How to be a great change agent

@HelenBevan 2
1 = little experience, skill and/or confidence
10 = highly experienced, skilled & confident
What’s your starting point as a
change agent?

@HelenBevan
We are helping to
build a global
community of
change agents
Y
NEARLY
10,000
More than

@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
multiple dimensions of impact at both
individual and organisational level

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

@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

@HelenBevan
Source: @NHSChangeDay

@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

@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

@HelenBevan
Change is changing

@HelenBevan
Kinthi Sturtevant, IBM
13th annual Change Management
Conference June 2015
We rarely see two, three or four
year change projects any more.
Now it’s 30-60-90 day change
projects
11

@HelenBevan
Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
Pilots are being replaced by rapid tests and
prototypes
12

@HelenBevan
How we communicate and connect

@HelenBevan
Hierarchy AND network

@HelenBevan
Change is changing
Change is moving to
the edge

@HelenBevan
An example from the
British Cabinet Office
http://www.slideshare.net/Openpolicymaking/060715-change-cardscollated?next_slideshow=1

@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

@HelenBevan
“I have some A&E
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam

@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

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

@HelenBevan
What’s the evidence?
The failure of large scale
transformational change projects is
rarely due to the content or
structure of the plans that are put
into action
To make big change happen we need to
connect networks of people who ‘want’
to contribute, including the influencers
http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-
257163-Campaign+-+01%2F09%2F2016
Source: David Dinwoodie (2015)
It’s much more about the role
of informal networks in the
organisations/systems affected
by change

@HelenBevan
“I have some Key
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam
29

@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
is the new normal!

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

@HelenBevan
We need rebels to lead change
•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

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

@HelenBevan
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

@HelenBevan
Source : Lois Kelly www.foghound.com
There’s a big difference between a rebel and
a troublemaker
Rebel
36

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

@HelenBevan
Source : Lois Kelly www.rebelsatwork.com
There’s a big difference between a
rebel and a troublemaker
Rebel
38

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

@HelenBevan
‘I do not think you can really deal with
change without a person asking real
questions about who they are and how they
belong in the world’
David Whyte, The Heart Aroused 1994
Source of image: fistfuloftalent.com

@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 agency
 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

@HelenBevan
Change agents need 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

@HelenBevan
A big debate in social science
Structure versus Agency

@HelenBevan
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

@HelenBevan
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

@HelenBevan
Building agency: 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

@HelenBevan
Being a great change agent is about knowing, doing,
living and being improvement

@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”.

@HelenBevan
Project Aristotle: http://qz.com/625870/after-years-of-intensive-
analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/
After years of intensive analysis, Google
discovers that the key to high performing,
innovative teams is being nice

@HelenBevan
Incivility diminishes collaboration and
performance in medical settings
• People who lack a sense of psychological
safety—the feeling that the team is a trusting,
respectful and safe place to take risks—shut
down, often without realising it
• People are less likely to seek or accept
feedback, to experiment, discuss errors or
speak up
Christine Porath, Mastering Civility, a Manifesto for the
Workplace

@HelenBevan
Key tactic for change agents:
Out-love everyone else
Source of image: Bradley Burgess

@HelenBevan Source of image: sport-fitness-advisor.com
Any force that stops or
slows movement
Resistance

@HelenBevan
Why do organisational change programmes
fail to achieve their objectives?
The majority of
reported
reasons are
related to
resistance to
change
Source:
McKinsey & Co

@HelenBevanImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

@HelenBevan
‘En este muno traidor
No hay verdad ni mentira,
Que todo esta en el color
Del cristal con que se mira.’
‘In this world of many mazes
There is nothing false or true:
All depends upon the hue
Of the glass through which one gazes’.
Sixteenth-century Spanish quatrain

@HelenBevan
Let’s think about “resistance” in
old/new power terms

@HelenBevan
Let’s think about “resistance” in
old/new power terms
• Change can be planned and
managed through a rigorous
process
• Resistance is a force to
overcome
• Resistance prevents change
• Change agents must
diagnose, manage and/or
overcome resistance
• Resisters can otherwise be
known as “laggards”,
“blockers”, “in denial”

@HelenBevan
Resistance to change:
the old power mindset

@HelenBevan
A transformation programme
Source: Sewell (2015) : Stop training our project managers to be
process junkies

@HelenBevan
Old power mindset:
the role of the change agent
“The role of the change agent is to
recognise the causes of resistance and
address each one. If this is not done,
then the change will be much harder to
implement successfully and may not
succeed at all”
David Stonehouse
The change agent: the manager’s role in change
British Journal of Healthcare Management, Vol. 19, Iss. 9, 09
Sep 2013, pp 443 - 445
Source of image: Health IT Outcomes

