Presentation from IHI National Forum on Quality and Safety
Minicourse M10 How to Be a Great Change Agent
It’s tough being a change agent, particularly when other people don’t want to change. Yet big change happens in health care organizations only because of heretics: passionate people who are willing to take responsibility for change. Such individuals support organizational goals, but also want to change existing thinking and practice and improve care for patients. This session provides a toolkit for surviving and thriving as a change agent.
After this session, participants will be able to:
Identify and practice tactics for being an effective change agent
Build a toolkit of powerful approaches to enable change
Connect with and learn from other change agents
Monday 9th December Crystal Ballroom, Salon D8.30am to 4.00pm
Helen Bevan @HelenBevan
Robert Varnam @RobertVarnam
Andrew Hasler @AndrewHasler
#IHI25Forum #ChangeAgents
Part one of the three part learning inputs from The School for Health & Care Radicals, for the InPerson meeting of the Innovation Learning Network meeting on 12th May 2015, co-hosted by @CenturaHealth, @healthcareILN and @NHSIQ
These are the slides for the one day School for Health and Care Radicals that Helen Bevan ran in Vancouver on 18th February as part of the British Columbia Quality Forum, organised by the BC Patient Safety and Quality Council
Presentation from IHI National Forum on Quality and Safety
Minicourse M10 How to Be a Great Change Agent
It’s tough being a change agent, particularly when other people don’t want to change. Yet big change happens in health care organizations only because of heretics: passionate people who are willing to take responsibility for change. Such individuals support organizational goals, but also want to change existing thinking and practice and improve care for patients. This session provides a toolkit for surviving and thriving as a change agent.
After this session, participants will be able to:
Identify and practice tactics for being an effective change agent
Build a toolkit of powerful approaches to enable change
Connect with and learn from other change agents
Monday 9th December Crystal Ballroom, Salon D8.30am to 4.00pm
Helen Bevan @HelenBevan
Robert Varnam @RobertVarnam
Andrew Hasler @AndrewHasler
#IHI25Forum #ChangeAgents
Part one of the three part learning inputs from The School for Health & Care Radicals, for the InPerson meeting of the Innovation Learning Network meeting on 12th May 2015, co-hosted by @CenturaHealth, @healthcareILN and @NHSIQ
These are the slides for the one day School for Health and Care Radicals that Helen Bevan ran in Vancouver on 18th February as part of the British Columbia Quality Forum, organised by the BC Patient Safety and Quality Council
Influencer Marketing is One Percent Inspiration, Ninety Nine Percent Perspira...Gerris
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Practical Diversity: Creating Space to Be AwesomeMeri Williams
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Agung Volcano - How to communicate about it and how to bounce back even stron...www.bookgreener.com
A social media campaign to inspire travelers to come back to Bali, #iaminBaliNOW is also an opportunity for the community to come together. We received the help of an international expert in crisis communication, Jeff Chatterton who shared his tips on how to communicate so people listen !
- Webinar by Jeff Chatterton (similar to his presentation) to learn key tips on communication: http://www.onlinemeetingnow.com/register/?id=ozxf3u0vmp&
- InBaliNOW Facebook Page: https://www.facebook.com/inBaliNOW/
- Community page: think tank about the future of Bali: https://www.facebook.com/groups/575830069421468/
Here is what you can do:
- print signs #iaminBaliNOW available on our FB page and ask friends to take selfies in beautiful parts of Bali
- Join our weekly meetups to talk about the volcano
- Be creative in your communication
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For my Social Media Marketing Strategy class, Professor Jennifer Osbon tasked us to compare two brands. I decided to take a deeper look into Trump's branding compared to Clinton's branding. The numbers are quite astounding. Trump more than doubled Clinton's amount of free media. Clinton was very effective in several social media channels; however, from a strictly numbers perspective, Trump won by far. I think it will be interesting to keep a eye on how much of an impact social media branding will have on our future elections.
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How do we build inclusive environments that can not just tolerate but positively encourage diverse teams to do their best? We'll look at some practical things you can do to make things better.
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Our role as technology leaders is changing. And somehow also staying the same. Though we work in new ways – for instance using Agile & Lean – we are still trying to achieve the same thing. Our mission is to create high performing teams to deliver high quality products that help our users and organizations to succeed.
