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#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
A one day
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Welcome to the School for Health and Care
Radicals – a global commu...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Joining in today and beyond
• Please tweet using hashtags #SHCR and...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The Fundamental Law of Conventional
Conferences
The sum of the
expe...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Everyone has gifts and strengths
What superpower do you have?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The genesis of the
School
2002
2014
2013
2010 2012
2003
NHS Change ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Source: @NHSChangeDay
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
People who are highly connected
have twice as much power to
influen...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“New truths begin as heresies”
(Huxley, defending Darwin’s theory o...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Starts on the fringe
(at the edge)
Starts with the activists
Gary H...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
So why do we keep reinventing the past
and calling it the future?
I...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Tomorrow belongs to those who
can hear it coming
David Bowie
“ “
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
SEISMIC SHIFTS
Change from the edge
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leading change in a new era
Dominant approach Emerging direction
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leading change in a new era
Dominant approach Emerging direction
Mo...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Source: Gary Hamel
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Source:@Alfacarlo
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
John Kotter, the most influential thought leader
globally, recognis...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
John Kotter: “Accelerate!”
• We won’t create big change
through hie...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
From “have to” to “want to”
Source of image s:www.slideshare.net/me...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Managers know how to command
obedience and diligence, but most are
...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The Network Secrets of Great Change Agents
Julie Battilana &Tiziana...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Discussion
What are the implications of the
“emerging direction” fo...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
is the new normal!
“By questioning existing ideas, by
opening new f...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
We need rebels!
•The principal champion of a change initiative, cau...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What happens to
heretics/radicals/rebels/mavericks
in organisations?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton@HelenBevan
Ostracism is experienced in the brain as
deeply as physi...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
We need to be boatrockers!
• Walk the fine line between
difference ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What are the risks for a boat rocker?
1. Our experiences of “being ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#NHSChangeDay #SHCRchat
Source : Lois Kelly www.foghound.com
There’s...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Reflection
• What are your insights around “rebels” and
“troublemak...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Peter Fuda’s Transformational Change Agent
framework
Skills and met...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Peter Fuda’s Transformational Change Agent
framework: my perspectiv...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Peter Fuda’s Transformational Change Agent
framework: my perspectiv...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Change starts with me
Source of image: jasonkeath.com
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
"There’s only...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
‘I do not think you can really deal with
change without a person as...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
1. able to join forces with others to create action
2. able to achi...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Self-efficacy
There is a positive, significant
relationship between...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What’s the difference between
self efficacy
and
self esteem,
self b...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Source: @NHSChangeDay
What is the issue here?
“permission” ?
(exter...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Building self...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Being a great change agent is about knowing, doing,
living and bein...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Avedis Donabedian
“Ultimately, the secret of
quality is love.
…… If...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Key tactic :
Out-love everyone else
Source of image: Bradley Burgess
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Kinds of people at work
Adapted from The Emotional Economy http://e...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Kinds of people at work
Adapted from The Emotional Economy http://e...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Questions for reflection
1. What are the opportunities for me to bu...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
We want a wel...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What is a
RCT?
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Randomized Coffee
Trial!
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Outcomes of randomised coffee trials
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource of image: outskirtsbattledome.wikispaces.com
The easiest way ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leading change in a new era
Dominant approach Emerging direction
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonFor more information/explanation visit: http://linkis.com/www.oscarb...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Power in community
“Power used to come largely through and from big...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“When we talk of social change, we talk of
movements, a word that s...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Learning from social movement leaders
http://www.slideshare.net/NHS...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Six characteristics of people or groups within
effective social mov...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Calls to Action
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leadership is….
…the art of mobilising others
to want to struggle f...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Framing
… is the process by which leaders construct,
articulate and...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What’s the
financial incentive?
Who is
performance
managing?
What’s...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The reality
“What the leader cares about (and typically bases at
le...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“I ha...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
If we want people to take action, we have to
connect with their emo...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
But n...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
‘‘Leaders mus...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Effective framing:
what do we need to do?
