@helenbevan
Rocking the boat and
staying in it:
respiratory leader
as organisational radical
Helen Bevan
Delivery team
NHS...
@helenbevan
@helenbevan
@helenbevan
How does it feel to be a
heretic/radical/rebel/maverick in
our organisation?
@helenbevan
@helenbevan
What happens to
heretics/radicals/rebels/mavericks
in organisations?
@helenbevan
@helenbevan
Are you a boat rocker?
• One who challenges the status
quo when they see that there
could be a better way
• En...
@helenbevan
Troublemaker Radical
Complain Create
Me-focused Mission-focused
Anger Passion
Pessimist Optimist
Energy-sappin...
@helenbevan
Task
• Talk to others at your table about your
experiences around “rebels” and
“troublemakers”
• Which have yo...
@helenbevan
First they ignore you, then they laugh at you,
then they fight you, then you win
Gandhi
@helenbevan
Valuing radicals
• “New truths begin as heresies” (Huxley, defending
Darwin’s theory of natural selection)
• b...
@helenbevan
@helenbevan Source: Foghound
@helenbevan
Four tactics for organisational radicals
1. Start with myself
2. Build alliances
3. Work out what might help o...
@helenbevan
Four tactics for organisational radicals
1. Start with myself
2. Build alliances
3. Work out what might help o...
@helenbevan
“There is nothing more
difficult to carry out, nor
more doubtful of success,
nor more dangerous to
handle, tha...
@helenbevan
"There’s only one corner of the
universe you can be certain of
improving, and that’s your own self."
Aldous Hu...
@helenbevan
@helenbevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be
fundamentally disempoweri...
@helenbevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be
fundamentally disempoweri...
@helenbevan Source: Foghound
@helenbevan
@helenbevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be
fundamentally disempoweri...
@helenbevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be
fundamentally disempoweri...
@helenbevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be
fundamentally disempoweri...
@helenbevan
What are the risks for a boat rocker?
1. Our experiences of “being different” can be
fundamentally disempoweri...
@helenbevan
1. convictions and values – driven
2. strong sense of “self-efficacy”
 belief that I am personally able to cr...
@helenbevan
Three assumptions for organisational
radicals
1. Assume that everyone has a noble intention
2. Motivation and ...
@helenbevan
Four tactics for organisational radicals
1. Start with myself
2. Build alliances
3. Work out what might help o...
@helenbevan
The easiest way to thrive as an outlier
...is to avoid being one
Seth Goodin
@helenbevan
“if you want to go fast, go alone. If you want to
go far, go together”
African proverb quoted by Al Gore
@helenbevan
Framing
Is the process by which leaders construct, articulate
and put across their message in a powerful and
c...
@helenbevan
What do we need to do?
1. Tell a story
@helenbevan
What do we need to do?
1. Tell a story
2. Make it personal
@helenbevan
What do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
@helenbevan
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 c...
@helenbevan
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 c...
@helenbevan
@helenbevan
@helenbevan
@helenbevan
@helenbevan
Four tactics for organisational radicals
1. Start with myself
2. Build alliances
3. Work out what might help o...
@helenbevan
@helenbevan
“Stages of change”
Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
@helenbevan
The model is mostly used around
health-related behaviours
• smoking cessation
• exercise adoption
• alcohol an...
@helenbevan
The model is mostly used around
health-related behaviours
• smoking cessation
• exercise adoption
• alcohol an...
@helenbevan
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I ...
@helenbevan
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I ...
@helenbevan
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I ...
@helenbevan
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I ...
@helenbevan
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I ...
@helenbevan
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I ...
@helenbevan
“Stages of change”
Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
@helenbevan
90% of the tools available for healthcare change
agents are designed for the “action” stage
The reality of our...
@helenbevan
Example - Surgical Checklist
• Designed for Stage 4
– ACTION!
• Mandated it through
targets
• Despite compelli...
@helenbevan
“One key issue is that many doctors already feel
that they are delivering patient centred care –
unfortunately...
@helenbevan
So what do we TEND to do?
• Lower our ambitions for improvement
• Focus our energies on those who are already ...
@helenbevan
So what SHOULD we do
• Listen and understand
• appreciate the starting point
• elaborate interests
• Build mea...
@helenbevan
Outwitted
He drew a circle that shut me out -
Heretic, rebel, a thing to flout.
But Love and I had the wit to ...
@helenbevan
Discussion
What might you do to:
• enhance your own role as a respiratory
maverick, radical or heretic?
• Supp...
@helenbevan
....the last era of management was about how
much performance we could extract from
people
.....the next is al...
@helenbevan
We have a choice
“This is the true joy of life, the being used up for a
purpose recognised by yourself as a mi...
Rocking the boat and staying in it
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Rocking the boat and staying in it

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Rocking the boat and staying in it: respiratory leader as organisational radical - Helen Bevan

Presented by Helen Bevan at 'Influencing and coordinating respiratory care in London': an invitation only event for current and future respiratory leaders in London.

Kings College London – Strand Campus, Friday June 28th 2013

PCRS-UK & the respiratory leaders programme – Part 1
The two PCRS-UK workshops considered different but complementary approaches to acquiring some of the essential knowledge, skills and qualities to
becoming an effective respiratory leader. In this first session Helen Bevan will inspired you to communicate your ideas and learn more effectively using innovative media
and show you how being a disruptive radical can help you and your organisation achieve better value care – a concept everybody can agree with.

