Helen Bevan explains the concept of 'boat rockers' - one of the core principles at the heart of NHS Change Day

1. Rocking
the
boat
and
staying
in
it:
respiratory
leader
as
organisa3onal
radical
Helen
Bevan
Delivery
team
NHS
Improving
Quality
@helenbevan
@NHSIQ
@helenbevan

2. @helenbevan

4. How
does
it
feel
to
be
a
here0c/
radical/rebel/maverick
in
our
organisa0on?
@helenbevan

5. @helenbevan

6. What
happens
to
here0cs/radicals/
rebels/mavericks
in
organisa0ons?
@helenbevan

7. @helenbevan

8. Are
you
a
boat
rocker?
• One
who
challenges
the
status
quo
when
they
see
that
there
could
be
a
be@er
way
• Energise
their
organisa0on
by
working
from
their
true
self
• Capable
of
working
with
others
to
create
success
NOT
a
destruc0ve
troublemaker
• Walk
the
fine
line
between
difference
and
fit,
inside
and
outside,
rock
the
boat
but
manage
to
stay
in
it
@helenbevan

9. Some3mes
people
see
us
radicals
as
troublemakers
Troublemaker
Radical
Complain
Me-­‐focused
Anger
Pessimist
Energy-­‐sapping
Alienate
Problems
Alone
Create
Mission-­‐focused
Passion
Op0mist
Energy-­‐genera0ng
A@ract
Possibili0es
Together
@helenbevan
Source
:
Lois
Kelly
www.foghound.com

10. Task
• Talk
to
others
at
your
table
about
your
experiences
around
“rebels”
and
“troublemakers”
• Which
have
you
been
and
why?
• What
moves
people
from
being
“good”
to
“bad”?
• How
do
we
protect
against
this?
@helenbevan

11.
First
they
ignore
you,
then
they
laugh
at
you,
then
they
fight
you,
then
you
win
Gandhi
@helenbevan

12. Valuing
radicals
• “New
truths
begin
as
heresies”
(Huxley,
defending
Darwin’s
theory
of
natural
selec0on)
• big
things
only
happen
in
organisa0ons
because
of
here0cs
and
radicals
@helenbevan

13. @helenbevan

14. @helenbevan
Source:
Foghound

15. Four
tac3cs
for
organisa3onal
radicals
1. Start
with
myself
2. Build
alliances
3. Work
out
what
might
help
others
to
change
4. Don't
be
a
martyr
@helenbevan

16. Four
tac3cs
for
organisa3onal
radicals
1. Start
with
myself
2. Build
alliances
3. Work
out
what
might
help
others
to
change
4. Don't
be
a
martyr
@helenbevan

17.
“There
is
nothing
more
difficult
to
carry
out,
nor
more
doub9ul
of
success,
nor
more
dangerous
to
handle,
than
to
ini;ate
a
new
order
of
things.
For
the
reformer
has
enemies
in
all
those
who
profit
by
the
old
order,
and
only
lukewarm
defenders
in
all
those
who
profit
by
the
new”
Niccolo
Machiavelli
15th
century
@helenbevan

18. "There’s
only
one
corner
of
the
universe
you
can
be
certain
of
improving,
and
that’s
your
own
self."
Aldous
Huxley
@helenbevan

19. @helenbevan

20. 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
@helenbevan

21. 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
@helenbevan

22. @helenbevan
Source:
Foghound

23. @helenbevan

24. 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
organisa0on
@helenbevan

25. 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
organisa0on
§ we
cannot
find
a
way
to
be
true
to
our
values
and
commitments
and
s0ll
survive
@helenbevan

26. 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
organisa0on
§ we
cannot
find
a
way
to
be
true
to
our
values
and
commitments
and
s0ll
survive
3. stridently
challenge
the
status
quo
in
a
manner
which
is
increasingly
radical
and
self-­‐defea0ng
@helenbevan

27. 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
organisa0on
§ we
cannot
find
a
way
to
be
true
to
our
values
and
commitments
and
s0ll
survive
3. stridently
challenge
the
status
quo
in
a
manner
which
is
increasingly
radical
and
self-­‐defea0ng
§ this
just
confirms
what
we
already
know
–
that
we
don’t
belong
@helenbevan