So how do we go about it? First of all, we steal the best lessons we can from psychology, management science, and other fields including sports. Then we focus on how to create an environment in which a diverse range of people can be themselves and be successful.
In this keynote we’ll take a whistle-stop tour of the relevant science, then focus on how to use it in our day-to-day – to create inclusive and effective work environments in which everyone can be awesome.
Agile improves how we work, can it also improve how we manage and develop people? A look at stealing some elements of agile, and working out how best to develop & manage people who are working with agile.
Given as a conference talk at Agile on the Beach, September 2014, in Falmouth, Cornwall.
These are the slides from Helen Bevan’s talk “ It’s time to rewrite the rules of change in health and care” to be given on 3rd September 2014 at the APAC Forum, Melbourne Australia.
The APAC Forum (1st to 3rd September 2014) is the premier healthcare conference in the Asia Pacific region. It offers innovative ideas and leading-edge solutions for clinicians, managers, policy-makers and academics seeking to deliver the highest quality healthcare with finite resources and seemingly infinite demand. More details at http://apacforum.com/
The School for Healthcare Radicals Institute for Healthcare Improvement Natio...NHS Improving Quality
The slides that Helen Bevan, Steve Fairman and Hannah wall will be using at the School for Healthcare Radicals minicourse at the IHI National Forum on 7th December 2015
"It's time to rewrite the rules of change in healthcare" - a presentation that Helen Beven, Chief Transformation Officer with the Horizons group, NHS Improving Quality, made at Yale on 10 June 2014.
This is the summary of the talk:
As leaders of health and care, we are seeking to create change in a world where the power of hierarchy is diminishing and change is happening faster and becoming more disruptive. Many of the ways we have traditionally gone about improving health and care were designed in a different mindset for a different set of circumstances and increasingly, they won't work. This means a fundamental rethink about what organisational change means; who does it (many change agents, not just a few) where it happens (increasingly 'at the edge' of organisations and the skills and mindsets that change agents need. This also means embracing disruption and 'disruptors' in our health and care organisations so that innovation happens; no longer seeking to 'overcome resistance to change' but welcoming difference, diversity and dissent as core operating principles in our approach to change. The slides end with a call to action: join the movement of health and care leaders across the world who are rewriting the rules of change and leading change from the future for different results.
Influencer Marketing is One Percent Inspiration, Ninety Nine Percent Perspira...Gerris
This is a presentation I am giving to the Elements of Communications Planning class at Georgetown a fun-filled presentation about earned media influencer marketing.
Practical Diversity: Creating Space to Be AwesomeMeri Williams
Practical tips for improving diversity & inclusion in your organisations, with a focus on creating environments in a broad variety of people can be themselves and be successful
Agung Volcano - How to communicate about it and how to bounce back even stron...www.bookgreener.com
A social media campaign to inspire travelers to come back to Bali, #iaminBaliNOW is also an opportunity for the community to come together. We received the help of an international expert in crisis communication, Jeff Chatterton who shared his tips on how to communicate so people listen !
- Webinar by Jeff Chatterton (similar to his presentation) to learn key tips on communication: http://www.onlinemeetingnow.com/register/?id=ozxf3u0vmp&
- InBaliNOW Facebook Page: https://www.facebook.com/inBaliNOW/
- Community page: think tank about the future of Bali: https://www.facebook.com/groups/575830069421468/
Here is what you can do:
- print signs #iaminBaliNOW available on our FB page and ask friends to take selfies in beautiful parts of Bali
- Join our weekly meetups to talk about the volcano
- Be creative in your communication
Donald Trump vs Hillary Clinton: a Comparison in Social Media BrandingVictor Wu
For my Social Media Marketing Strategy class, Professor Jennifer Osbon tasked us to compare two brands. I decided to take a deeper look into Trump's branding compared to Clinton's branding. The numbers are quite astounding. Trump more than doubled Clinton's amount of free media. Clinton was very effective in several social media channels; however, from a strictly numbers perspective, Trump won by far. I think it will be interesting to keep a eye on how much of an impact social media branding will have on our future elections.
