if "Action on Accident & Emergency" was a social movemt

@HelenBevan @ActiononAandE #ActiononA&E
If Action on A&E was a
social movement…..
Helen Bevan
@HelenBevan
@ActiononAandE
#ActiononA&E

“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

What do successful social movements do?
• Define the change they want to see
• Identify the pillars of power
• Create a spectrum of allies
• Seek to attract not overpower
• Build a plan to survive victory
Source: Satell G (2017)
How to create
transformational change,
according to the world’s
most successful social
movements

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

“I have some A&E
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam

“We must act with all due alacrity
[speed/swiftness], yet also with the thoughtfulness
and seriousness of purpose appropriate to
meaningful action”
Dr Martin Luther King Jr.

14,000 contributions identified
10 barriers to change:
Confusing strategies
Over controlling
leadership
Perverse incentivesStifling innovation
Poor workforce
planning
One way
communication
Inhibiting
environment
Undervaluing staff
Poor project
management
Playing it safe
Source: Health Service Journal, Nursing Times, NHS Improving
Quality, “Change Challenge”

Front line teams get inundated with high priority
messages from leaders each day, making it
difficult for them to know what to focus on
Increasing number of messages
as information cascade through
the organisation
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-fail-
don.aspx

Front line teams get inundated with high priority
messages from leaders each day, making it difficult for
them to know what to focus on
Increasing number of messages
as information cascade through
the organisation
Don’t overload front line staff with
strategies if you want improvements
in quality and safety
http://healthaffairs.org/blog/2014/03/07/the-
dangers-of-quality-improvement-overload-insights-
from-the-field/

Identify the pillars of power

Jeremy Heimens, Henry Timms
This is New Power
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship

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

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

Create a spectrum of allies
Source of image: Greg Satell

WHO will make the change happen?
List A
• The A&E Delivery Board
• The programme sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Clinical Leads
• The Directors of
participating organisations
• The Change Facilitators
Source: adapted by Helen Bevan
from Leandro Herrera

WHO will make the change happen?
List A
• The A&E Delivery Board
• The programme sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Clinical Leads
• The Directors of
participating organisations
• The Change Facilitators
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who spread
behaviours, role model at a scale,
set mountains on fire and multiply
anything they get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
ones
Source: adapted by Helen Bevan
from Leandro Herrera

What’s the evidence?
The failure of large scale
transformational change projects
is rarely due to the content or
structure of the plans that are put
into action
http://iedp.com/articles/vertical-leadership/?utm_source=Sign-
Up.to&utm_medium=email&utm_campaign=13787-257163-Campaign+-+01%2F09%2F2016
Source: David Dinwoodie (2015)
It’s much more about the
role of informal networks in
the organisations and
systems affected by change
To make large scale change
happen we should connect
networks of people who ‘want’ to
contribute

Mark Jaben on the science behind resistance
What NOT to do
But what we do do Instead of buyers (who
“buy-in”), we need investors
What TO do
Engage
people here
Engage
people here

Seek to attract not overpower

Two kinds of people at work
• Feel connected to a higher
purpose
• Controlled & coordinated
through shared goals &
values
• Collaborate
• Embrace change
• Work to who they are
The contributors The compliant
• Feel disconnected from
purpose
through performance
management & 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/

Two kinds of people at work
• Feel connected to a higher
purpose
through shared goals &
values
• Collaborate
• Embrace change
• Work to who they are
The contributors The compliant
• Feel disconnected from
purpose
through performance
management & standardised
procedures
• Hold back
• Resist change
• Work to a role specification
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/worldwide-
employees-engaged-work.aspx

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]…..
Charles O’Reilly, Leaders in Difficult Times
Source of image:
vintage-radio.com
What leaders pay attention to
matters to staff, and
consequently staff pay attention
to that too

Shared purpose
Owned by everyone
who has a stake in the
change and
improvement we are
seeking to create
OUR
SHARED
PURPOSE
At the end of the
day, it is about
looking after
people in the way
they want to be
looked after
Director of Urgent
Care

Shared purpose or “de facto” purpose?
• hitting the four hour
target
• freeing up bed capacity
• managing demand
• reducing costs
• completing activities
within a timescale
• complying with regulators
PURPOSE
Owned by everyone
change and
improvement we are
seeking to create
OUR
SHARED
PURPOSE

Shared purpose or “de facto” purpose?
• hitting the four hour target
• freeing up bed capacity
• managing demand
• reducing costs
• completing activities within a
timescale
• complying with regulators
Source: Delivering Public Services That Work: The Vanguard
Method in the Public Sector
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
PURPOSE
Owned by everyone
change and
improvement we are
seeking to create
OUR
SHARED
PURPOSE

Change is not the goal;
the goal is the goal
Peter Fuda
Source of image:
timemanagementninja.com

New Public
Passion:
a growing
global
movement

• Did we accomplish the goal we were trying to
accomplish?
• Did our community grow stronger? (create
capacity; new power – power we didn’t have
before)
• Did individuals involved in the whole effort learn,
grow and develop their capacity to organise with
others?
How would we know if Action on A&E
was successful from a social movement
perspective?

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

• Steve Christian, Action on A&E
• Sasha Karakusevic, Horizons team
• Kathryn Perera, Horizons team
• Simon Sethi, Yeovil District Hospital NHS
Foundation
• Debbie Sorkin, The Leadership Centre

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