The revised slide deck from the workshop that @helenbevan and @kateslater2 led at the International Forum on Quality and Safety in Healthcare March 27th 2019

1. How to be a BRILLIANT
change agent
Source of image: @voinonen
:Kate Pound
@KateSlater2
Helen Bevan
@HelenBevan
Pete Gordon
@PeteGordon68
#Quality2019
See the slides: bit.do/BrilliantChangeAgent

3. 3 |
We will cover
• My own journey as a change agent
• Change agents need power
• Influence and superconnectors
• Rocking the boat and staying in it
• A coffee break with a difference
• Case study: emergency care
• Building shared purpose
• Change starts with me
@helenbevan @KateSlater2 #Quality2019

4. Today’s event code is…
#Quality2019
www.sli.do
Select Hall 2

5. 5 |
A poll
Do you know :
• The person to the right of you?
• The person to the left of you?
• The people on both sides?
• Neither of them?
www.sli.do

6. 6 |
Five proposed ground rules
1. we're all equal (no hierarchy)
2. Everyone participates and listens, equally
3. What is said here stays here
4. No idea is stupid
5. No topics are off the table

7. Ideas for action
Longer term actions
Adapted from www.idenk.com
What could we
speed up / do
more of ?
(Accelerate)
What could we
stop doing ?
(Brake)
What could we
start doing?
(Create)
The next 30 days The next 60 days The next 90 days

8. Change AGENCY definition:
The power, individually and collectively, to make a
positive difference. It is about pushing the
boundaries of what is possible, mobilising others
and making change happen more quickly
Change AGENT definition:
Someone who is actively developing the skills,
confidence, power, relationships and courage to
make a positive difference

9. 9 |
A poll
What is your level of brilliance (skills,
confidence & impact) as a change agent?
Brilliant
already
Not at all
brilliant

10. 10 |
My journey as a change agent:
pick three cards
2. “Where are you now (here)?”
One card for how you think and act now
3. “Where are you going (to there)?”
One card about possibilities for your future team
1. “Where are you from?”
One card that captures how you thought and
acted when you first saw yourself as a
change agent

11. 11 |
My journey as a change agent:
pick three cards
2. “Where are you now (here)?”
One card for how you think and act now
3. “Where are you going (to there)?”
One card about possibilities for your future team
1. “Where are you from?”
One card that captures how you thought and
acted when you first became a team

12. 12 |
Question: describe your journey as a
change agent in a single word or phrase

13. Transformations is
a tool for understanding key patterns in your life,
individually and together in groups, organisations and
communities.
@HelenBevan @KateSlater2 #Quality2019

14. “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

15. Starts on the fringe
Starts with the activists
Gary Hamel
always
@helenbevan @KateSlater2 #Quality2019

16. Two kinds of people at work
• Feel disconnected from purpose
• Controlled & coordinated through
performance management and
standardised procedures
• Hold back
• Resist change
• Work to a role specification
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 Compliant

17. Two kinds of people at work
• Feel connected to a higher
purpose
• Direction set through shared goals
& values (“magnetic north”)
• Collaborate
• Embrace change
• Work to who they are
The Contributor
• Feel disconnected from purpose
• Controlled & coordinated through
performance management and
standardised procedures
• Hold back
• Resist change
• Work to a role specification
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 Compliant

18. Two kinds of people at work
• Feel connected to a higher
purpose
• Direction set through shared goals
& values (“magnetic north”)
• Collaborate
• Embrace change
• Work to who they are
The Contributor
• Feel disconnected from purpose
• Controlled & coordinated through
performance management and
standardised procedures
• Hold back
• Resist change
• Work to a role specification
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 Compliant
Gallup global research:
• Only 13% of the workforce are
engaged (Contributors)
• Contributors create six times
the value to an organisation
compared to the compliant

19. What do we mean by power?
Power is the
ability to produce
intended effects
Bertrand Russell

20. Jeremy Heimens, Henry Timms New Power: How it’s changing the 21st Century and why you
need to know (2018)
new power
Current
Made by many
Pulled in
Shared
Open
Relationship
old power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction

21. The Network Secrets of Great
Change Agents
Julie Battilana &Tiziana Casciaro
As a change agent, my centrality in the
informal network is more important than
my position in the formal hierarchy

