This is the presentation on “health and care radicals for large scale improvement” that Helen Bevan made at the University of Jönköping on 17th January 2014. The occasion was a mini-symposium on improvement science to celebrate Jönköping Academy’s first 5 years. Helen Bevan is Chief of Service Transformation, working in the Horizons Group at NHS Improving Quality, the national improvement body that supports the NHS in England. Follow her on Twitter @HelenBevan

1. Health and care radicals for large scale
improvement
Presentation at the mini-symposium on
improvement science to celebrate Jönköping
Academy’s first 5 years
Helen Bevan
@HelenBevan
@HelenBevan

2. Theothersidestory.co.uk
@GrangerKate
@HelenBevan

3. Emerging themes in large scale change
Dominant
Organisation
approach
Power through hierarchy
Mission and vision
Emerging
direction
Community
Power through connection
Shared purpose
Making sense through
rational argument
Making sense through
emotional connection
Leadership-driven (top
down) innovation
Viral (grass-roots
driven) creativity
Tried and tested,
based on experience
Transactions
@HelenBevan
“ Open” approaches , sharing
ideas & data, co-creating change
Relationships
Source: @HelenBevan

4. The implications for leaders
and change agents (of moving
from left to right) are
profound!
Dominant approach
Organisation
Power through hierarchy
Mission and vision
Emerging direction
Community
Power through connection
Shared purpose
Making sense through
rational argument
Making sense through
emotional connection
Leadership-driven (top
down) innovation
Viral (grass-roots
driven) creativity
Tried and tested,
based on experience
Transactions
@HelenBevan
“ Open” approaches , sharing
ideas & data, co-creating change
Relationships

5. John Kotter: “Accelerate!”
• We won’t create big change through hierarchy
on its own
• We need hierarchy AND network
• Many change agents, not just the usual few
• Changing our mindset
• From “have to” to “want to”
• Head and heart, not just head
and
@HelenBevan

6. 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
@HelenBevan

7. “If people give to a cause, they expect a
relationship, not a transaction”
Nilofer Merchant
@HelenBevan

8. “A cynic, after all,
is a passionate person
who does
not want to be
disappointed again”
Zander R and Zander B (2000) The art of
possibility. Harvard Business School Press. As
quoted by Steve Onyett
@HelenBevan

9. 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
@HelenBevan
Image by neilperkin.typepad.com

10. Across the world, the change agent
movement is exploding!
@chagww
Changeagentsworldwide.com
@rebelsatwork rebelsatwork.com
@corprebels
Corporaterebelsunited.com
@HelenBevan

11. The largest simultaneous improvement
initiative in the history of the NHS
@HelenBevan

12. Its started with a tweet!
Young clinical leaders &
improvement leaders
started to talk about how
they could improve care
Damian Roland
Stuart Sutton
Helen Bevan
@HelenBevan

13. NHS Change Day - A call to action
@HelenBevan

14. 14
@HelenBevan

15. A 189,000 pledge mountain!
15
@HelenBevan

16. People took action all over the country
5%
7%
10%
42%
10%
26%
@HelenBevan #NHSChangeDay
@PowerNHS
Bet t er Pat ient Care
Spreading I nnovat ion
Per sonal D evelopm ent
U sing ser vices effect ively
Celebr at ing Ser vices
I m plem ent ing I nt egr at ion

17. Probably the only
winner of a global
challenge to
develop leaders
in the corporate
world that names
Saul Alinsky and
Marshall Ganz as
major influencers
@HelenBevan

18. Change Day 2013 was an extraordinary moment in the history of
the NHS. It taught us that large-scale improvement is possible in
the NHS & that the best way to do it is through collective
commitment, action & by keeping it simple.
@HelenBevan

19. The largest simultaneous
improvement
initiative in the history of
the NHS
@HelenBevan

20. Source: @NHSChangeDay
@HelenBevan

21. @helenbevan #1000LivesPlus

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

23. @helenbevan
@HelenBevan

24. “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
@helenbevan
@HelenBevan

25. 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
@helenbevan
@HelenBevan

26. Sometimes organisational leaders see
radicals as troublemakers
@helenbevan
@HelenBevan
Source : Lois Kelly www.foghound.com

27. Task
• Talk to others around you about your
experiences regarding “radicals” and
“troublemakers”
• Which have you been and why?
• What moves people from being “radical” to
“troublemaker”?
• How do we protect against this?
@helenbevan
@HelenBevan

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

29. 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
@helenbevan
@HelenBevan

30. @helenbevan
@HelenBevan
Source: Foghound

31. "There’s only one corner of the
universe you can be certain of
improving, and that’s your own self."
Aldous Huxley
@helenbevan
@HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents

32. @helenbevan
@HelenBevan

33. What do we know about successful boat rockers?
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, selfefficacy and confidence
6. optimistic in the face of challenge


see opportunities
take account of obstacles
@helenbevan
@HelenBevan
Source: adapted from Debra E Meyerson

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

35. Five modules:
• 31st January: Starting from a position of
strength: change starts with me
• 7th February: Forming communities: building
alliances for change
• 14th February: Rolling with resistance
• 21st February: Making change happen
• 28th February: Moving beyond the edge
www.changeday.nhs.uk/healthcareradicals
@helenbevan
@HelenBevan

36. 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
@helenbevan
@HelenBevan