts are learning opportunities
• uncertainty becomes curiousity
3. Make change routine rather than an exceptional
activity
4. Get social support
5. Learn from the best

58.
@HelenBevan
Module 1
Being a health and care radical:
Change starts with me
Supported by:
Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

59.
@HelenBevan

60.
@HelenBevan
C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

61.
@HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

62.
@HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

63.
@HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

64.
@HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

65.
@HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal
PERFORMANCE target.

66.
@HelenBevan Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

67.
@HelenBevan
Research from the sales industry:
How many NOs should we be seeking to get?
• 2% of sales are made on the first contact
• 3% of sales are made on the second contact
• 5% of sales are made on the third contact
• 10% of sales are made on the fourth contact
• 80% of sales are made on the fifth to twelfth
contact
Source: http://www.slideshare.net/bryandaly/go-for-no

68.
@HelenBevan
“Papers that are more likely to contend against
the status quo are more likely to find an
opponent in the review system—and thus be
rejected —but those papers are also more
likely to have an impact on people across the
system, earning them more citations when
finally published”
V. Calcagno et al., “Flows of research manuscripts among
scientific journals reveal hidden submission patterns,”
Science, doi:10.1126/science.1227833, 2012.
—

69.
@HelenBevan
Our awareness provides the underlying ground out of
which our thinking and doing emerge

70.
@HelenBevan
Avedis Donabedian
Ultimately, the secret
of quality is love.
…… If you have love,
you can then work
backward to monitor
and improve the
system

71.
@HelenBevan
Tactic for radicals:
Out-love everyone else
Source of image: Bradley Burgess

72.
@HelenBevan
Take part in an RCT
What is a
RCT?

73.
@HelenBevan
• Randomised Coffee Trial!
• Randomised Coffee Trial!
Randomised Coffee Trial!

74.
@HelenBevan
Outcomes of Randomised Coffee Trials

75.
@HelenBevanSource of image: outskirtsbattledome.wikispaces.com
The easiest way to thrive as an
outlier
...is to avoid being one
Seth Goodin

76.
@HelenBevanFor more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW

77.
@HelenBevan
Power in community
“Power used to come largely through and from big
institutions.
Today power can and does come from connected individuals
in community.
When community invests in an idea, it co-owns its success.
Source of image: orton.org
Instead of trying to
achieve scale all by
ourselves, we have a new
way to have scale. Scale
can be in, with and
through community.”
Nilofer Merchant

78.
@HelenBevan
Managers know how to command
obedience and diligence, but most are
clueless when it comes to galvanizing the
sort of volunteerism that animates life on
the social web. Initiative, imagination and
passion can’t be commanded—they’re gifts.
Gary Hamel
http://www.mixmashup.org/blog/reinventing-
management-mashup-architecture-ideology
‘

79.
@HelenBevan
“When we talk of social change, we talk of
movements, a word that suggest vast
groups of people walking together, leaving
behind one way and travelling towards
another”
Rebecca Solnit

80.
@HelenBevan
Learning from social movement leaders
http://www.slideshare.net/NHSIQ/the-power-of-one-the-power-of-
many?qid=97bb3464-07c2-4883-9531-c3d436a66aa1&v=qf1&b=&from_search=2

81.
@HelenBevan

82.
@HelenBevan
Action

83.
@HelenBevan
Leadership is….
…the art of mobilising others
to want to struggle for shared
aspirations
Jim Kouzes
Source of image: environmentvictoria.org.au

84.
@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)

85.
@HelenBevan
What’s the
financial incentive?
Who is
performance
managing?
What’s the
project plan?
Source: @RobertVarnam

86.
@HelenBevan
The reality
“What the leader cares about (and typically bases at
least 80% of his or her message to others on) does
not tap into roughly 80% of the workforce’s primary
motivators for putting extra energy into the change
programme”
Scott Keller and Carolyn Aiken (2009)
The Inconvenient Truth about Change Management
Source of image: swedenbourg-openlearning.org.uk

87.
@HelenBevan
1. People speak intellectually but engage
emotionally
2. Facts are hard to remember and easy to
challenge
3. If we only talk about our success people won’t
believe us
4. People don’t want more communication; they
want meaningful communication
http://www.peterfuda.com/2014/10/30/traditional-comms-fail-engage/
Four gaps between
how we
communicate
change
how people
engage with that
communication

88.
@HelenBevan
“I have some Key
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam

89.
@HelenBevan
If we want people to take action, we have to
connect with their emotions through values
action
values
emotion
Source: Marshall Ganz