1. Tell a story
2. Make i...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-
crafti...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Vivid...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Talk to the person next to you
• Tell your story about why the chan...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Harvard researchers put a gorilla image on this
lung scan
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Harvard researchers put a gorilla image on this
lung scan
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What proportion of the radiologists who
reviewed this scan actually...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
How do we cre...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Moving beyond us and them
to us and us
Source of image: www.delta7....
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The Network Secrets of Great Change Agents
Julie Battilana &Tiziana...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
strong ties (cohesive)
v.
weak ties (disconnected)
Source of image:...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
When we spread change through strong ties:
• we interact with “peop...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
When we spread change through strong ties:
• we interact with “peop...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The pros and cons of strong ties
Pros Cons
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
When we seek to spread change through weak
ties
• we build bridges ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Why we need to build weak ties AS WELL AS
strong ties
• Weak ties a...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Sources of weak ties
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Three components of a great narrative
• Diagnostic – what is the pr...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Four keys to collaboration
• Lean into your discomfort
• Listen as ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
101
http://weneedsocial.com/blog/2013/8/25/disr
upted-disruptors-un...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Source of image: http://switchandshift.com/transactional-or-
transf...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“You ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Questions for reflection
1. What learning and inspiration can you t...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Employee resistance is the
most common reason
executives cite for t...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“
Thousands of patients have died
needlessly because of a
damaging ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leaders ask their staff to be ready for change,
but do not engage e...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Resistant behaviour is a good
indicator of missing relevance
Harald...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Cultural change
is a million
subversive acts
of resistance
Brene Br...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonImage copyrigh...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-r...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandl...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandl...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandl...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandl...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandl...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandl...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Research from the sales industry:
How many NOs should we be seeking...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“Papers that are more likely to contend against
the status quo are ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“Stages of change”
Transtheoretical model of behaviour change
Proch...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• smoking cessation
• exercise adoption
• alcohol and drug use
• we...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• smoking cessation
• exercise adoption
• alcohol and drug use
• we...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
I am not aware my
smoking is a
problem – I have no
intention to qui...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
I am not aware my
smoking is a
problem – I have no
intention to qui...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Prochaska, DiClemente & Norcross (1992)
“Stages of change”
Transthe...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• Which stage do most change activities in
health and care focus on...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The reality of our change situation
• Our tools are often not effec...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• Designed for Stage 4 –
ACTION!
• Mandated it through
targets
• De...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
IN A NUTSHELL
• Evidence from observational studies that the use of...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• Lower our ambitions for improvement
• Focus our energies on those...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The single biggest problem
in communication is the
illusion that it...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• Listen and understand
• appreciate the starting point
• elaborate...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
• The focus should be on
creating awareness for me of
the need to c...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Focussing on Prochaska, DiClemente and
Norcross’s Stages of Change ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
If your horse dies,
get off it
Cherokee proverb
Source of image: fe...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source: Helen Bevan
Compliance
States a minimum performance
standar...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Leaders who
focus on meaning also
get compliance,
without focusing ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
We know that ...
• Shared purpose is a common thread in successful
...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#NHSChangeDay #SHCRchat
A 3-word concept
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
[Shar...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The power of shared purpose:
Perhaps the single most important infl...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
As leaders, we are “signal generators”
“As a leader, think of yours...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Avoiding “de facto” purpose
• What leaders pay attention to matters...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Police
@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Education
@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Healthcare
@SimonJGuilfoyle Police Inspector and systems thinker
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
....the last era of management was about how
much performance we co...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“Tomorrow’s
management systems
will need to value
diversity, dissen...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The Fundamental Law of Conventional
Conferences
The sum of the
expe...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Traditional conference
The agenda is pre-set
One way learning style...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The unconference:
4 principles and a law
Principles:
1. Whoever com...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Our process
• Think about a topic that you would like to
explore wi...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
The task
• Discuss your topic and identify key actions that
should ...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
What’s our approach to change?
Deficit based
• what is wrong?
