Where social movements meet co-design: participation in healthcare improvement

Where social movements meet
co-design:
participation in healthcare
improvement
Helen Bevan
@HelenBevan #Quality2017

@HelenBevan @HorizonsNHS #Quality2017

“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

What is co-design?
Source: adapted from Design for Europe
Source of image: Penny Hagen
• An umbrella term for design processes that are
participatory, co-creating and open
• Means that a wide range of people can make a
creative contribution to formulate and solve problems
• Goes beyond consultation by building and deepening
equal collaboration between users, patients, families
and citizens affected by a particular challenge
• Users, as experts of their own experience, are central
to the design process

Where social movements
meet co-design
Engaging the key people not just in mapping and
analysing the problem but also in action to solve
the problem

Where social movements
meet co-design
Engaging the key people not just in mapping and
analysing the problem but also in action to solve
the problem
A step further: engaging people in action to
solve problems of POWER

The most significant theme at this
Forum has been AGENCY
• The capacity of individuals to make their own
choices and to take action in a given environment
• Words that are connected to agency:
• Action
• Activity
• Effect
• Influence
• Power
• Choice

A big debate in social science
Structure versus Agency

Source: @NHSChangeDay

Individual AND collective agency
Individual agency:
People get more power
and control in their own
lives: patient activation,
shared decision-making
and self-care
Collective agency:
People act together,
united by a common
cause, harnessing the
power and influence of
the group and building
mutual trust

Building agency for large scale change
We do not become transformed alone, we
become transformed when we’re in relationship
with others
Hahrie Han
Source of image: Idahoc Community Action

Agency is linked to power
Power is one’s
ability to achieve
goals
Bertrand Russell

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

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

The 3% rule for change
Just 3% of people
in the organisation
drive
conversations with
90% of other
people
Source: research by IC Kollectif

We are witnessing the collapse of expertise
and rise of collaborative sensemaking
David Holzmer
Source of image: ACCA

@HelenBevan @HorizonsNHS #Quality2017 Source: Jason Leitch and Derek Feeley

@HelenBevan
New Public
Passion:
a growing
global
movement

Systems leaders can only progress at the
speed of trust

Which kind of activists are most successful at
delivering change?
Lone wolves
Build power by expertise and information — through
advocacy, oversight, contributing to committees, public
comments and other forms of consultation
Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

From tokenism to empowerment

Many PFAC members I’ve talked to say that staff
members only ask them to do superficial tasks (like
reviewing patient brochures or food menus) or involve
them in meaningless conversations. It’s not that menus
and brochures aren’t important, but if that’s all you’re
asking your PFAC members to do, you’re not using this
resource to its full potential. Great ideas, organizational
energy, and goodwill may be going to waste.

Patient leaders as “lone wolves”
“What I am ranting about is the way in which patients are
being streamed into advisory sub committees, the way we are
being used as tokens and to help tick off the right box…..
Where is the attitude that patients are part of the team in
healthcare, that we are partners? Why are we always asked
to participate inside a pre-determined frame? When will we
see co-design of new policies, and ultimately co-production?”
Annette McKinnon

Which kind of activists are most successful at creating
agency & delivering results?
Lone wolves
Mobilisers
Build power by mobilising people – being able to call
on large numbers of people to contribute, engage in
change and take action

Which kind of activists are most successful at creating
agency & delivering results?
Lone wolves
Mobilisers
Organisers
Build power by growing leaders – identifying, recruiting
and training future leaders in a distributed network:
building a community and protecting its strength

More numbers
Centralised
responsibility
Independent
Marketing
pitches
What do they do differently?
Strategy for
power
Structure
Types of asks
Communication
Transformative
leaders
Decentralised
responsibility
Interdependent
Relationships
Mobilising Organising
Source: Hahrie Han (2016) Organising for transformational change

Which kind of activists are most successful at
delivering change?
Lone wolves
Mobilisers
Organisers
Build power by growing leaders – identifying, recruiting
and training future leaders in a distributed network:
building a community and protecting its strength

Focus on the “We”
“Great social movements get their
energy by growing a distributed
leadership”
Joe Simpson

“Resources” for change
Economic resources
diminish with use
• money
• materials
• technology
Social resources
grow with use
• relationships
• commitment
• community
Based on principles from Albert
Hirschman and Marshall Ganz

A problem
Strategic leaders don’t see the resources
that we see in the system as solutions to
the biggest problems
Don Berwick

• Did we accomplish the goal we were trying to
accomplish?
• Did our community grow stronger? (create
capacity; new power – power we didn’t have
before)
• Did individuals involved in the whole effort learn,
grow and develop their capacity to organise with
others?
How would we know if we are
successful from a social movement
perspective?

@HelenBevan Copyright: <a href='http://www.123rf.com/profile_iqoncept'>iqoncept / 123RF Stock Photo</a>
Beyond top down and
bottom up change…….
Beyond the service lens
through which systems
leaders typically conceive
the problems we’re trying
to solve….
Bringing positive
disruption into the system
for faster change & bigger
outcomes
Disruptive co-creation
Adapted from SOLACE

....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

Where social movements meet co-design: participation in healthcare improvement

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