90.
@HelenBevan

91.
@HelenBevan

92.
@HelenBevan
But not all emotions are equal.........
inertiaurgency
anger apathy
solidarity isolation
you can make a
difference
Self-doubt
hope fear
Overcomes
Action motivators Action inhibitors
Source: Marshall Ganz

93.
@HelenBevan
‘‘Leaders must wake people out of inertia.
They must get people excited about
something they’ve never seen before,
something that does not yet exist”
Rosa Beth Moss Kanter
Source of image: www.linkedin.com/company/activate-brand-agency

94.
@HelenBevan
Effective framing:
what do we need to do?
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
Source of image: woccdoc.org

95.
@HelenBevan
http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-
crafting-visual-stories-with-data?sf3881865=1

96.
@HelenBevan
Source: Hahrie Han (2014) How organisations develop activists
Lone wolves
Mobilisers
Organisers
What’s different about activist organisations/
communities with high participation rates?

97.
@HelenBevan@HelenBevan
Focus on the “We”
“Great social movements get their
energy by growing a distributed
leadership”

98.
@HelenBevan
Harvard researchers put a gorilla image on this
lung scan

99.
@HelenBevan
What proportion of the radiologists who
reviewed this scan actually saw the gorilla?
90%
25% 17%
80%
9%
60%

100.
@HelenBevan
Question: what’s the most reliable way to
predict the future effectiveness of a
team?
Source:
http://www.fastcompany.com/3049524/know-it-all/the-
science-behind-team-intelligence

101.
@HelenBevan
Effective framing:
what do we need to do?
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
Source of image: woccdoc.org

102.
@HelenBevan
Vivid details
Source: Marshall Ganz

103.
@HelenBevan
“You don’t need an engine when you
have wind in your sails”
Paul Bate

104.
@HelenBevan
Talk to the person next to you
• Tell your story about why the change you are
involved in now is so important to you
• Relate it to a personal experience
You have:
• 2 minutes to prepare your story
• 3 minutes each to tell your story

105.
@HelenBevan
How do we create a sense of
“us” to build momentum for
change?
Source of image: www.tannerfriedman.com

106.
@HelenBevan
Moving beyond us and them
to us and us
Source of image: www.delta7.com

107.
@HelenBevan
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

108.
@HelenBevan
strong ties (cohesive)
v.
weak ties (disconnected)
Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml

109.
@HelenBevan
When we spread change through strong ties:
• we interact with “people like us”, with
the same life experiences, beliefs and
values
• Change is “peer to peer”; GP to GP,
social worker to social worker, nurse to
nurse, community leader to
community leader
• Influence is spread through people
who are strongly connected to each
other, like and trust each other

110.
@HelenBevan
When we spread change through strong ties:
• we interact with “people like us”, with
the same life experiences, beliefs and
values
• Change is “peer to peer”; GP to GP,
social worker to social worker, nurse to
nurse, community leader to
community leader
• Influence is spread through people
who are strongly connected to each
other, like and trust each other
IT WORKS BECAUSE: people are far
more likely to be influenced to
adopt new behaviours or ways of
working from those with whom they
are most strongly tied

111.
@HelenBevan
The pros and cons of strong ties
Pros Cons

112.
@HelenBevan
When we seek to spread change through weak
ties
• we build bridges between groups and
individuals who were previously different and
separate
• we create relationships based not on pre-
existing similarities but on common purpose
and commitments that people make to each
other to take action
• We can mobilise all the resources in our
organisation, system or community to help
achieve our goals

113.
@HelenBevan
Why we need to build weak ties AS WELL AS
strong ties
• Weak ties are more likely to lead to change at scale
because they enable us to access more people with
fewer barriers
More on weak ties: https://www.youtube.com/watch?v=w7AzRVxhEXA#t=45

114.
@HelenBevan
Why we need to build weak ties AS WELL AS
strong ties
• Weak ties are more likely to lead to change at scale
because they enable us to access more people with
fewer barriers
• In situations of uncertainty, we have a tendency to
revert to our strong tie relationships
 yet the evidence tells us that weak ties are
much more important than strong ties when it
comes to searching out resources in times of
scarcity

115.
@HelenBevan
Why we need to build weak ties AS WELL AS
strong ties
• Weak ties are more likely to lead to change at scale
because they enable us to access more people with
fewer barriers
• In situations of uncertainty, we have a tendency to
revert to our strong tie relationships
 yet the evidence tells us that weak ties are
much more important than strong ties when it
comes to searching out resources in times of
scarcity
• The most breakthrough innovations and most
radical change will come when we tap into our weak

