Slides used during the Fab Change Day Activists School (Newcastle) on Wednesday 14 September 2016 and delivered by the Horizons team. If you have any comments or questions about these slides, please email england.si-horizons@nhs.net. This year, NHS Change Day is joining forces with The Academy of Fabulous Stuff to create Fabulous Change Day on Wednesday 19 October 2016. We hope that you will be able to take action on this date (and all year round) to improve things for patients, service users, families and colleagues. Ahead of Fab Change Day, we’re running one-day training events at six venues round the country to build your skills in leading change and help you make a real difference to patients and staff.

1. Supporting large scale change in the NHS and the wider care system

2. Agenda
11am Coffee Break
12.30pm Lunch
2.45pm Coffee Break
4.30pm End of day

3. Agenda
Introduction to Fab Change Day
The future of Change
Change starts with me
From Me to We
Connecting with stories
Rolling with resistance
What are you going to do?

4. Housekeeping
Fire alarms and exits Security
Toilet location
Slides Mobile technology Wifi

5. How we make a difference
The School has been formally evaluated by
the Chartered Institute for Personnel
& Development
Statistically significant positive effect on EVERY
dimension of impact at both individual and
organisational level
• 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

6. Twitter
#FabChangeDay
@FabChangeDay
Facebook group
facebook.com/
FabChangeDay
Join in on social media
@ollybenson
@kateslater2
@dementiaboy
@janedouthwaite

7. • Horizons is a small team of people
within the NHS who support
improvement and change.
• We tune into and engage with the
best change thinking and practice in
healthcare and other industries around
the world and seek to translate this
learning into practical approaches to
change.
• The team has emerged through years
of supporting change in the NHS and
wider health and care system

8. Supporting Fab Change
Day
World’s largest
randomised coffee trial
The Edge
Edge Talks
Large Scale Spread
Hacks
Digital Activism and
broadcasting
People’s Transformathon
School for Health and
Care Radicals

9. Who’s in the room?
Previous involvement in Change Day
I have never previously
participated
I made a pledge and
completed my action.
I took part in an event
within my direct setting
e.g. office or ward.
I fully participated in
Change Day

10. Who’s in the room?
Have you previously attended the
School for Health and Care Radicals?
Yes
No

11. Who’s in the room?
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
1 2 3 4 5 6 7 8 9 10
How confident do you feel about suggesting changes in
your own team/work-place/organisation?

12. Who’s in the room?
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
1 2 3 4 5 6 7 8 9 10
How confident do you feel in
leading others through change?

13. Who’s in the room?
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
1 2 3 4 5 6 7 8 9 10
Currently how well connected are you
to other change agents?

19. NHS Change Day 2013
• Aim of 65,000 pledges
• Achieved 189,000 pledges
• 25% of NHS organisations participated
• Social movement theory
• Distributed leadership
• Relational – people made commitments
• Collective action

20. Change Day 2014 & 2015
• Where pledges had been vital to NHS
Change Day in 2014, in 2015 the focus
moved to actions and campaigns.
• More than two thirds of Acute Trusts,
Clinical Commissioning Groups and
Mental Health Trusts were involved in NHS
Change Day 2015

21. Fab Change Day 2016
• Academy of Fabulous Stuff
• 34 days to go!
• App to capture actions
• Campaigns
• World’s largest RCT

22. How you can get involved
• Do something in your local organisation:
make it about what is important to you.
Visit fabchangeday.net for inspiration.
• Inspire and support others to do
something.
• If you are a manager, let permission
flourish.

23. How you can be supported
• Become a ‘hubbie’ – a support network of
likeminded people from across the
country.
• Weekly phone call, Wednesday at 6pm.
Dial in No: 0800 917 1950 User pin:
33136606#
• What’s App group. Message me on
+447920 845437 if you want to join.