• sol...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“Dotocracy”
• One person from each group to stand by their
place in...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
1. Follow on Twitter
@HelenBevan
@BoelGare
2. Subscribe to
3. Get m...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
www.nhsiq.nhs.uk/ImprovementFundamentals
• Delivered entirely onlin...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Come join us at #Folkslab2015
A new approach to learning and sharin...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
References and links
Baron A (2014) Preparing for a changing world:...
#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
Jarche H (2014) Moving to the edges
Kotter J (2014) Accelerate! Har...
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A one day school for health and care radicals: Minicourse M4 at International Forum on Safety and Quality in Healthcare

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These are the slides presented by Helen Bevan, Jackie Lynton and Boel Andersson Gäre for the minicourse M4 "A one day school for health and care radicals" at the International Forum on Quality and Safety in Healthcare, 21st April 2015.

Globally, more than 5,000 people have signed up for the School for Health and Care Radicals, either virtually or as a face to face learning experience. Based on connectivist learning principles, it enables change activists in health and care from across the globe to connect with each other and build the skills and confidence to rock the boat and stay it it. For further details of the school see http://www.theedge.nhsiq.nhs.uk/school/

Follow us on Twitter
@HelenBevan
@JackieLynton
@BoelGare
@School4Radicals
#SHCR

Published in: Healthcare
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A one day school for health and care radicals: Minicourse M4 at International Forum on Safety and Quality in Healthcare

  1. 1. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton A one day
  2. 2. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Welcome to the School for Health and Care Radicals – a global community of change agents • More than 5,000 change agents in health and care have taken part in The School for Health and Care Radicals • From more than 60 countries, including: Australia, Belgium, Canada, Czech Republic, Denmark, England, France, Germany, Ireland, Netherlands, New Zealand, Norway, Northern Ireland, Philippines, Saudi Arabia, Scotland, Spain, Sweden, Ukraine, United Arab Emirates, USA, Wales
  3. 3. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Joining in today and beyond • Please tweet using hashtags #SHCR and #Quality2015 and the handle @School4Radicals • Alumni from the School for Health and Care Radicals will also be joining in • We will produce summaries of the content and discussions today using Storify and Pinterest • Join our Facebook group School for Health and Care Radicals
  4. 4. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  5. 5. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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
  6. 6. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  7. 7. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  8. 8. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Everyone has gifts and strengths What superpower do you have?
  9. 9. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton The genesis of the School 2002 2014 2013 2010 2012 2003 NHS Change Day 2013 “A school for healthcare radicals” Applying social movement thinking to healthcare improvement “The School for Health and Care Radicals” “A one day school for organisational radicals” Applying community organising principles to healthcare improvement 2015
  10. 10. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source: @NHSChangeDay
  11. 11. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton People who are highly connected have twice as much power to influence change as people with hierarchical power Leandro Herrero http://t.co/Du6zCbrDBC
  12. 12. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton “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
  13. 13. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Starts on the fringe (at the edge) Starts with the activists Gary Hamel always
  14. 14. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton So why do we keep reinventing the past and calling it the future? Image used under Creative Commons licence: Kicki
  15. 15. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Tomorrow belongs to those who can hear it coming David Bowie “ “
  16. 16. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton SEISMIC SHIFTS Change from the edge
  17. 17. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Leading change in a new era Dominant approach Emerging direction
  18. 18. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Leading change in a new era Dominant approach Emerging direction Most healthcare transformation efforts are driven from this side
  19. 19. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  20. 20. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source: Gary Hamel
  21. 21. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source:@Alfacarlo
  22. 22. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton John Kotter, the most influential thought leader globally, recognises new approaches are needed FROM
  23. 23. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton John Kotter: “Accelerate!” • We won’t create big change through hierarchy on its own • We need hierarchy AND network • Many change agents, not just a few, with many acts of leadership • At least 50% buy-in required • Changing our mindset • From “have to” to “want to” TO
  24. 24. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton From “have to” to “want to” Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years- of-the-cipd-online-community
  25. 25. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Managers know how to command obedience and diligence, but most are clueless when it comes to galvanizing the sort of volunteerism that animates life on the social web. Initiative, imagination and passion can’t be commanded—they’re gifts. Gary Hamel http://www.mixmashup.org/blog/reinventing- management-mashup-architecture-ideology ‘
  26. 26. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro 1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy 2. If you want to create small scale change, work through a cohesive network If you want to create big change, create bridge networks between disconnected groups
  27. 27. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Discussion What are the implications of the “emerging direction” for the way we work as change agents?
