School for Change Agents E-learning modules transcript

1. E-Learning Module transcripts
This document contains the transcripts of the three School for Change Agents 2018 e-
learning modules.
Please note: These transcripts are based on the original scripts for the modules; which may
not exactly reflect what has been recorded.
Welcome message
Hello and welcome to the School for Change Agents 2018!
We’re really pleased you’ve joined us for this year’s School, and are choosing to be part of a
thriving community of like-minded people working hard to change the world.
The School for Change Agents is the most widely utilised, popular skill-building programme
for change in the NHS. So far, 11,000 people have taken part and external evaluation has
shown it makes a significant impact on ability to implement change at both individual and
organisational levels.
And it’s so much more. A typical School term will involve more than a million contributions,
messages and downloads. And each year, people from dozens of countries, from right across
the public and voluntary sector, participate. You’re joining a community of change agents
who are changing the world:
[Helen to give best examples from past School cohorts]We hope that the School provides an
opportunity for you to build your skills, confidence and networks, and to access new ideas
that expand your current thinking.
Think about the change to which you will apply your learning during the programme. It will
help you to ground new concepts and bring them alive with real challenges.
This Learning Portal gives you access to a rich database of content and other resources to
test and expand your knowledge. Over the course of School, three learning sessions will
open. You can use these to explore more deeply three major themes from the Main
Modules:
1. Being in the world – how change starts with me
2. Resistance and resilience; and
3. Moving from me to we: growing our communities
When you complete the School programme, you’ll be able to apply for Continuing
Professional Development points. NHS Horizons will also acknowledge you as a certified
Change Agent.

2. Module 1
Video 1
Often when we think about change in the health service we think about what we have to do,
the targets, the objectives, and how we will make it happen in terms of delivery.
Our focus is primarily on the plan for change, the doing and methods of change.
We will cover this, but when the targets become very hard to achieve, and the normal
methods and approaches won’t work then transformation is needed.
Fundamentally new ways of seeing things are needed, we have to see things differently, see
them in a new light, to make breakthroughs and find new ways forward.
Transformation also starts in a different place. It starts with me, with what I really care about
and will go an extra 100 miles to achieve! My values. It’s about who I am as a human being,
and what drives me.
And it’s about us, what we are passionate about as a community, how we connect around a
shared purpose that energises and focuses us.
As Peter Fuda says, change starts with me, we are the transformation we are working to
bring about, as role models first, and as preachers second.
Video 2
For those of us who dream about making the world a better place and transforming health
and social care; here are some of the new themes in change and Transformation.
Increasingly, traditional, hierarchical structures and being challenged by innovate, bottom-
up approaches, that rely more on connection, intuition and relationships that command,
logic and “the way things have always been done.”
Take a look at Jeremy Heimans and Henry Timms, two global political campaigners,
explaining this in a different way:
“Tetris was the number one game of the nineties; in fact the biggest game of all time. Tetris
works like old power – it is top town, literally things drop onto your head, everything fits into
neat lines and it gets faster and faster until you breakdown. Does that sound like any systems
you are aware of?
If that’s the old power world that works like Tetris –what is this? [PAUSE] Who knows what this
is? Minecraft. It’s now the second biggest game of all time. Interestingly, it is also block-based,

3. made of blocks. Minecraft, if you don’t already know it, works very differently. Minecraft starts
with an empty green field – there is literally nothing at the start of Minecraft; it is built by the
users together, bottom-up, so everything in this picture here has been built by collaborations of
users coming together to build things in this world.“
This shifting dynamic presents several challenges for those seeking to influence change.
The most effective change agents are those who have learned to manage the tension
between traditional structures and emergent ways of creating change. They are able to rock
the boat, yet stay in it.

4. Module 2
Video 1: Resistance
One phenomenon that will be familiar to everyone who has tried to make change happen is
resistance from others, it is common!
It is also normal to perceive resistance as a negative force, something to be battled with in
order to win
Let’s now start to explore different ways of thinking about resistance, and our own resilience,
so we can use it to build energy for positive change
Resistance is any force that stops or slows movement. It is inevitable… as change agents we
need to learn to expect it, and welcome it.
How we deal with ‘resistance to change’ depends on how we perceive the resistance.
Is it something negative that will get in the way of the changes that we are seeking to
implement?
Is resistance a matter of ‘difficult people’ whose views we need to overcome in order to
deliver change?
Or could resistance be a sign of ‘missing relevance’ – something to which we need to pay
attention?
What if we consider it as something that might bring a different perspective that could help
us build better change with others?
Video 2: Constancy of Purpose and Grit
The partner and complement of resistance is a constancy of purpose and grit
Being prepared and willing to take the knocks and the challenges and work through them
because the end goal deserves this!
The latest cognitive science research by Professor Angela Duckworth highlights the
importance of bringing a constancy of purpose in order to sustain change over time She calls
this grit, which she defines as perseverance and passion for long-term goals
Clearly this is a critical skillset of any effective change agent, so take a look at how you
perform on Professor Duckworth’s Grit Scale.