24. Change begins with me
Photo credit: white_ribbons / flickr

25. “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

26. #
WHO makes change happen in health and care?
Source: adapted by Helen Bevan
from Leandro Herrera
List A
• The Transformation
Programme Board
• The programme sponsor
• The Programme Management
Office
• The leads of the [insert
number] transformation work
streams
• The Clinical Director
• The Team Leader /Unit
Manager
• The Change Facilitator

27. #
Who makes change happen in health & care?
Source: Sewell (2015) : Stop training our project managers to be process junkies

28. #
WHO makes change happen in health and care?
List A
• The Transformation
Programme Board
• The programme sponsor
• The Programme Management
Office
• The leads of the [insert
number] transformation work
streams
• The Clinical Director
• The Team Leader /Unit
Manager
• The Change Facilitator
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The contrarians, because they can
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected. Good or
bad, they spread behaviours, role
model at a scale, set mountains
on fire and multiply anything they
get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
ones Source: adapted by Helen Bevan
from Leandro Herrera

29. #
WHO makes change happen in healthcare?
List A
• The Transformation
Programme Board
• The programme sponsor
• The Programme Management
Office
• The leads of the [insert
number] transformation work
streams
• The Project Manager
• The Team Leader /Unit
Manager
• The Change Facilitator
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The contrarians, because they can
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected. Good or
bad, they spread behaviours, role
model at a scale, set mountains
on fire and multiply anything they
get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
ones Source: adapted by Helen Bevan
from Leandro Herrera

30. #
Change is changing

31. Kinthi Sturtevant, IBM
13th annual Change Management
Conference June 2015
We rarely see two, three or four
year change projects anymore.
Now it’s 30-60-90 day change
projects

32. Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”

33. #
Change is changing

34. #

35. #
Change is changing

37. #
Change is changing

38. #

39. #
Change is changing
Change from the edge

40. #
http://www.slideshare.net/Openpolicymaking/policy-lab-slide-
share-introduction-final

41. #
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

42. #
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

43. 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

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

45. #

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

48. Source: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-o

49. #
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

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

51. #
We need rebels!
Source : @PeterVan http://t.co/6CQtA4wUv1
•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

52. #
We need to create more boat rockers!
• Rock the boat but manage
to stay in it
• Walk the fine line between
difference and fit, inside
and outside
• Conform AND rebel
• Capable of working with
others to create success
NOT a destructive
troublemaker
Source: Debra Meyerson

53. #
Source : Lois Kelly www.foghound.com
There’s a big difference between a rebel
and a troublemaker
Rebel

54. #
Reflection
• What are your insights around “rebels” and
“troublemakers”?
• What moves people from being “rebel” to
“troublemaker”?
• How do we protect against this?

55. #
Source : Lois Kelly www.rebelsatwork.com
There’s a big difference between a
rebel and a troublemaker
Rebel

56. Coffee break.
See you at 11.30am

57. From Me to We
Photo credit: hmoong / flickr

58. Photo credit: Flickr / hugobernard

59. So how can we harness the
power of our shared humanity
to help us accomplish positive
change?

60. Photo credit: Flickr / mikemcsharry

61. “Communities are
characterized by three things:
common interests,
frequent interaction, and
identification.“
Wally Block

62. Photo credit: Flickr / geoffandsherry

63. “There is no power for change
greater than a community
discovering what it cares
about.”
Margaret Wheatley

64. Where are your communities?

65. Photo credit: Flickr / stjc

66. Learning from previous social
movements

67. How do organisations develop
activists?

68. Photo credit: Flickr / Angell Williams.

69. Photo credit: Flickr / memespring

70. Photo credit: Flickr / santanuvasant

71. “Great social movements get
their energy by growing a
distributed leadership”
Joe Simpson

72. Lunch.
See you at 1.15pm

73. Connecting with stories
Photo credit: bulke41 / flickr

74. “That’s so important that we’ll
put it in the staff newsletter”

75. “[My biggest mistake] was thinking that this job
was just about getting the policy right. And
that's important.
But the nature of this office is also to tell a story
to people that gives them a sense of unity and
purpose and optimism, especially during tough
times.”

76. “I have some Key
Performance Indicators
for you”
“I have a dream”

77. Using emotions to create change
inertia
apathy
fear
isolation
self-doubt
urgency
passion/anger
hope
solidarity
you can make a difference

79. Story of self
Photo credit: gonzale / flickr

80. Story of us
Photo credit: anti_mullet9 / flickr

81. Story of now
Photo credit: gonzale / flickr

82. Tell a story
Make it personal.
Be authentic.
Create a sense of ‘us’ (and be clear who ‘us’ is)
Build in a call for urgent action.

83. Pixar storytelling formula
Once upon a time there was ___.
Every day, ___.
One day ___.
Because of that, ___.
Because of that, ___.
Until finally ___.

