These are the slides for Module 1 of the 2016 School for Health and Care Radicals - Being a health and care radical: Change starts with me

1. #SHCR @School4Radicals
Module 1
Being a health and care radical:
Change starts with me
Supported by:
http://www.theedge.nhsiq.nhs.uk/school/
Module 1
Being a health and care radical:
Change starts with me

2. #SHCR @School4Radicals
Welcome to the School for Health and Care
Radicals
A global community of change agents
Over 7000 people have now taken part in The School
for Health and Care Radicals, from around the world,
including:
Argentina, Australia, Austria, Belgium, Brazil, Canada,
Denmark, England, France, Georgia, Germany, Greece,
India, Ireland (Republic), Italy, Netherlands, New Zealand,
Nigeria, Norway, Northern Ireland, Pakistan, Qatar, Russian
Federation, Saudi Arabia, Scotland, Singapore, Slovenia,
South Africa, Spain, Sweden, Switzerland, Thailand, Tunisia,
Ukraine, USA, Wales

3. #SHCR @School4Radicals
Make your mark!

4. #SHCR @School4Radicals
Where on earth are you?

5. #SHCR @School4Radicals
Where in the UK are you?

6. #SHCR @School4Radicals
How are you feeling today?
I’m ready to be
radical!
I’m cautiously
optimistic.
I remain
unconvinced or
sceptical.
I’m feeling
positive, let’s see
how I can make
this work!

7. #SHCR @School4Radicals
Joining in today…and beyond
• Please use the chat box to contribute continuously during the
web seminar
• Please tweet using hashtag #SHCR and the handle
@School4Radicals
• Send a request to join our Facebook group School for Health
and Care Radicals
• We will produce summaries of each module discussion using
Storify and Stella and put on the website
• Join in the #SHCR Tweetchat each Tuesday at 1900 (GMT)

8. #SHCR @School4Radicals
Study guides
Programme Study Guide:
http://www.slideshare.net/TheEdgeNHS/school-for-health-and-care-radicals-iii-
study-guide-2016?related=2
Module 1 Study Guide:
http://www.slideshare.net/TheEdgeNHS/the-school-for-health-and-
care-radical-2016-module-1-study-guide?related=1

9. #SHCR @School4Radicals
The team today
Session lead:
Helen Bevan
@HelenBevan
Learning lead:
Pip Hardy
@PilgrimPip Storyteller alumna:
Jon Bryant
@chicustard
Session chair:
Kate Pound
@kateslater2
Twitter monitor:
Olly Benson
@ollybenson
Storyteller alumna:
Wendy McIntosh
@1wenmac
Chat monitor:
Dominic Cushnan
@domcushnan

10. #SHCR @School4Radicals
Modules
4th February: Being a health and care radical:
change starts with me
11th February: Creating connections and
building communities
18th February: Rolling with resistance
25th February: Making change happen
3rd March: Moving beyond the edge

11. #SHCR @School4Radicals
School for Health and Radical Change Agents
Get certificated!

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The first 30 Day Change Challenge guide
This is our first 30 Day Change
Challenge we would like you to:-
• form a team
• agree a change to undertake as
a team
• complete the change
• review and learn
• and celebrate.

13. #SHCR @School4Radicals
Today
• Background to The School for Health and Care Radicals
• Learning processes
• Context: emerging directions in transformation and
change
• Some challenges for health and care radicals
• The difference between a radical and a troublemaker
• How to rock the boat AND stay in it
• How to thrive and survive as a radical
• Questions and call to action
Sourceofimage:www.freshnessmag.com

14. #SHCR @School4Radicals
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”
Applying
community organising
principles to
healthcare
improvement
2016
“A one day school for
organisational
radicals”

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The School has been formally evaluated by the Chartered
Institute for Personnel & Development
http://theedge.nhsiq.
nhs.uk/school/school-
evaluation/
How has the School for Health and Care
Radicals made a difference?

16. #SHCR @School4Radicals
The School has been formally evaluated by the Chartered
Institute for Personnel & Development
• Change knowledge
• Sense of purpose & motivation to improve practice
• Ability to challenge the status quo
• Rocking the boat & staying in it
• Connecting with others to build support for change
Statistically significant positive effect on
EVERY dimension of impact at both individual
and organisational level

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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

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

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Source: @NHSChangeDay

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“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

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Starts on the fringe
(at the edge)
Starts with the activists
Gary Hamel
always

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Tomorrow belongs to those
who can hear it coming
David Bowie
“

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If I put my ear down on the
railroad track, I can hear the train
coming, and we ain’t ready.
Ray Smith, former Chairman and CEO of
Bell Atlantic
Source of image: cubimention.net
“ “

25. #SHCR @School4Radicals
The Five Year Forward View
Mentions
“radical”
12 times
“transformation/transformational”
13 times
“change”
42 times

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What is happening with change?