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

23. We still organise healthcare like the
Tabulating Machine Co. of 1917
Source of image: @corp_rebels

24. Find the 3%!
Just 3% of people in the organisation or
system typically influence 85% of the
other people
Source: Organisational Network Analysis by Innovisor

25. Find the 3%:
meet Mandy Carney, Head of
Patient Flow at Yeovil Hospital
• “Knows everyone in the
hospital”
• “Everyone follows Mandy on
Facebook”
• The go-to person for advice
• Mandy makes sense of things
and reduces ambiguity for
people
• Mandy presents her own
monthly award “the Carney cup”

26. 26

27. As senior leaders, we may be less
influential than we think
If we want to get the same level of influence
through top down change as the 3% get, we
need four times more people
Source : Jeppe Hansgaard

28. The 3% rule also appears true for social
media
Source: research by Graham MacKenzie using NodeXL
In health and
healthcare globally,
tweets by 3.3% of
tweeters accounted
for 85% of retweets
@helenbevan @KateSlater2

29. The powerful medical “superconnectors”
Source: NodeXL analysis @gmacscotland
@helenbevan @KateSlater2 #Quality2019

30. Rosie Skrypak, change agent at the Royal Free
Hospital

31. 1. Build relationships with the teams,
set out a shared purpose and
challenge
2. Continue to support and build
relationships – don’t forget to say well
done
3. Ripples create spread, watch it
grow!

32. Reducing in the number of patients staying in
hospital over 21 days

33. “Tomorrow’s management
systems will need to value
diversity, dissent and
divergence as highly as
conformance, consensus and
cohesion.”
Gary Hamel
@HelenBevan @KateSlater2 #Quality2019

34. 34 |
What happens to
rebels/heretics/radicals/mavericks
in organisations?
Source of image: thinglink.com
?
@helenbevan @KateSlater2 #Quality2019

35. 35 |

36. Source: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-ou

37. 37 |
We need to be boatrockers!
Source: Debra Meyerson
• Rock the boat but manage to stay in
it
• Walk the fine line between
difference and fit, inside and outside
• Conform AND rebel
• Capable of working with others to
create success NOT perceived by
others as a destructive
troublemaker
@helenbevan @KateSlater2 #Quality2019

38. Source: adapted from Rebels at Work

39. 39 |
“A cynic, after all, is a
passionate person who
does not want to be
disappointed again.”
Source of graphic: Benjamin Zander’s TED talk

40. Source of image: Tord the Meme
by Marley Bryn
The world feels
terrible if I
choose to
distrust it

41. Source: adapted from Rebels at Work

42. 42 |
Reflection
• What are your insights around “boatrocking” and “falling
out”?
• What moves people from being “boatrockers” to “falling
out”?
• How do we protect against this?

43. 43 |
A poll
Where are you now?
Rocking the
boat
Fallen
out of
the boat

44. Source: adapted from Rebels at Work

45. 45 |
More reading
Source of graphic : Umair Haque
Lois Kelly and Carmen Medina The rebel at work handbook
Harvey Schachter How to be a rebel, not a troublemaker at
work
Debra Meyerson Tempered radicals: how people use difference
to inspire change at work
Jane Watson A spotter’s guide to rebels and cynics
Umair Haque How to be more loving in a cynical world
Clark Quinn Skeptical optimist or hopeful cynic? A science
mindset
Marcella Bremer Cynicism or opticism?
@helenbevan @KateSlater2 #Quality2019

46. 46 |
Question: What are your insights or reflections
around “boatrocking” and “falling out”?

47. 47 |
Question: What are your insights or reflections
around “boatrocking” and “falling out”?

48. 48 |

49. 49 |
https://nhshorizons.passle.net/post/102fg7a/building-networks-the-power-of-randomised-coffee-trials

50. P50Number one rule of being a change agent: you can’t be
a change agent on your own: build relationships
Source:
Marshall
Ganz

51. P51

52. A big debate in social science
Structure versus Agency
@HelenBevan #LeanIsland

53. 53 |
The predominant approach in recent years has been
STRUCTURE but globally there is a big shift towards AGENCY
The design dilemma at the heart of change
Structures and
systems
Performance goals
Compliance
Regulation
Competition
Programme
Management
Incentive systems
Activation
Ability to make choices
Capability
Leaders everywhere
Social action
Solidarity
Social movements

54. The power, individually
and collectively, to
make a positive
difference
@HelenBevan #LeanIsland

55. Source: @NHSChangeDay
55

56. Source: @NHSChangeDay
56

57. Source: @NHSChangeDay
Problematic:
changing a
“permission
culture” can
take years
The good
news: we can
usually build
agency much
more quickly 57