Practical Diversity at Thinking Digital Women Meri Williams
How do we build inclusive environments that can not just tolerate but positively encourage diverse teams to do their best? We'll look at some practical things you can do to make things better.
Stealing Project Management Lessons from Artificial IntelligenceMeri Williams
My keynote from the Digital Project Management Summit 2014 (http://dpm2014.com/) looking at what lessons we can steal from advances in artificial intelligence, for reapplication in project management.
Modern Management: Creating Space for Everyone to Be AwesomeMeri Williams
Our role as technology leaders is changing. And somehow also staying the same. Though we work in new ways – for instance using Agile & Lean – we are still trying to achieve the same thing. Our mission is to create high performing teams to deliver high quality products that help our users and organizations to succeed.
So how do we go about it? First of all, we steal the best lessons we can from psychology, management science, and other fields including sports. Then we focus on how to create an environment in which a diverse range of people can be themselves and be successful.
In this keynote we’ll take a whistle-stop tour of the relevant science, then focus on how to use it in our day-to-day – to create inclusive and effective work environments in which everyone can be awesome.
Agile improves how we work, can it also improve how we manage and develop people? A look at stealing some elements of agile, and working out how best to develop & manage people who are working with agile.
Given as a conference talk at Agile on the Beach, September 2014, in Falmouth, Cornwall.
These are the slides from Helen Bevan’s talk “ It’s time to rewrite the rules of change in health and care” to be given on 3rd September 2014 at the APAC Forum, Melbourne Australia.
The APAC Forum (1st to 3rd September 2014) is the premier healthcare conference in the Asia Pacific region. It offers innovative ideas and leading-edge solutions for clinicians, managers, policy-makers and academics seeking to deliver the highest quality healthcare with finite resources and seemingly infinite demand. More details at http://apacforum.com/
The School for Healthcare Radicals Institute for Healthcare Improvement Natio...NHS Improving Quality
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"It's time to rewrite the rules of change in healthcare" - a presentation that Helen Beven, Chief Transformation Officer with the Horizons group, NHS Improving Quality, made at Yale on 10 June 2014.
This is the summary of the talk:
As leaders of health and care, we are seeking to create change in a world where the power of hierarchy is diminishing and change is happening faster and becoming more disruptive. Many of the ways we have traditionally gone about improving health and care were designed in a different mindset for a different set of circumstances and increasingly, they won't work. This means a fundamental rethink about what organisational change means; who does it (many change agents, not just a few) where it happens (increasingly 'at the edge' of organisations and the skills and mindsets that change agents need. This also means embracing disruption and 'disruptors' in our health and care organisations so that innovation happens; no longer seeking to 'overcome resistance to change' but welcoming difference, diversity and dissent as core operating principles in our approach to change. The slides end with a call to action: join the movement of health and care leaders across the world who are rewriting the rules of change and leading change from the future for different results.
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School for Health and Care Radicals Melbourne slide set
1. #SHCR @HelenBevan @FreerMary
A one day
Network: MConnect
Download the slides at:
http://www.slideshare.net/CarynHamburger/school-
for-health-and-care-radicals-melbourne-slide-set
2. #SHCR @HelenBevan @FreerMary
SCHOOL FOR HEALTH AND CARE
RADICALS MELBOURNE - 5
AUGUST 2015
EMAIL US FEEDBACK AT:
SHCR@DHHS.VIC.GOV.AU
OR
TWEET ABOUT THE MELBOURNE SCHOOL USING
THE HASHTAG:
#SHCR and the handle @School4Radicals
3. #SHCR @HelenBevan @FreerMary
A one day
Network: Mconnect
Download the slides at:
http://www.slideshare.net/NHSIQ/the-school-for-
health-and-care-radicals-victoria
8. #SHCR @HelenBevan @FreerMary
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
9. #SHCR @HelenBevan @FreerMary
Joining in today and beyond
• Use the network MConnect
• Please tweet using the hashtag #SHCR and the handle
@School4Radicals
• Alumni from the School for Health and Care Radicals will
also be joining in
• We will produce summaries of the content and
discussions today
• Join our Facebook group School for Health and Care
Radicals
15. #SHCR @HelenBevan @FreerMary
People who are highly connected
have twice as much power to
influence change as people with
hierarchical power
Leandro Herrero
http://t.co/Du6zCbrDBC
16. #SHCR @HelenBevan @FreerMary
“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
21. #SHCR @HelenBevan @FreerMary
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
25. #SHCR @HelenBevan @FreerMary
Research by IBM
41% of leaders considered
they were successful in
managing change
20% of leaders considered
they were successful in
managing change
Source: Jorgensen, Bruel & Franke, Making
change work….while the work keeps changing”
quoted in Foster F (2015) “Using crowdsourcing
to deliver transformational change
28. #SHCR @HelenBevan @FreerMary
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
29. #SHCR @HelenBevan @FreerMary
What does that mean?