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

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

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What is happening with change?

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Empower your staff to be the voice of the
organisation. They’ve got audience & credibility.

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What is happening with change?

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What is happening with change?

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Change from the edge
What is happening with change?

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Moving to the edge
“ Traditional R&D is no longer sufficient. Big
companies invest in innovation centers; some aim
to act like start ups, others set out to partner with
or acquire them.
Either way, innovation centers spark new ideas,
experiment faster, fail faster and gain momentum to
affect HQ and force change from the outside in”
Disruptive technology trends 2016-2018

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

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By joining The School for Health and
Care Radicals,
you are moving to the edge!

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Why go to the edge?
“ Leading from the edge brings us
into contact with a far wider range
of relationships, and in turn, this
increases our potential for diversity
in terms of thought, experience
and background. Diversity leads to
more disruptive thinking, faster
change and better outcomes.
Aylet Baron
“

39. #SHCR @School4Radicals
Jeremy Heimens TED talk “What new power looks like”
https://www.youtube.com/watch?v=j-S03JfgHEA
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship

40. #SHCR @School4Radicals
The essential flaw of quality improvement
methods
The essential flaw of [quality
improvement methodology] is
that, when implemented, it tends
to reinforce the mechanistic and
hierarchical models that are
consistent with the mental maps
of most managers.
Chris Argyris, Flawed advice and
the management trapSource of image:
www.biblicalcreation.org.uk
Read more at: http://www.slideshare.net/jurgenappelo/management-30-workout

41. #SHCR @School4Radicals
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

42. #SHCR @School4Radicals
People who are highly connected
have twice as much power to
influence change as people with
hierarchical power.
Leandro Herrero
http://t.co/Du6zCbrDBC

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Discussion
What are the implications of old vs.new
power for the way change agents work?

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Is your change process a cathedral or a bazaar?
http://www.unterstein.net/su/docs/CathBaz.pdf

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We have a lot of cathedrals
Source: Sewell (2015) : Stop training our project managers to be process junkies

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People at every level recognise that things
aren’t right
“Legacy constructs that enforce
bureaucracy through command-
and-control structures …with gated
handovers between organizational
silos are pervasive across large
organisations. These processes
were built to mitigate risk for an
environment that doesn’t exist
today.”
“With this in mind, many
organisations are looking for
ways to improve employee
participation in the
organisation’s strategy and in
turn, increase retention rates
and hold on to the great
people they’ve already
invested in. This results in a
radical shift in the existing
work constructs……”
Thoughtworks, The unfinished business of organizational transformation

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Success….depends on having an open, engaging,
and iterative process that harnesses the energies of
clinicians, patients, carers, citizens, and local
community partners including the independent and
voluntary sectors, and local government.
Sustainability and Transformation Plans

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• systematic “change
management”
• too often, leaders
prescribe outcome
and method of change
in a top-down way
• change is experienced
by people at the front
line as “have to”
(imposed) rather than
“want to” (embraced)
Change
Programmes
• everyone (including
service users and families)
can help tackle the most
challenging issues
• value diversity of thought
• connect people, ideas and
learning
• Role of formal leaders is to
create the conditions and
get out of the way
Change
Platforms
“Tear down the walls”

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“Tomorrow’s management systems
will need to value diversity, dissent
and divergence as highly as
conformance, consensus and
cohesion.”
Gary Hamel
Image by neilperkin.typepad.com
“The single biggest mistake to
avoid? Creating disruption at work.
Focus on developing relationships,
not disrupting and alienating
people. .” Peter Vander Awera on
learning from setbacks and failures
is the new normal!

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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

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

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

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55. #SHCR @School4RadicalsSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

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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

57. #SHCR @School4Radicals
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
Source: adapted from Debra E Meyerson

58. #SHCR @School4Radicals
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
Source: adapted from Debra E Meyerson

59. #SHCR @School4Radicals
Research shows the psychological distress
that comes with inauthentic behaviour
"Staying true to yourself matters, even if it is
difficult, because we notice that there is a cost
involved in straying too far from your personal
values.”
“It seems to be true that to act in accordance
with one’s own self, emotions, and values is a
fundamental aspect of well-being.”
F. Gino, Maryam Kouchaki and Adam D. Galinsky (2015) The moral virtue of
authenticity: how inauthenticity produces feelings of immorality and impurity
Psychological Science July 2015