58. 58 |
70 day challenge: to
give patients back one
million days of their
precious time that
would otherwise be
wasted in bed in a
hospital or care home.
@HelenBevan @KateSlater2 #Quality2019

59. @HelenBevan @KateSlater2 #Quality2019

60. @HelenBevan @KateSlater2 #Quality2019

62. 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 trap
Source of image:
www.biblicalcreation.org.uk
@HelenBevan @kateslater2 #Quality2019

63. + +
OUR
Who are the
people who will
be impacted by
the change?
Who will need
to be part of
the change?
SHARED
What unites
us?
PURPOSE
Why are we
taking action?
How does it
connect with
the things that
really matter to
us?

64. The
Change
Model
https://www.e
ngland.nhs.uk
/sustainablei
mprovement/
change-
model/

65. "Exploring the new world: practical insights for
funding, commissioning & managing in
complexity"
https://t.co/I9hI
UCBGaY

66. Improvement
is anchored in
purpose

67. 67 |
Don’t confuse
PURPOSE with AIM
• An aim is setting a determined course in order to
achieve a set goal. Aims determine a set course or a
target at the end that a person wants to reach
• Purpose seeks to make explicit the reason behind
something that is being done. Purpose defines why a
person is doing something she/he is doing, what there is
reasoning behind doing a particular thing and what they
plan to achieve from it

68. Purpose is the deepest dimension within us – our
central core or essence – where we have a
profound sense of who we are, where we came
from and where we’re going. Purpose is the
quality we choose to shape our lives around.
Purpose is a source of energy and direction.
Leider
The “purpose” test:
Does your proposed purpose fit
with this?

69. + +
OUR
Who are the
people who will
be impacted by
the change?
Who will need
to be part of
the change?
SHARED
What unites
us?
PURPOSE
Why are we
taking action?
How does it
connect with
the things that
really matter to
us?

70. 70

71. 71 |
Question: What is your shared purpose in a
single sentence or phrase?

72. If we want people to take action, we have to
connect with their emotions through values
action
values
emotion
Source: Marshall Ganz

73. Mark Jaben on the science behind resistance
What NOT to do
But what we do do
Engage
people here

74. Mark Jaben on the science behind resistance
What NOT to do
(but what we usually do)
We don’t need buyers (who “buy-in” to change)
We need investors
What TO do
Engage
people here
Engage
people here

75. Change starts with me

76. We are not outside of the change:
we ARE the change
Source of graphic: Reos Partners
Source of graphic: @gapingvoid
@HelenBevan @KateSlater2 #Quality2019

77. 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

78. After years of intensive analysis,
Google discovered that the key to high performing teams
that deliver change is
being nice
Project Aristotle: https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-
xoaZybvz9f0b1_6bJyG7zZO6L

79. horizonsnhs.com/school

80. 80 |
Thursday 15 March

81. 81 |
Have we got the power to change things?
Research with groups shows a 25%-10%-3% pattern:
When a minority group pushing change was below
25% of the total group, its efforts failed. But they reached 25%,
the majority of the population adopted the new way of thinking
very quickly
When just 10% of a population holds an unshakable
belief, their belief is likely to be adopted by the majority
Typically in organisations, around 3% of people (the
informal influencers) drive conversations and influence 85% of
other people. They are not typically the senior leaders
Source: Harold Jarche 2018: 25-10-3

82. 82 |
Our finale: “Snowstorm”
• Write down one key thing you have
learnt from this workshop on a
sheet of white paper

83. 83 |
Our finale: “Snowstorm”
• Write down one key thing you have
learnt from this workshop on a
sheet of white paper
• Screw the paper up

84. 84 |
Our finale: “Snowstorm”
• Write down one key thing you have
learnt from this workshop on a
sheet of white paper
• Screw the paper up
• On the signal, throw your paper
snowball in the air

85. 85 |
Our finale: “Snowstorm”
• Write down one key thing you have learnt
from this workshop on a sheet of white paper
• Screw the paper up
• On the signal, throw your paper snowball in
the air
• Pick up a snowball that lands near you and
read it aloud to the rest of your table

86. 86 |
A poll
What is your level of brilliance (skills,
confidence & impact) as a change
agent?
Brilliant
already
Not at all
brilliant