@HelenBevan
• Change can be planned and
managed through a
rigorous process
• Resistance is a force to
overcome
• Resistance prevents change
• Change agents must
diagnose, manage and/or
overcome resistance
• Resisters can otherwise be
known as “laggards”,
“blockers”, “in denial”
• Change in human systems is
often emergent and hard to
predict
• Change results from
connections and interactions
stimulating different
viewpoints, shaping how
people think about things
• Resistance is an inevitable
consequence of a complex
change process
• Resistance should be
embraced and rolled with
Let’s think about “resistance” in old/new
power terms

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

@HelenBevan
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
‘‘

@HelenBevan
1. Create the conditions for transformational
conversations by asking questions that are focussed on
future possibilities, by inviting diversity into the system
and by being welcoming
2. Create opportunities for everyone to express their
views, spot opportunities and build on each other’s
ideas
3. Create ways for people to reflect together to find
meaning, understanding and shared purpose in the
change
Source: Peggy Holman
New power mindset:
the role of the change agent
Source of image: rachtalks.pressprestige.com

@HelenBevan
Mark Jaben on the science behind resistance
What NOT to do
But what we do do Instead of buyers (who
“buy-in”), we need investors
What TO do
Engage
people here
Engage
people here

@HelenBevan
Data and facts don’t change our minds
http://www.newyorker.com/magazine/2017/02/27/why-facts-dont-change-our-minds

@HelenBevan
Our effectiveness as change agents is not a
matter of intention; it’s a matter of impact

@HelenBevan
• Helen’s intent was to give people quick
solutions, help them do their work faster
and get on to the next problem at hand
• However, her impact was that people did
not know how to solve their own
problems so that Helen’s style was
impeding their development
Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee
Source of image: thedigitalawards.com

@HelenBevan
The best advice
Don’t assume motives
Assume a positive intent

@HelenBevan
“Stages of change”
Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)

@HelenBevan
• 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
The model is mostly used around
health-related behaviours

@HelenBevan
• 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
It works for
organisational and
service change too!
The model is mostly used around
health-related behaviours

@HelenBevan
Smoking
I am not aware my
smoking is a
problem – I have no
intention to quit

@HelenBevan
Smoking
I am not aware my
smoking is a
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet

@HelenBevan
I am not aware my
smoking is a
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
Smoking

@HelenBevan
I am not aware my
smoking is a
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
Smoking

@HelenBevan
I am not aware my
smoking is a
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking
Smoking

@HelenBevan
Transtheoretical model of behaviour change

@HelenBevan
• Which stage do most change activities in
health and care focus on?
• Which stage are most people actually at?
Some questions

@HelenBevan
The reality of our change situation
• Our tools are often not effective at the stage of change
that most people we work with are at
• It’s hard to engage people in change
• It’s hard to get people to make the changes we want
them to make
• People get irritated, defensive, irrational
• We feel powerless in our ability to lead or facilitate the
change
90% of the tools available for health and care change
agents are designed for the “action” stage

@HelenBevan
• Designed for Stage
4 – ACTION!
• Mandated it
through targets
• Despite compelling
case for change –
people often
resisted it
• People did the task
and missed the
point
Example – WHO Surgical Safety Checklist

@HelenBevan
Source: Russ et al (2015) A
Qualitative Evaluation of the
Barriers and Facilitators
Toward Implementation of the
WHO Surgical Safety Checklist
Across Hospitals in England:
Lessons From the “Surgical
Checklist Implementation
Project” Ann Surg
Source of infographic here

@HelenBevan
“In hospitals without adequate resources and efficient systems, simply
requiring the checklist to be used might not only fail to improve
patient safety but might also introduce new risks for staff and
patients. This is the exact opposite of what the checklist was designed
to achieve”.

@HelenBevan
• 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 such as
“blocker” or “resister” or “laggard”
• Blame “the management” for not
enforcing change
So what do we TEND to do when people
resist?

@HelenBevan
The single biggest problem
in communication is the
illusion that it has taken
place
George Bernard Shaw
‘‘

@HelenBevan
• Listen and understand
• appreciate the starting point
• elaborate interests
• Roll with resistance
• Don’t argue against it
• Be curious and accepting
• Encourage elaboration of resistance
• What makes it so hard?
• What would help?
• Build meaning and conviction in the change
So what SHOULD we do?
See Motivational interviewing as a change management strategy

@HelenBevan
• The focus should be on
creating awareness for me of
the need to change
• Remember the goal is not to
make me (as a
precontemplator) change
immediately, but to help me
move to contemplation
• I am not thinking about
changing my behaviours,
actions or work processes
• The problem or issue is
outside my frame of
awareness or my perceived
need

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

@HelenBevan
Focussing on Prochaska, DiClemente and
Norcross’s 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

@HelenBevan 96
1 = little experience, skill and/or confidence
10 = highly experienced, skilled & confident
Where are you now as a change
agent?

@HelenBevan
More for change agents
Session D10 or E10
“Head and heart in healthcare
improvement”

How to be a great change agent

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to How to be a great change agent

Similar to How to be a great change agent (20)

More from NHS Horizons

More from NHS Horizons (20)

Recently uploaded

Recently uploaded (20)

How to be a great change agent

Editor's Notes