60. #SHCR @School4Radicals

61. #SHCR @School4Radicals
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
Source: adapted from Debra E Meyerson

62. #SHCR @School4Radicals
Research shows the psychological distress
that comes with inauthentic behaviour
“it is important to note that a threat to someone’s
moral self-concept is different from other negative
states of mind such as feeling confused, disrespected,
or overwhelmed. Clear instructions, positive
feedback, and flexible hours are all undoubtedly
appreciated, but for leaders who want to keep their
employees engaged for as long as possible,
understanding their need for a positive moral self-
concept might be key.”
F. Gino, Maryam Kouchaki and Adam D. Galinsky (2015) The moral
virtue of authenticity: how inauthenticity produces feelings of
immorality and impurity Psychological Science July 2015

63. #SHCR @School4Radicals
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
Source: adapted from Debra E Meyerson

64. #SHCR @School4Radicals
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 disruptive and self-defeating
Source: adapted from Debra E Meyerson

65. #SHCR @School4Radicals
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

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

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

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

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Telling her story
Wendy McIntosh
@1wenmac

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Storyteller: Wendy McIntosh

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Change starts with me
Source of image: jasonkeath.com

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"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

74. #SHCR @School4Radicals
“The success of our actions as change-
makers does not depend on what we do or
how we do it, but on the inner place from
which we operate.”
Otto Scharmer
Leading from the emerging future

75. #SHCR @School4Radicals
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

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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

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What’s the difference between
self efficacy
and
self esteem,
self belief,
self-confidence?

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Source: @NHSChangeDay

79. #SHCR @School4Radicals
Source: @NHSChangeDay
What is the issue here?
“permission” ?
(externally generated)
or
Self efficacy ?
(internally generated)

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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

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Our awareness provides the underlying ground out of
which our thinking and doing emerge

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Avedis Donabedian
Ultimately, the secret
of quality is love.
…… If you have love,
you can then work
backward to monitor
and improve the
system.’

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Tactic for radicals:
Out-love everyone else
Source of image: Bradley Burgess

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Telling his story
Jon Bryant
@chicustard

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Share the School: set up a local group!

87. #SHCR @School4Radicals
Share the School: set up a local group!

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Calls to action from this module
• Discuss tactics for ‘rocking the boat and
staying in it’ with other radicals.
• Take part in a RCT (Randomised Coffee Trial).
• Tweet #my3words
http://chrisbrogan.com/3-words-2016/

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Take part in an RCT
What is a
RCT?

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• Randomised Coffee Trial!
• Randomised Coffee Trial!
Randomised Coffee Trial!

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Outcomes of Randomised Coffee Trials

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How to take part
• Instructions in News from Jo
• Send an email to say you want to take part in the RCT
to radicals@nhsiq.nhs.uk
• We will randomly match you with another
participant in the School for Health and Care Radicals
from anywhere in the world.
• At some time in the next four weeks, arrange to have
a conversation over Skype (or other communication
system) with a cup of coffee!

93. #SHCR @School4Radicals
Questions for reflection
• How can I build self-efficacy (the belief that
I can deliver change)
• How can I move beyond skills and knowledge
of change to ‘live and be the change’?
• What or who do I need to support my work as
a change agent?
Questions for reflection

94. #SHCR @School4Radicals
Questions for reflection
• How can I build self-efficacy (the belief that
I can deliver change)?
• How can I move beyond skills and knowledge
of change to ‘live and be the change’?
• What or who do I need to support my work as
a change agent?
Call to action

95. #SHCR @School4Radicals
Celebration and certification
Put your learning into action.
Become a certificated change agent.

96. #SHCR @School4Radicals
Next issue due out
soon!

97. #SHCR @School4Radicals
#EdgeTalks presents…
In Search of the Perfect Health System
with Mark Britnell @MarkBritnell
Webinar joining details: theedge.nhsiq.nhs.uk/events/2626-2
Friday 5th February, 2016
09:30-11:00 GMT
This free, live webinar will take you on a whistle-stop tour through the key messages
and conclusions of Mark Britnell’s experiences of having run a hospital, a health
system, a global healthcare enterprise and his own personal story as a cancer patient.
Join in the conversation on Twitter
using the hashtag #EdgeTalks

98. #SHCR @School4Radicals
Next opportunities for learning
• Next Tuesday, 9th February
1900-2000 GMT: Tweet chat #SHCR
• Next Thursday 6th February
1430-1600 GMT: Module 2:
Creating connections and building
communities

99. #SHCR @School4Radicals
Goodbye and good luck!
‘Be the change you want to see in the world.’
Goodbye and good luck!