  28. 28. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton is the new normal! “By questioning existing ideas, by opening new fields for action, change agents actually help organisations survive and adapt to the 21st Century.” Céline Schillinger Image by neilperkin.typepad.com
  29. 29. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  30. 30. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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
  31. 31. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton What happens to heretics/radicals/rebels/mavericks in organisations?
  32. 32. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  33. 33. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out
  34. 34. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton@HelenBevan Ostracism is experienced in the brain as deeply as physical pain
  35. 35. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton We need to be boatrockers! • Walk the fine line between difference and fit, inside and outside, rock the boat but manage to stay in it • Able to challenge the status quo when we see that there could be a better way • Conform AND rebel • Capable of working with others to create success NOT a destructive troublemaker Source: Debra Meyerson
  36. 36. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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 organisation  we cannot find a way to be true to our values and commitments and still survive 3. stridently challenge the status quo in a manner which is increasingly radical and self-defeating  this just confirms what we already know – that we don’t belong Source: adapted from Debra E Meyerson
  37. 37. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  38. 38. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  39. 39. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#NHSChangeDay #SHCRchat Source : Lois Kelly www.foghound.com There’s a big difference between a rebel and a troublemaker Rebel
  40. 40. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Reflection • What are your insights around “rebels” and “troublemakers”? • What moves people from being “rebel” to “troublemaker”? • How do we protect against this?
  41. 41. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Peter Fuda’s Transformational Change Agent framework Skills and methods for creating change Ability to make sense of, and reshape perceptions of ‘reality’ Personal characteristics and qualities
  42. 42. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Peter Fuda’s Transformational Change Agent framework: my perspective “Doing” • Where most change agents in health and care put most of their effort and emphasis • What others typically judge us on • What we often perceive we need to do to add value • What most change and improvement courses focus on
  43. 43. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Peter Fuda’s Transformational Change Agent framework: my perspective “Seeing ” and “Being” • We can only do effective “doing” if we build on strong foundations of “seeing and being” • Change begins with me • Hopeful futures, creative opportunities and potential • Multiple lenses for change • See myself in the context of my higher purpose
  44. 44. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Change starts with me Source of image: jasonkeath.com
  45. 45. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton "There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley Source of image: timcoffeyart.wordpress.com
  46. 46. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton ‘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
  47. 47. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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 “self-efficacy”  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
  48. 48. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Self-efficacy There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change and get good outcomes Source of image:www.h3daily.com
  49. 49. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton What’s the difference between self efficacy and self esteem, self belief, self-confidence?
  50. 50. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source: @NHSChangeDay What is the issue here? “permission” ? (externally generated) or Self efficacy ? (internally generated)
  51. 51. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Building self-efficacy: 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
  52. 52. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Being a great change agent is about knowing, doing, living and being improvement
  53. 53. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Avedis Donabedian “Ultimately, the secret of quality is love. …… If you have love, you can then work backward to monitor and improve the system”.
  54. 54. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Key tactic : Out-love everyone else Source of image: Bradley Burgess
  55. 55. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Kinds of people at work Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the- winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/ The Contributors The Compliant The Contras
  56. 56. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Kinds of people at work Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the- winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/ The Contributors The Compliant The Contras Gallup global research: • Only 13% of the workforce are engaged (Contributors) • Contributors create six times the value to an organisation compared to the Compliant http://www.gallup.com/poll/165269/wor ldwide-employees-engaged-work.aspx
  57. 57. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Questions for reflection 1. What are the opportunities for me to build my perspectives and skills as an agent of change? 2. How can I build self efficacy as a change agent? 3. How do I move beyond skills and knowledge of change to live and be change? 4. Who can help and support me as a change agent? 5. What are the implications for the way I work?