• One foot in the system and one foot beyond
• Pulling in assets, ideas, knowledge and
connections rather than pushing them down
• Working at the edge of the existing system so
we can see the potential and make
connections that we couldn’t do if we were at
the centre
• Prepare the existing culture by embracing
pathfinders from the new culture
• Conform and rebel
31. #SHCR @HelenBevan @FreerMary
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
32. #SHCR @HelenBevan @FreerMary
The battle and balancing between the old
and new power will be a defining feature of
society and business in the coming years
Jeremy Heimans and Henry Timms
Understanding new power, Harvard Business
Review, December 2014
https://hbr.org/2014/12/understanding-
new-
power?utm_campaign=Socialflow&utm_sou
rce=Socialflow&utm_medium=Tweet
33. #SHCR @HelenBevan @FreerMary
The battle and balancing between the old
and new power will be a defining feature of
society and business in the coming years
Jeremy Heimans and Henry Timms
Understanding new power, Harvard Business
Review, December 2014
https://hbr.org/2014/12/understanding-new-
power?utm_campaign=Socialflow&utm_source=Socia
lflow&utm_medium=Tweet
The battle and balancing
between old and new
power will also be the
defining feature of the
health and care system in
the coming years
37. #SHCR @HelenBevan @FreerMary
John Kotter: “Accelerate!”
• We won’t create big change
through hierarchy on its own
• We need hierarchy AND network
• Many change agents, not just a
few, with many acts of leadership
• At least 50% buy-in required
• Changing our mindset
• From “have to” to “want to”
TO
38. #SHCR @HelenBevan @FreerMary
From “have to” to “want to”
Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-
of-the-cipd-online-community
39. #SHCR @HelenBevan @FreerMary
Managers know how to command
obedience and diligence, but most are
clueless when it comes to galvanizing the
sort of volunteerism that animates life on
the social web. Initiative, imagination and
passion can’t be commanded—they’re gifts.
Gary Hamel
http://www.mixmashup.org/blog/reinventing-
management-mashup-architecture-ideology
‘
40. #SHCR @HelenBevan @FreerMary
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
41. #SHCR @HelenBevan @FreerMary
is the new normal!
“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
43. #SHCR @HelenBevan @FreerMary
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
47. #SHCR @HelenBevan @FreerMary
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
48. #SHCR @HelenBevan @FreerMary
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
49. #SHCR @HelenBevan @FreerMary
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
52. #SHCR @HelenBevan @FreerMary
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
53. #SHCR @HelenBevan @FreerMary
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
54. #SHCR @HelenBevan @FreerMary
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
Source: adapted from Debra E Meyerson
55. #SHCR @HelenBevan @FreerMary
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
57. #SHCR @HelenBevan @FreerMary
Reflection
• What are your insights around “rebels” and
“troublemakers”?
• What moves people from being “rebel” to
“troublemaker”?
• How do we protect against this?
59. #SHCR @HelenBevan @FreerMary
Peter Fuda’s Transformational Change Agent
framework
Skills and methods for creating
change
Ability to make sense of, and reshape
perceptions of ‘reality’
Personal characteristics and
qualities
60. #SHCR @HelenBevan @FreerMary
Peter Fuda’s Transformational Change Agent
framework: my perspective
“Doing”
• Where most change agents
in health and care put most
of their effort and emphasis
• What others typically judge
us on
• What we often perceive we
need to do to add value
• What most change and
improvement courses focus
on
61. #SHCR @HelenBevan @FreerMary
Peter Fuda’s Transformational Change Agent
framework: my perspective
“Seeing ” and “Being”
• We can only do effective
“doing” if we build on strong
foundations of “seeing and
being”
• Change begins with me
• Hopeful futures, creative
opportunities and potential
• Multiple lenses for change
• See myself in the context of
my higher purpose
64. #SHCR @HelenBevan @FreerMary
"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
65. #SHCR @HelenBevan @FreerMary
‘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’
David Whyte, The Heart Aroused 1994
Source of image: fistfuloftalent.com
66. #SHCR @HelenBevan @FreerMary
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
67. #SHCR @HelenBevan @FreerMary
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
70. #SHCR @HelenBevan @FreerMary
Source: @NHSChangeDay
What is the issue here?