84. @janedouthwaite

88. O
O
X
X
O
X
O
X
B O X
Who knows where it may lead …
Think outside of the

90. Rolling with resistance
Photo credit: alohateam / flickr

91. Image sourced from: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
50 reasons not to change

92. “Employee resistance is the
most common reason
executives cite for the failure of
big organizational-change
efforts”
Scott Keller and Colin Price (2011),
Beyond Performance: How Great Organizations Build Ultimate Competitive
Advantage

93. Think about when you were last told ‘no’
How did it make you feel?

95. Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

96. Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

97. Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

98. Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

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

100. Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

101. 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 5th to 12th
contact
Source: http://www.slideshare.net/bryandaly/go-for-no

102. “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,”
Reflect
Seek better
evidence
Sharpen
your idea

103. How people see your change initiative

104. “Resistant behaviour is a good
indicator of missing relevance”
Harald Schirmer

105. ‘Outlove’ those who resist your ideas
Throw people off balance by not reacting
negatively to their resistance

106. Transtheoretical model of
behaviour change
Prochaska, DiClemente & Norcross (1992)

107. Where the model has been used
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

108. I am not aware my
smoking is a problem
– I have no intention
to quit
Prochaska, DiClemente & Norcross (1992)

109. I know my smoking
is a problem – I want
to stop but no plans
yet

110. I am making plans
& changing things
I do in
preparation.

111. I have
stopped
smoking!

112. I am continuing to not
smoke.
I sometimes miss it –
but I am still not
smoking

113. Which stage do most change activities in health and
care focus on?
Which stage are most people actually at?

114. 90% of the tools available for health and
care change agents are designed for the
“action” stage

115. Focussing on Stages of Change model:
• What stage of change are some of the key
people that you need to influence for your
change initiative at?
• What actions can you take to help them
move to the next stage?
Thinking about your own situation…

116. Example – WHO Surgical Safety Checklist
• Designed by one
organisation and
worked
fantastically.
• Dropped into
another
organisation –
didn’t work as well.
• Missed the ‘why’

117. So what do we tend to do
when people resist?
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: “blocker”
“resister” or “laggard”
Blame “the
management” for
not enforcing
change

118. “The single biggest problem in
communication is the illusion
that it has taken place”
George Bernard Shaw

119. • Listen and understand
• appreciate the starting point
• elaborate interests
• Roll with resistance (Singh)
• Don’t argue against it
• Encourage elaboration of resistance
• What makes it so hard?
• What would help?
• Build meaning and conviction in the change
So what SHOULD we do?

120. The Change Challenge
• Ground-breaking: the first-ever crowd-
sourced theory of change in the NHS
• 14,000 contributors to the joint campaign
to “challenge top down change”

121. 10 barriers to change
Confusing strategies
Over controlling
leadership
Perverse incentivesStifling innovation
Poor workforce
planning
One way
communication
Inhibiting
environment
Undervaluing staff
Poor project
management
Playing it safe
Source: Health Service Journal, Nursing Times, NHS
Improving Quality, “Change Challenge” March 2015

122. 11 building blocks for change
Inspiring & supportive
leadership
Collaborative working
Thought diversity
Autonomy & trust
Smart use of resources
Flexibility &
adaptability
Long term thinking
Nurturing our
people
Fostering an open
culture
A call to action
Challenging the
status quo
Source: Health Service Journal, Nursing Times, NHS
Improving Quality, “Change Challenge” March 2015

123. If your horse dies, get off it
Cherokee proverb
Source of image: fenwickgallery.co.uk

124. Coffee break.
See you at 3pm

125. Unconference session

126. Four principles and a law
Principles:
• Whoever comes are the right people
• Whatever happens is the only thing that could have
happened.
• When it starts is the right time
• When it's over it's over
The Law is known as the Law of Two Feet:
"If you find yourself in a situation where you are not
contributing or learning, move somewhere where you can."

127. Our process
• Think about a topic that you would like to
focus on for Fab Change Day and explore
with other people based on what you have
heard today
• Suggest your idea to the big group

128. Unconference: The task
• Discuss your topic and identify key actions
that should be taken
• Summarise your discussion on the sheet of
paper provided
• Write one “big idea” for an action you can
take tomorrow, within a week and within a
month