  58. 58. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton We want a welcoming Sweden. FIKA for everyone!
  59. 59. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  60. 60. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton What is a RCT?
  61. 61. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Randomized Coffee Trial!
  62. 62. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Outcomes of randomised coffee trials
  63. 63. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource of image: outskirtsbattledome.wikispaces.com The easiest way to thrive as an outlier ...is to avoid being one Seth Goodin
  64. 64. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Leading change in a new era Dominant approach Emerging direction
  65. 65. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonFor more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW
  66. 66. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Power in community “Power used to come largely through and from big institutions. Today power can and does come from connected individuals in community. When community invests in an idea, it co-owns its success. Source of image: orton.org Instead of trying to achieve scale all by ourselves, we have a new way to have scale. Scale can be in, with and through community.” Nilofer Merchant
  67. 67. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton “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
  68. 68. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Learning from social movement leaders http://www.slideshare.net/NHSIQ/the-power-of-one-the-power-of- many?qid=97bb3464-07c2-4883-9531-c3d436a66aa1&v=qf1&b=&from_search=2
  69. 69. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  70. 70. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Six characteristics of people or groups within effective social movements 1. They share a sense of PURPOSE: There is purposefulness about collaborations, discussions, actions, decisions and a sense of forward momentum 2. They are UNITED: They have learned to manage their differences well enough that they can unite to accomplish their purpose. Differences are openly debated, discussed, and resolved. 3. They share UNDERSTANDING: There is a widely shared understanding of what's going on, what the challenges are and why what is being done has to be done 4. People PARTICIPATE: Lots of people and organisations in the system are active - not just in discussions and meetings, but getting the work done. 5. They take INITIATIVE: Rather than reacting to whatever happens in their environment, they are proactive, and act upon their environment. 6. They ACT: People do the work they must do to make the things happen that need to happen Source: adapted from Wellstone Action
  71. 71. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Calls to Action
  72. 72. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Leadership is…. …the art of mobilising others to want to struggle for shared aspirations Jim Kouzes Source of image: environmentvictoria.org.au
  73. 73. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Framing … is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action. Snow D A and Benford R D (1992)
  74. 74. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton What’s the financial incentive? Who is performance managing? What’s the project plan? Source: @RobertVarnam
  75. 75. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton The reality “What the leader cares about (and typically bases at least 80% of his or her message to others on) does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into the change programme” Scott Keller and Carolyn Aiken (2009) The Inconvenient Truth about Change Management Source of image: swedenbourg-openlearning.org.uk
  76. 76. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton “I have some Key Performance Indicators for you” or “I have a dream” Source: @RobertVarnam
  77. 77. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton If we want people to take action, we have to connect with their emotions through values action values emotion Source: Marshall Ganz
  78. 78. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  79. 79. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton But not all emotions are equal......... inertiaurgency anger apathy solidarity isolation you can make a difference Self-doubt hope fear Overcomes Action motivators Action inhibitors Source: Marshall Ganz
  80. 80. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton ‘‘Leaders must wake people out of inertia. They must get people excited about something they’ve never seen before, something that does not yet exist” Rosa Beth Moss Kanter Source of image: www.linkedin.com/company/activate-brand-agency
  81. 81. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Effective framing: what do we need to do? 1. Tell a story 2. Make it personal 3. Be authentic 4. Create a sense of “us” (and be clear who the “us” is) 5. Build in a call for urgent action Source of image: woccdoc.org
  82. 82. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk- crafting-visual-stories-with-data?sf3881865=1
  83. 83. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Vivid details Source: Marshall Ganz
  84. 84. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Talk to the person next to you • Tell your story about why the change you are involved in now is so important to you • Relate it to a personal experience You have: • 2 minutes to prepare your story • 3 minutes each to tell your story
  85. 85. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Harvard researchers put a gorilla image on this lung scan
  86. 86. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Harvard researchers put a gorilla image on this lung scan
  87. 87. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton What proportion of the radiologists who reviewed this scan actually saw the gorilla? 90% 25% 17% 80% 9% 60%
  88. 88. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton How do we create a sense of “us” to build momentum for change? Source of image: www.tannerfriedman.com
  89. 89. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Moving beyond us and them to us and us Source of image: www.delta7.com
  90. 90. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro 1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy 2. If you want to create small scale change, work through a cohesive network If you want to create big change, create bridge networks between disconnected groups
  91. 91. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton strong ties (cohesive) v. weak ties (disconnected) Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml
  92. 92. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton When we spread change through strong ties: • we interact with “people like us”, with the same life experiences, beliefs and values • Change is “peer to peer”; GP to GP, social worker to social worker, nurse to nurse, community leader to community leader • Influence is spread through people who are strongly connected to each other, like and trust each other