28. What do we know about successful boat rockers?
1. convic0ons
and
values
–
driven
2. strong
sense
of
“self-­‐efficacy”
§
§
belief
that
I
am
personally
able
to
create
change
belief
in
others
3. ac0on
orientated
§
§
ignite
collec0ve
ac0on
mobilising
others,
inspiring
change
4. able
to
join
forces
with
others
§
work
as
a
collec0ve
body
for
commonly
valued
changes
5. able
to
achieve
small
wins
which
create
a
sense
of
hope,
self-­‐
efficacy
and
confidence
6. op0mis0c
in
the
face
of
challenge
§
§
see
opportuni0es
take
account
of
obstacles
@helenbevan

29. Three
assump3ons
for
organisa3onal
radicals
1. Assume
that
everyone
has
a
noble
inten0on
2. Mo0va0on
and
behaviour
in
a
change
process
are
due
to
interpersonal
interac;on
(not
just
innate
character
trait)
3. My
role
as
a
change
agent
is
about
alignment,
not
judgement
@helenbevan

30. Four
tac3cs
for
organisa3onal
radicals
1. Start
with
myself
2. Build
alliances
3. Work
out
what
might
help
others
to
change
4. Don't
be
a
martyr
@helenbevan

31. The
easiest
way
to
thrive
as
an
outlier
...is
to
avoid
being
one
Seth
Goodin
@helenbevan

32. “if
you
want
to
go
fast,
go
alone.
If
you
want
to
go
far,
go
together”
African
proverb
quoted
by
Al
Gore
@helenbevan

33. Framing
Is
the
process
by
which
leaders
construct,
ar3culate
and
put
across
their
message
in
a
powerful
and
compelling
way
in
order
to
win
people
to
their
cause
and
call
them
to
ac3on
Snow
D
A
and
Benford
R
D
(1992)
@helenbevan

34. What
do
we
need
to
do?
1. Tell
a
story
@helenbevan

35. What
do
we
need
to
do?
1. Tell
a
story
2. Make
it
personal
@helenbevan

36. What
do
we
need
to
do?
1. Tell
a
story
2. Make
it
personal
3. Be
authen0c
@helenbevan

37. 1.
2.
3.
4.
What
do
we
need
to
do?
Tell
a
story
Make
it
personal
Be
authen0c
Create
a
sense
of
“us”
(and
be
clear
who
the
“us”
is)
@helenbevan

38. 1.
2.
3.
4.
What
do
we
need
to
do?
Tell
a
story
Make
it
personal
Be
authen0c
Create
a
sense
of
“us”
(and
be
clear
who
the
“us”
is)
5. Build
in
a
call
for
urgent
ac0on
@helenbevan

39. @helenbevan

40. @helenbevan

41. @helenbevan

42. @helenbevan

43. Four
tac3cs
for
organisa3onal
radicals
1. Start
with
myself
2. Build
alliances
3. Work
out
what
might
help
others
to
change
4. Don't
be
a
martyr
@helenbevan

44. @helenbevan

45. “Stages
of
change”
Transtheore0cal
model
of
behaviour
change
@helenbevan
Prochaska,
DiClemente
&
Norcross
(1992)

46. The
model
is
mostly
used
around
health-­‐related
behaviours
•
•
•
•
•
•
•
•
•
•
smoking
cessa0on
exercise
adop0on
alcohol
and
drug
use
weight
control
fruit
and
vegetable
intake
domes0c
violence
HIV
preven0on
use
of
sunscreens
to
prevent
skin
cancer
medica0on
compliance
mammography
screening
@helenbevan

47. The
model
is
mostly
used
around
health-­‐related
behaviours
•
•
•
•
•
•
•
•
•
•
smoking
cessa0on
exercise
adop0on
alcohol
and
drug
use
weight
control
fruit
and
vegetable
intake
It
works
for
organisa3onal
and
domes0c
violence
HIV
preven0on
service
change
too!
use
of
sunscreens
to
prevent
skin
cancer
medica0on
compliance
mammography
screening
@helenbevan

48. “Stages
of
change”
Smoking
I
am
not
aware
my
smoking
is
a
problem
–
I
have
no
inten0on
to
quit
Prochaska,
DiClemente
&
Norcross
(1992)
@helenbevan

49. “Stages
of
change”
Smoking
@helenbevan
I
am
not
aware
my
smoking
is
a
problem
–
I
have
no
inten0on
to
quit
I
know
my
smoking
is
a
problem
–
I
want
to
stop
but
no
plans
yet
Prochaska,
DiClemente
&
Norcross
(1992)

