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

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The slide deck from Helen Bevan's talk at the ILN InPerson Meeting, 18th October 2017

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

  1. 1. @HelenBevan #ILN17 Where social movements meet co-design: participation in healthcare innovation and improvement Helen Bevan @HelenBevan #ILN17
  2. 2. @HelenBevan #ILN17 The Horizons team: Change agents and change agency • A small, diverse team of people within the English National health Service that supports change agents and builds change agency • We tune into the latest change thinking and practice in healthcare and other industries around the world • The team has emerged through years of supporting change in the NHS and the wider health and care system
  3. 3. @HelenBevan #ILN17
  4. 4. @HelenBevan #ILN17 IS ABOUT
  5. 5. @HelenBevan #ILN17 “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
  6. 6. @HelenBevan #ILN17
  7. 7. @HelenBevan #ILN17 Co-design Source: adapted from Design for Europe Source of image: Penny Hagen • Participatory, co-creating and open • 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
  8. 8. @HelenBevan #ILN17 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
  9. 9. @HelenBevan #ILN17 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
  10. 10. @HelenBevan #ILN17 Power is linked to 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
  11. 11. @HelenBevan #ILN17 A big debate in social science Structure versus Agency
  12. 12. @HelenBevan #ILN17 The predominant approach in recent years has been STRUCTURE but globally there is a big shift towards AGENCY The design dilemma at the heart of change Systemic approaches Performance goals Regulation Competition Programme Management Incentive systems Activation Patients Included Capability Leaders everywhere Social action Solidarity Social movements
  13. 13. @HelenBevan #ILN17 Makin sure that only people who should be in hospital are in hospital • The number of hospital beds occupied by patients whose transfer of care has been delayed should be reduced to 3.5% • Less than 15% of assessments [for continuing care] should take place in an acute hospital setting; • a performance dashboard is being introduced
  14. 14. @HelenBevan #ILN17
  15. 15. @HelenBevan #ILN17
  16. 16. @HelenBevan #ILN17 Royal Devon and Exeter Hospital
  17. 17. @HelenBevan #ILN17 East Sussex Healthcare
  18. 18. @HelenBevan #ILN17 “Because we want to, not because we have to”
  19. 19. @HelenBevan #ILN17 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
  20. 20. @HelenBevan #ILN17 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
  21. 21. @HelenBevan #ILN17 The implosion of trust Source: http://www.edelman.com/news/2017-edelman-trust- barometer-reveals-global-implosion / 21
  22. 22. @HelenBevan #ILN17 We are witnessing the collapse of expertise and rise of collaborative sensemaking David Holzmer Source of image: ACCA
  23. 23. @HelenBevan #ILN17 “Many times experts fail because they are experts in the past version of the world” Vikram Khosia
  24. 24. @HelenBevan #ILN17 Source: Jason Leitch and Derek Feeley
  25. 25. @HelenBevan #ILN17 New Public Passion: a growing global movement
  26. 26. @HelenBevan #ILN17 http://biggerboat.org/exploring-moodocs/ MOODOCs (Massive, Online, Open, Disease Oriented Communities)
  27. 27. @HelenBevan #ILN17 The NHS Continuing Healthcare Collaborative approach The Improvement Community All local groups The Development Group 10 local groups The Test and Scale Group 16 local groups 1000 participants £100,000 saved per meeting cycle 1000 ideas and contributions in 45 minutes Designed to engage a mass of contributors right from the start and make the process of spread much easier 27
  28. 28. @HelenBevan #ILN17 Agency is linked to power Power is one’s ability to achieve goals Bertrand Russell
  29. 29. @HelenBevan #ILN17 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
  30. 30. @HelenBevan #ILN17 The 3% rule for change Just 3% of people in the organisation drive conversations with 90% of other people Source: research by IC Kollectif
  31. 31. @HelenBevan #ILN17 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
  32. 32. @HelenBevan #ILN17 From tokenism to empowerment
  33. 33. @HelenBevan #ILN17 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.
  34. 34. @HelenBevan #ILN17 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
  35. 35. @HelenBevan #ILN17 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 Structural issues encourage this kind of participation
  36. 36. @HelenBevan #ILN17 Which kind of activists are most successful at creating agency & delivering results? Lone wolves Build power by expertise and information — through advocacy, oversight, contributing to committees, public comments and other forms of consultation Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century
  37. 37. @HelenBevan #ILN17 Which kind of activists are most successful at creating agency & delivering results? Lone wolves Build power by expertise and information — through advocacy, oversight, contributing to committees, public comments and other forms of consultation Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action Organisers Build power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century
  38. 38. Strategy for power Structure Types of asks Communication More numbers Centralised responsibility Independent Pitches for action What do they do differently? Transformative leaders Decentralised responsibility Interdependent Relationships Mobilising Organising Source: Hahrie Han (2016) Organising for transformational change
  39. 39. @HelenBevan #ILN17 Which kind of activists are most successful at creating agency & delivering results? Lone wolves Build power by expertise and information — through advocacy, oversight, contributing to committees, public comments and other forms of consultation Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action Organisers Build power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century
  40. 40. @HelenBevan #ILN17 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 Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action Organisers Build power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century
  41. 41. @HelenBevan #ILN17 Focus on the “We” “Great social movements get their energy by growing a distributed leadership” Joe Simpson
  42. 42. @HelenBevan #ILN17 “Resources” for change Economic resources diminish with use • money • materials • technology Social assets grow with use • relationships • commitment • community Based on principles from Albert Hirschman and Marshall Ganz
  43. 43. @HelenBevan #ILN17 At the heart of the issue Strategic leaders don’t see the resources that we see in the system as solutions to the biggest problems Don Berwick
  44. 44. @HelenBevan #ILN17 • 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?
  45. 45. @HelenBevan #ILN17 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
  46. 46. @HelenBevan #ILN17 COMPLIANT POWERFUL! CHANGE AGENTS WANT TO MAKE A CHANGE….. ROCK THE BOAT BUT NOT FALL OUT? Join the • Starts Thursday 15th February 2018 • For 5 weeks • Every Thursday 15.00-16.00 GMT • Live webinar • Recordings available • Completely free and open to all • Handbooks and study guides • Meet fellow change agents from across the globe theedge.nhsiq.nhs.uk/school/ #S4Change @SCH4Change

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