  93. 93. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton When we spread change through strong ties: • we interact with “people like us”, with the same life experiences, beliefs and values • Change is “peer to peer”; GP to GP, social worker to social worker, nurse to nurse, community leader to community leader • Influence is spread through people who are strongly connected to each other, like and trust each other IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied
  94. 94. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton The pros and cons of strong ties Pros Cons
  95. 95. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton When we seek to spread change through weak ties • we build bridges between groups and individuals who were previously different and separate • we create relationships based not on pre- existing similarities but on common purpose and commitments that people make to each other to take action • We can mobilise all the resources in our organisation, system or community to help achieve our goals
  96. 96. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Why we need to build weak ties AS WELL AS strong ties • Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers • In situations of uncertainty, we have a tendency to revert to our strong tie relationships  yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity • The most breakthrough innovations and most radical change will come when we tap into our weak
  97. 97. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Sources of weak ties
  98. 98. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Three components of a great narrative • Diagnostic – what is the problem that we are addressing? What is the extent of the problem? What is the specific source or sources? • Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan? • Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of our audience? Source: Benford and Snow Source of image: www.ecommercedefense.com
  99. 99. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Four keys to collaboration • Lean into your discomfort • Listen as an ally • State your intent • Share your “street corner” Source: Judith Katz and Fred Miller
  100. 100. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  101. 101. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 101 http://weneedsocial.com/blog/2013/8/25/disr upted-disruptors-unite
  102. 102. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source of image: http://switchandshift.com/transactional-or- transformational-which-leadership-style-is-best
  103. 103. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton “You don’t need an engine when you have wind in your sails”
  104. 104. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Questions for reflection 1. What learning and inspiration can you take from social movement leaders to help you in your role as an agent of change in health and care? 2. How will you attract the attention of the people you want to call to action? 3. Who are the people who are currently disconnected that you want to unite in order to achieve your goal for change? How can you build a sense of “us” with them?
  105. 105. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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 Source of image: Businessconjunctions.com
  106. 106. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton “ Thousands of patients have died needlessly because of a damaging reluctance amongst doctors and the public to accept changes in the NHS, according to the country’s top emergency doctor “
  107. 107. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........ Sensemaking is not done via marketing...or slogans but by emotional connection with employees Ron Weil
  108. 108. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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 ‘‘
  109. 109. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Cultural change is a million subversive acts of resistance Brene Brown Source of image: zazzle.com ‘‘
  110. 110. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
  111. 111. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  112. 112. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  113. 113. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  114. 114. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  115. 115. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  116. 116. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  117. 117. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively Make it a personal PERFORMANCE target.
  118. 118. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  119. 119. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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 fifth to twelfth contact Source: http://www.slideshare.net/bryandaly/go-for-no
  120. 120. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton “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,” Science, doi:10.1126/science.1227833, 2012. —
  121. 121. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  122. 122. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
  123. 123. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton • 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
  124. 124. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton • 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
  125. 125. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton I am not aware my smoking is a problem – I have no 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 “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  126. 126. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton I am not aware my smoking is a problem – I have no 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 “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  127. 127. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Prochaska, DiClemente & Norcross (1992) “Stages of change” Transtheoretical model of behaviour change
  128. 128. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton • Which stage do most change activities in health and care focus on? • Which stage are most people actually at? Some questions
  129. 129. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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
  130. 130. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton • Designed for Stage 4 – ACTION! • Mandated it through targets • Despite compelling case for change – people resisted it – no values connection • People did the task and missed the point Example – WHO Surgical Safety Checklist
  131. 131. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton IN A NUTSHELL • Evidence from observational studies that the use of surgical safety checklists results in striking improvements in outcomes • Led to rapid adoption of such checklists worldwide • Researchers studied effect of mandatory adoption of checklists in Ontario, Canada • Use of checklists not associated with significant reductions in operative mortality or complications
  132. 132. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton • 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?