116.
@HelenBevan
Sources of weak ties

117.
@HelenBevan
Three components of a great narrative
• Diagnostic – what is the problem that
we are addressing? What is the extent
of the problem? What is the specific
source or sources?
• Prognostic – what could the future look
like? What is our “plan of attack” and
our strategy for carrying out the plan?
• Motivational – why is this urgent?
What is our call for action that
connects with the motivational and
emotional drivers of our audience?
Source: Benford and Snow
Source of image: www.ecommercedefense.com

118.
@HelenBevan
Four keys to collaboration
• Lean into your discomfort
• Listen as an ally
• State your intent
• Share your “street corner”
Source: Judith Katz and Fred Miller

119.
@HelenBevan

120.
@HelenBevan
120
http://weneedsocial.com/blog/2013/8/25/disr
upted-disruptors-unite

121.
@HelenBevan
Source of image: http://switchandshift.com/transactional-or-
transformational-which-leadership-style-is-best

122.
@HelenBevan
“You don’t need an engine when you have
wind in your sails”

123.
@HelenBevan
Questions for reflection
1. What learning and inspiration can you take
from social movement leaders to help you in
your role as an agent of change in health and
care?
2. How will you attract the attention of the people
you want to call to action?
3. Who are the people who are currently
disconnected that you want to unite in order to
achieve your goal for change? How can you
build a sense of “us” with them?

124.
@HelenBevan #gpconf15 Source of image: ivysea.com
Building
energy for
change

125.
@HelenBevan #gpconf15 Source of image: Whatsthebigideascwartzy.blogspot.com

126.
@HelenBevan #gpconf15
Most change programmes fail to
deliver their objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
70%
25%
5%
Gets anywhere near
achieving the
change and
delivering the
benefits

127.
@HelenBevan #gpconf15
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
70%
25%
5% Delivers and
sustains the change
Most change programmes fail to
deliver their objectives

128.
@HelenBevan #gpconf15
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: http://www.nhsiq.nhs.uk/8530.aspx

129.
@HelenBevan #gpconf15
Typically, around any change effort, there is an
initial spike of tangible energy, and change, but
when leadership loses interest, the momentum
of change slows down drastically.”
Tara Paluck

130.
@HelenBevan #gpconf15
Anatomical
approach
 Improving clinical
systems
 Seeking to reduce
harm and reduce risk
 Redesigning pathways
 Standardising
 Measuring
Physiological
approach
The vitality and life-giving forces
that enable the system and its
people to develop, grow &
change
 creating higher purpose
and deeper meaning
 Leading through values
 building commitment
 creating hope and
optimism about the future
 calling to action

131.
@HelenBevan #gpconf15
Anatomical
approach
 Improving clinical
systems
 Seeking to reduce
harm and reduce risk
 Redesigning pathways
 Standardising
 Measuring
Physiological
approach
The vitality and life-giving forces
that enable the system and its
people to develop, grow &
change
 creating higher purpose
and deeper meaning
 Leading through values
 building commitment
 creating hope and
optimism about the future
 calling to action
It’s all
about
energy!

132.
@HelenBevan #gpconf15
Resistant behaviour is a good
indicator of missing relevance
Harald Schirmer
http://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-
role-of-hr-driving-social-adoption-and-change-in-the-enterprise
Source of image: driverlayer.com
‘‘

133.
@HelenBevan #gpconf15
Intrinsic motivation
People engage in the
activity for the pleasure
and satisfaction of doing it
Invokes many positive
behaviours
Extrinsic motivation
People engage in the
activity for the rewards or
avoiding punishment
Any external influence is
referred to as extrinsic
motivation
Images: pixgood.com

134.
@HelenBevan #gpconf15
The power of extrinsic drivers

135.
@HelenBevan #gpconf15
Persistent application of power
and authority drains energy
from those in its wake
Dan Rockwell

136.
#SHCR @School4Radicals
Research shows that more than almost
any other factor affecting an
organisation, energy can lead to either a
wellspring of corporate vitality or the
destruction
of its very core
Source: Bruch and Vogel

137.
#SHCR @School4Radicals@HelenBevan #gpconf15
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%

138.
#SHCR @School4Radicals

139.
#SHCR @School4Radicals@HelenBevan #gpconf15
Energy for change
The capacity and drive of a team,
organisation or system to act and
make the difference necessary to
achieve its goals
http://www.institute.nhs.uk/tools/energ
y_for_change/energy_for_change_.html

140.
#SHCR @School4Radicals@HelenBevan #gpconf15
Psychological
Physical
Spiritual
Social Intellectual
Energy for change

141.
#SHCR @School4Radicals@HelenBevan #gpconf15
Social energy
Energy of personal
engagement, relationships and
connections between people
It’s where people feel a sense of
“us and us”
rather than
“us and them”