50. “Stages
of
change”
Smoking
I
am
not
aware
my
smoking
is
a
problem
–
I
have
no
inten0on
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
prepara0on.
@helenbevan
Prochaska,
DiClemente
&
Norcross
(1992)

51. “Stages
of
change”
Smoking
I
have
stopped
smoking!
@helenbevan
I
am
not
aware
my
smoking
is
a
problem
–
I
have
no
inten0on
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
prepara0on.
Prochaska,
DiClemente
&
Norcross
(1992)

52. “Stages
of
change”
Smoking
I
am
con0nuing
to
not
smoke.
I
some0mes
miss
it
–
but
I
am
s0ll
not
smoking
I
have
stopped
smoking!
I
am
not
aware
my
smoking
is
a
problem
–
I
have
no
inten0on
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
prepara0on.
Prochaska,
DiClemente
&
Norcross
(1992)
@helenbevan

53. “Stages
of
change”
Smoking
I
am
con0nuing
to
not
smoke.
I
some0mes
miss
it
–
but
I
am
s0ll
not
smoking
I
have
stopped
smoking!
@helenbevan
I
am
not
aware
my
smoking
is
a
problem
–
I
have
no
inten0on
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
prepara0on.
Prochaska,
DiClemente
&
Norcross
(1992)

54. “Stages
of
change”
Transtheore0cal
model
of
behaviour
change
@helenbevan
Prochaska,
DiClemente
&
Norcross
(1992)

55. 90%
of
the
tools
available
for
healthcare
change
agents
are
designed
for
the
“ac3on”
stage
The
reality
of
our
change
situa3on
• Our
tools
are
oken
not
effec0ve
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,
irra0onal
• We
feel
powerless
in
our
ability
to
lead
or
facilitate
the
change
@helenbevan

56. Example
-­‐
Surgical
Checklist
• Designed
for
Stage
4
–
ACTION!
• Mandated
it
through
targets
• Despite
compelling
case
for
change
–
people
resisted
it
–
no
values
connec0on
• People
did
the
task
and
missed
the
point
@helenbevan

57. “One
key
issue
is
that
many
doctors
already
feel
that
they
are
delivering
pa;ent
centred
care
–
unfortunately
that
is
not
what
pa;ents
report.”
Dr
Nigel
Mathers,
Vice
Chair,
Royal
College
of
General
Prac0ce
@helenbevan

58. So
what
do
we
TEND
to
do?
• Lower
our
ambi0ons
for
improvement
• Focus
our
energies
on
those
who
are
already
in
the
“ac0on”
stage
• Put
nega0ve
labels
on
those
who
are
not
yet
at
the
ac0on
stage
such
as
“blocker”
or
“resister”
or
“laggard”
• Blame
the
leadership
for
not
enforcing
change
• Overes0mate
the
mo0va0on
of
those
who
say
they’re
ready
to
change
and
underes0mate
the
mo0va0on
of
those
who
indicate
no
interest
in
change
(Lundberg)
@helenbevan

59. So
what
SHOULD
we
do
• Listen
and
understand
• appreciate
the
star0ng
point
• elaborate
interests
• Build
meaning
and
convic0on
in
the
change
• Roll
with
resistance
(Singh)
• Don’t
argue
against
it
• Encourage
elabora0on
of
resistance
• What
makes
it
so
hard?
• What
would
help?
• Build
shared
purpose
@helenbevan

60. OutwiPed
He
drew
a
circle
that
shut
me
out
-­‐
Here0c,
rebel,
a
thing
to
flout.
But
Love
and
I
had
the
wit
to
win:
We
drew
a
circle
that
took
him
in.
Edward
Markham
@helenbevan

61. Discussion
What
might
you
do
to:
• enhance
your
own
role
as
a
respiratory
maverick,
radical
or
here0c?
• Support
other
mavericks,
radicals
or
rebels
in
your
organisa0on
or
system?
@helenbevan

62. ....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
@helenbevan

63. We
have
a
choice
“This
is
the
true
joy
of
life,
the
being
used
up
for
a
purpose
recognised
by
yourself
as
a
mighty
one,
being
a
force
of
nature
instead
of
a
feverish,
selfish
li@le
clot
of
ailments
and
grievances,
complaining
that
the
world
will
not
devote
itself
to
making
you
happy”
George
Bernard
Shaw
@helenbevan