  133. 133. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton The single biggest problem in communication is the illusion that it has taken place George Bernard Shaw ‘‘
  134. 134. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton • 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?
  135. 135. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton • 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
  136. 136. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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
  137. 137. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton If your horse dies, get off it Cherokee proverb Source of image: fenwickgallery.co.uk ‘‘
  138. 138. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  139. 139. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Source: Helen Bevan Compliance States a minimum performance standard that everyone must achieve Uses hierarchy, systems and standard procedures for co- ordination and control Threat of penalties/ sanctions/ shame creates momentum for delivery What is our approach to change? Commitment States a collective goal that everyone can aspire to Based on shared goals, values and sense of purpose for co- ordination and control Commitment to a common purpose creates energy for delivery
  140. 140. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Leaders who focus on meaning also get compliance, without focusing on it @JeremyScrivens
  141. 141. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton We know that ... • Shared purpose is a common thread in successful change programmes* • Organisations and change initiatives with strong shared purpose consistently outperform those without it.** *What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute) **Management Agenda 2013 Boury et al (Roffey Park Institute)
  142. 142. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#NHSChangeDay #SHCRchat A 3-word concept
  143. 143. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton [Shared] purpose goes way deeper than vision and mission; it goes right into your gut and taps some part of your primal self. I believe that if you can bring people with similar primal-purposes together and get them all marching in the same direction, amazing things can be achieved. Seth Carguilo
  144. 144. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton The power of shared purpose: Perhaps the single most important influence on program response by individual units—either in promoting or resisting change—was the extent of consensus and coalition among the senior medical and nursing staff on individual ICUs…. Transforming or boosting of efforts was most likely to occur when those locally charged with implementation were sincere in their beliefs about the value of the program, were able to create transdisciplinary alliances, had local credibility among peers, were prepared to tolerate debate but exercise firmness, and used multiple tactics including role modelling, persuasion, sanctioning, reminders, and constant feedback…. [Consultant says] ‘I think it’s been successful because it’s a unifying program, it’s one of the few things that we’ve done that hasn’t been just a doctor thing, or just a nurse thing, it’s involved the doctors and the nurses together.’ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/
  145. 145. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton As leaders, we are “signal generators” “As a leader, think of yourself as a “signal generator” whose words and actions are constantly being scrutinised and interpreted, especially by those below you” [in the hierarchy] “Signal generators reduce uncertainty and ambiguity about what is important and how to act” Charles O’Reilly, Leaders in Difficult Times Source of image: vintage-radio.com
  146. 146. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Avoiding “de facto” purpose • What leaders pay attention to matters to staff, and consequently staff pay attention to that too • Shared purpose can easily be displaced by a “de facto” purpose:  hitting a target  reducing costs  reducing length of stay  eliminating waste  completing activities within a timescale  complying with an inspection regime • If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector
  147. 147. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton@SimonJGuilfoyle Police Inspector and systems thinker
  148. 148. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton@SimonJGuilfoyle Police Inspector and systems thinker
  149. 149. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Police @SimonJGuilfoyle Police Inspector and systems thinker
  150. 150. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Education @SimonJGuilfoyle Police Inspector and systems thinker
  151. 151. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Healthcare @SimonJGuilfoyle Police Inspector and systems thinker
  152. 152. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton ....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
  153. 153. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton “Tomorrow’s management systems will need to value diversity, dissent and divergence as highly as conformance, consensus and cohesion.” Gary Hamel Source of image: www.fastcompany.com
  154. 154. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  155. 155. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 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
  156. 156. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Traditional conference The agenda is pre-set One way learning style with Questions & Answers People sit in rows or round tables as prescribed Networking between sessions Hard to leave the session once it starts Absorbing information Unconference People set the agenda Based on discussion People sit where they want Networking the whole time Encouraged to find the right session Connecting to action Source: adapted from @BCPSQC
  157. 157. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton The unconference: 4 principles and a law Principles: 1. Whoever comes are the right people 2. Whatever happens is the only thing that could have happened. 3. When it starts is the right time 4. 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."