142.
#SHCR @School4Radicals@HelenBevan #gpconf15
Spiritual energy
Energy of commitment to a common
vision for the future, driven by shared
values and a higher purpose
Gives people the confidence to move towards a
different future that is more compelling than
the status quo

143.
#SHCR @School4Radicals@HelenBevan #gpconf15
Psychological energy
Energy of courage, resilience and feeling
safe to do things differently
Involves feeling supported to make a change and
trust in leadership and direction

144.
#SHCR @School4Radicals@HelenBevan #gpconf15
Physical energy
Energy of action, getting things done and
making progress
The flexible, responsive drive to make things
happen

145.
#SHCR @School4Radicals@HelenBevan #gpconf15
Intellectual energy
Energy of analysis, planning and thinking
Involves gaining insight as well as planning and
supporting processes, evaluation, and arguing a
case on the basis of logic/ evidence

146.
#SHCR @School4Radicals@HelenBevan #gpconf15
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

147.
#SHCR @School4Radicals@HelenBevan #gpconf15
Some questions
 Which group likely to have
higher spiritual energy
scores (clinicians/non
clinicians?)
 Nearer to CEO, higher or
lower energy scores?

148.
@helenbevan@helenbevan #Quality2013
• Are particular
energy domains
more dominant
than others for
our team at the
moment?
• Is this the
optimal energy
profile to help
us achieve our
improvement
goals?
Energy for change profile
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual

149.
#SHCR @School4Radicals@HelenBevan #gpconf15
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual
Team 1: what’s your assessment of
their energy for change?

150.
#SHCR @School4Radicals@HelenBevan #gpconf15
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual
Team 2: what’s your assessment of
their energy for change?

151.
#SHCR @School4Radicals@HelenBevan
Where is your team?
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual

152.
#SHCR @School4Radicals
There has never been a time in the history
of healthcare when this advice has been
more pertinent
“Leadership is not about making clever
decisions and doing bigger deals. It is about
helping release the positive energy that
exists naturally within people”
Henry Mintzberg

153.
#SHCR @School4Radicals@HelenBevan #gpconf15

154.
#SHCR @School4Radicals@HelenBevan #gpconf15 Source: Helen Bevan
Compliance
States a minimum performance
standard that everyone must
achieve
Uses hierarchy, systems and
standard procedures for co-
ordination and control
Threat of penalties/ sanctions/
shame creates momentum for
delivery
What is our approach to change?
Commitment
States a collective goal that
everyone can aspire to
Based on shared goals, values
and sense of purpose for co-
ordination and control
Commitment to a common
purpose creates energy for
delivery

155.
#SHCR @School4Radicals@HelenBevan #gpconf15
We know that ...
 Shared purpose is a common thread in
successful change programmes*
 Organisations and change initiatives with strong
shared purpose consistently outperform those
without it.**
*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)
**Management Agenda 2013 Boury et al (Roffey Park Institute)

156.
#SHCR @School4Radicals@HelenBevan
A 3-word concept

157.
#SHCR @School4Radicals@HelenBevan #gpconf15
[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

158.
#SHCR @School4Radicals@HelenBevan #gpconf15
The power of shared purpose:
Perhaps the single most important influence on program
response by individual units—either in promoting or
resisting change—was the extent of consensus and
coalition among the senior medical and nursing staff on
individual Intensive Care Units….
[Consultant says] ‘I think it’s been successful because it’s
a unifying program, it’s one of the few things that we’ve
done that hasn’t been just a doctor thing, or just a nurse
thing, it’s involved the doctors and the nurses together.’
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/

159.
#SHCR @School4Radicals@HelenBevan #gpconf15
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
 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

160.
#SHCR @School4Radicals@HelenBevan #gpconf15 @SimonJGuilfoyle Police Inspector and systems thinker

161.
#SHCR @School4Radicals@HelenBevan #gpconf15 @SimonJGuilfoyle Police Inspector and systems thinker

162.
#SHCR @School4Radicals@HelenBevan #gpconf15
Police
@SimonJGuilfoyle Police Inspector and systems thinker

163.
#SHCR @School4Radicals@HelenBevan #gpconf15
Education
@SimonJGuilfoyle Police Inspector and systems thinker

164.
#SHCR @School4Radicals@HelenBevan #gpconf15
Healthcare
@SimonJGuilfoyle Police Inspector and systems thinker

165.
#SHCR @School4Radicals@HelenBevan #gpconf15
....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

166.
@HelenBevan
If you enjoyed today, you’ll love this…
theedge.nhsiq.nhs.uk/school
New term started 4.2.16