5. Video 3 - Resilience
Resilience can be defined as ‘the ability of an individual to adjust to adversity, maintain
equilibrium, retain some sense of control over their environment and continue to move on in
a positive manner’ (Jackson et al 2007).
Resilience Is About How You Recharge, Not How You Endure
Where sustainability aims to put the world back into balance, resilience looks for ways to
manage in an unbalanced world. It is about why things bounce back. (Andrew Zolli and Ann
Marie Healy)
This particularly matters when the organisational conditions are tough. So how do you
increase and manage your resilience?
In part, this means taking time to be kind to ourselves.
Sometimes this is simply practicing some mindfulness techniques such as sitting quietly and
breathing, or stopping to eating lunch rather than having a working lunch or none at all, or
going for a walk over lunch to get some fresh air, exercise and a break from the intensity of
doing our work.
By taking time simply to be versus do, we are building our reserves and ability to handle the
intensity of work stresses and change.
Video 4 – Resilience through others
When we think about resilience, we sometimes have a tendency to focus only on the
individual: What do I need? What helps me be healthy and happy?
There is a further dimension to resilience. That is the resilience we can build, through work, in
developing the health, wellbeing and resilience of others.
Henry Mintzberg, the great management thinker, wrote that leadership is not about making
clever decisions and doing bigger deals, least of all for personal gain.
It is about energizing other people to make good decisions and do better things.
In other words, it is about helping release the positive energy that exists naturally within
people.
It inspires more than empowers; connects more than controls; demonstrates more than
decides.
Put another way, taking responsibility for building the resilience of others may be a key way
in which we build it for ourselves.

7. Module 3
Video 1
Dr Martin Luther King spoke of “the fierce urgency of now”. There has never been more
need for urgency in healthcare improvement.
The way we deliver services at present will not enable us to achieve results at the pace and
quality needed in future.
One of our most pressing needs is to improve our understanding of people’s motivation to
make improvements.
How do we move our focus from mandating change (as something done to) to facilitating
change (as something done with)?
How can we create change that surges with energy, as an unstoppable force?
How do we mobilise all those who could and should contribute to our change efforts, not
just the powerful few?
In his book, The Heart Aroused, David Whyte wrote: “I do not think you can really deal with
change without a person asking real questions about who they are and how they belong in
the world.”
Let’s start our module by considering two great examples of social movements and see what
we can learn from the way they approached their work.
Video 2
The future of change has to be about co-producing with our staff groups, with our patients,
with our citizens, and with our communities. It’s about mobilising social action, It’s about
ceding power, it’s about theory Y, this is the way the world is going to go.
The effectiveness of the Pilot and Roll it out model for managing human change is being
questioned around the globe. There is little evidence that a successful Pilot leads to wide-
spread adoption.
The people in the Roll-out don’t have the investment, OR the engagement that the Pilot
team had, and the Pilot may not fit their context. Consequently the imposed solution simply
does not stick or work.
As John Atkinson says: “If we opened our eyes we would see the wonderful irony. Trying to
manage human change through Pilot and Roll-out has actually grown something. A
proliferation of Project Managers.”

8. So what does work? Jeremy Heimens and Henry Timms provide the ACE framework for
thinking about how to spread change in a new power world.
Let’s now find out more about ACE and apply it.
Video 3
#endPJparalysis came from a 2016 talk by Brian Dolan to staff at Nottingham University
Hospitals about his work on #last1000days.
#last1000 days is a metaphor that places patient time at the heart of care practices. For
example, based on developed nations’ statistics, if you are an 80 year old white woman, you
have 1,000 days left to live! So how many of these would you choose to spend in hospital?
Now consider the following facts about the impact of bed-days spent in a hospital:
 for every 10 days of bed-rest in hospital, the equivalent of 10 years of muscle
ageing occurs in people over 80-years old
 and any reconditioning takes twice as long
 one week of bedrest equates to 10% loss in strength, and
 for an older person this may make the difference between dependence and
independence.
Yet sometimes patients may spend an entire day in bed and receive little or no value-adding
acute care to help them get to discharge.
For example, no investigations, no assessments, and no procedures or therapeutic
interventions.
These are called Red Days which are of no value to the patient. See #red2green for more
In the discussion about this with Brian and NUH staff, Ann-Marie Riley, Deputy Chief Nurse,
asked staff what could they do to value patient time? Get more patients dressed! was the
suggestion. That evening Brian sent the following tweet:
“Nursing was born in the church and raised in the army, so leaving patients in pyjamas is
their 'uniform' #Letsfixthat”
Within a few days #Letsfixthat became #endPJparalysis and a movement was born!
NUH and Brian Nolan have had a fantastic impact through endPJparalysis, and the change
has now spread far and wide.