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Rocking the boat and staying in it

  1. 1. @helenbevan Rocking the boat and staying in it: respiratory leader as organisational radical Helen Bevan Delivery team NHS Improving Quality @helenbevan @NHSIQ
  2. 2. @helenbevan
  3. 3. @helenbevan
  4. 4. @helenbevan How does it feel to be a heretic/radical/rebel/maverick in our organisation?
  5. 5. @helenbevan
  6. 6. @helenbevan What happens to heretics/radicals/rebels/mavericks in organisations?
  7. 7. @helenbevan
  8. 8. @helenbevan Are you a boat rocker? • One who challenges the status quo when they see that there could be a better way • Energise their organisation by working from their true self • Capable of working with others to create success NOT a destructive troublemaker • Walk the fine line between difference and fit, inside and outside, rock the boat but manage to stay in it
  9. 9. @helenbevan Troublemaker Radical Complain Create Me-focused Mission-focused Anger Passion Pessimist Optimist Energy-sapping Energy-generating Alienate Attract Problems Possibilities Alone Together Source : Lois Kelly www.foghound.com Sometimes people see us radicals as troublemakers
  10. 10. @helenbevan 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?
  11. 11. @helenbevan First they ignore you, then they laugh at you, then they fight you, then you win Gandhi
  12. 12. @helenbevan Valuing radicals • “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection) • big things only happen in organisations because of heretics and radicals
  13. 13. @helenbevan
  14. 14. @helenbevan Source: Foghound
  15. 15. @helenbevan Four tactics for organisational radicals 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Don't be a martyr
  16. 16. @helenbevan Four tactics for organisational radicals 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Don't be a martyr
  17. 17. @helenbevan “There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate 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
  18. 18. @helenbevan "There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley
  19. 19. @helenbevan
  20. 20. @helenbevan 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
  21. 21. @helenbevan 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
  22. 22. @helenbevan Source: Foghound
  23. 23. @helenbevan
  24. 24. @helenbevan 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
  25. 25. @helenbevan 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
  26. 26. @helenbevan 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
  27. 27. @helenbevan 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
  28. 28. @helenbevan 1. convictions and values – driven 2. strong sense of “self-efficacy”  belief that I am personally able to create change  belief in others 3. action orientated  ignite collective action  mobilising others, inspiring change 4. able to join forces with others  work as a collective body for commonly valued changes 5. able to achieve small wins which create a sense of hope, self- efficacy and confidence 6. optimistic in the face of challenge  see opportunities  take account of obstacles What do we know about successful boat rockers?
  29. 29. @helenbevan Three assumptions for organisational radicals 1. Assume that everyone has a noble intention 2. Motivation and behaviour in a change process are due to interpersonal interaction (not just innate character trait) 3. My role as a change agent is about alignment, not judgement
  30. 30. @helenbevan Four tactics for organisational radicals 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Don't be a martyr
  31. 31. @helenbevan The easiest way to thrive as an outlier ...is to avoid being one Seth Goodin
  32. 32. @helenbevan “if you want to go fast, go alone. If you want to go far, go together” African proverb quoted by Al Gore
  33. 33. @helenbevan 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)
  34. 34. @helenbevan What do we need to do? 1. Tell a story
  35. 35. @helenbevan What do we need to do? 1. Tell a story 2. Make it personal
  36. 36. @helenbevan What do we need to do? 1. Tell a story 2. Make it personal 3. Be authentic
  37. 37. @helenbevan 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)
  38. 38. @helenbevan 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
  39. 39. @helenbevan
  40. 40. @helenbevan
  41. 41. @helenbevan
  42. 42. @helenbevan
  43. 43. @helenbevan Four tactics for organisational radicals 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Don't be a martyr
  44. 44. @helenbevan
  45. 45. @helenbevan “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
  46. 46. @helenbevan The model is mostly used around health-related behaviours • 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
  47. 47. @helenbevan The model is mostly used around health-related behaviours • 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!
  48. 48. @helenbevan “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992) I am not aware my smoking is a problem – I have no intention to quit
  49. 49. @helenbevan “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992) 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
  50. 50. @helenbevan “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992) 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.
  51. 51. @helenbevan “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992) 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!
  52. 52. @helenbevan “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992) 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
  53. 53. @helenbevan “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992) 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
  54. 54. @helenbevan “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
  55. 55. @helenbevan 90% of the tools available for healthcare change agents are designed for the “action” stage 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
  56. 56. @helenbevan Example - Surgical Checklist • 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
  57. 57. @helenbevan “One key issue is that many doctors already feel that they are delivering patient centred care – unfortunately that is not what patients report.” Dr Nigel Mathers, Vice Chair, Royal College of General Practice
  58. 58. @helenbevan So what do we TEND to do? • 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 leadership for not enforcing change • Overestimate the motivation of those who say they’re ready to change and underestimate the motivation of those who indicate no interest in change (Lundberg)
  59. 59. @helenbevan So what SHOULD we do • Listen and understand • appreciate the starting point • elaborate interests • Build meaning and conviction in the change • Roll with resistance (Singh) • Don’t argue against it • Encourage elaboration of resistance • What makes it so hard? • What would help? • Build shared purpose
  60. 60. @helenbevan Outwitted He drew a circle that shut me out - Heretic, rebel, a thing to flout. But Love and I had the wit to win: We drew a circle that took him in. Edward Markham
  61. 61. @helenbevan Discussion What might you do to: • enhance your own role as a respiratory maverick, radical or heretic? • Support other mavericks, radicals or rebels in your organisation or system?
  62. 62. @helenbevan ....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
  63. 63. @helenbevan 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 little clot of ailments and grievances, complaining that the world will not devote itself to making you happy” George Bernard Shaw

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