  158. 158. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Our process • Think about a topic that you would like to explore with other people based on what you have heard today • It should be a topic that you want to take action on over the next twelve months • Suggest your idea to the big group
  159. 159. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton The task • Discuss your topic and identify key actions that should be taken • Summarise your discussion on one sheet of flip chart • On a separate sheet of A4 paper write one “big idea” • Identify one person from your group to explain your discussion and conclusions in a “gallery” session Time available: 50 minutes
  160. 160. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton What’s our approach to change? Deficit based • what is wrong? • solve problems • identify what we need to improve • fill gaps and deficiencies Strength based • what is strong? • work with our existing assets and resources • amplify what works • “positive deviants”
  161. 161. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton “Dotocracy” • One person from each group to stand by their place in the “gallery” • Each person has four dots • We are voting for the idea that offers the best potential for radical/transformational change • You can give all your dots to one idea or one dot each to four ideas • Switch the “standing” person half way so they can vote • Time allowed 12 minutes
  162. 162. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton 1. Follow on Twitter @HelenBevan @BoelGare 2. Subscribe to 3. Get materials from The School for Health and Care Radicals: www.theedge.nhsiq.nhs.uk/school 4. Sign up to our MOOC (Massive Open Online Course) on “Improvement Fundamentals”) 5. Come to the #Folkslab on Wednesday, Thursday or Friday TheEdge.nhsiq.nhs.uk Five ways to connect! @JackieLynton @School4Radicals @TheEdgeNHS
  163. 163. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  164. 164. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton www.nhsiq.nhs.uk/ImprovementFundamentals • Delivered entirely online to study atyour own time and pace • Features live knowledge exchangeevents with experts and other participants • Gives you the tools to put improvement ideas into practice • Connect with aglobal improvement community • Free to ANYONE interested in improving health and care
  165. 165. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Come join us at #Folkslab2015 A new approach to learning and sharing. An informal guided creative process to discuss, share and design solutions to these common issues: • Improvements in Primary Care • The revolution in care for older people • Spreading change • Person-centred care • Clinical Innovation Learn more about Human Centred Design Wednesday or Thursday 11-12:30 or Friday 12-13:00 Or try a taster session Wednesday or Thursday 13-13:30
  166. 166. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
  167. 167. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton References and links Baron A (2014) Preparing for a changing world: the power of relationships Battilano J, Casciaro T (2013) The network secrets of the great change agents Harvard Business Review, July-August Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Bevan H, Fairman S (2014) The new era of thinking and practice in change and transformation, NHS Improving Quality Change Agents Worldwide (2013) Moving forward with social collaboration SlideShare Diaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontier Fuda P (2012) 15 qualities of a transformational change agent Grant, M (2014) Humanize: How people centric organisations succeed in a social world http://prezi.com/usju20i0nzhd/humanize-how-people-centric- organizations-succeed-in-a-social-world/ Hamel G (2014)Why bureaucracy must die Jarche, H (2013) Rebels on the edges
  168. 168. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton Jarche H (2014) Moving to the edges Kotter J (2014) Accelerate! Harvard Business Review Press Merchant N (2013) eleven rules for creating value in the social era Llopis G (2014) Every leader must be a change agent or face extinction Meyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BP Perkins N (2014) Bats and pizzas (agility and organisational change) Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated School for health and Care radicals (2014) www.changeday.nhs.uk/healthcareradicals Shinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadership Williams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activism Verjans S (2013) How social media changes the way we work together References and links

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