“permission” ?
(externally generated)
or
Self efficacy ?
(internally generated)
71. #SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
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
73. #SHCR @HelenBevan @FreerMary
Avedis Donabedian
“Ultimately, the secret of
quality is love.
…… If you have love, you
can then work backward
to monitor and improve
the system”.
75. #SHCR @HelenBevan @FreerMary
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
• Controlled & coordinated
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/
76. #SHCR @HelenBevan @FreerMary
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
• Controlled & coordinated
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/wor
ldwide-employees-engaged-work.aspx
78. #SHCR @HelenBevan @FreerMary
Questions for reflection
1. What are the opportunities for me to build my
perspectives and skills as an agent of change?
2. How can I build self efficacy as a change agent?
3. How do I move beyond skills and knowledge of
change to live and be change?
4. Who can help and support me as a change
agent?
5. What are the implications for the way I work?
79. #SHCR @HelenBevan @FreerMary
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
80. #SHCR @HelenBevan @FreerMarySource of image: outskirtsbattledome.wikispaces.com
The easiest way to thrive as an
outlier
...is to avoid being one
Seth Goodin
82. #SHCR @HelenBevan @FreerMary
Power in community
“Power used to come largely through and from big
institutions.
Today power can and does come from connected individuals
in community.
When community invests in an idea, it co-owns its success.
Source of image: orton.org
Instead of trying to
achieve scale all by
ourselves, we have a new
way to have scale. Scale
can be in, with and
through community.”
Nilofer Merchant
83. #SHCR @HelenBevan @FreerMary
“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
84. #SHCR @HelenBevan @FreerMary
Learning from social movement leaders
http://www.slideshare.net/NHSIQ/the-power-of-one-the-power-of-
many?qid=97bb3464-07c2-4883-9531-c3d436a66aa1&v=qf1&b=&from_search=2
87. #SHCR @HelenBevan @FreerMary
Leadership is….
…the art of mobilising others
to want to struggle for shared
aspirations
Jim Kouzes
Source of image: environmentvictoria.org.au
88. #SHCR @HelenBevan @FreerMary
Framing
… is the process by which leaders construct,
articulate and put across their message in a powerful
and compelling way in order to win people to their
cause and call them to action.
Snow D A and Benford R D (1992)
90. #SHCR @HelenBevan @FreerMary
The reality
“What the leader cares about (and typically bases at
least 80% of his or her message to others on) does
not tap into roughly 80% of the workforce’s primary
motivators for putting extra energy into the change
programme”
Scott Keller and Carolyn Aiken (2009)
The Inconvenient Truth about Change Management
Source of image: swedenbourg-openlearning.org.uk
91. #SHCR @HelenBevan @FreerMary
1. People speak intellectually but engage
emotionally
2. Facts are hard to remember and easy to
challenge
3. If we only talk about our success people won’t
believe us
4. People don’t want more communication; they
want meaningful communication
http://www.peterfuda.com/2014/10/30/traditional-comms-fail-engage/
Four gaps between
how we
communicate
change
how people
engage with that
communication
93. #SHCR @HelenBevan @FreerMary
If we want people to take action, we have to
connect with their emotions through values
action
values
emotion
Source: Marshall Ganz
95. #SHCR @HelenBevan @FreerMary#IQTGOLD#SCHR @HelenBevan @freermary
But not all emotions are equal.........
inertiaurgency
anger apathy
solidarity isolation
you can make a
difference
Self-doubt
hope fear
Overcomes
Action motivators Action inhibitors
Source: Marshall Ganz
96. #SHCR @HelenBevan @FreerMary
‘‘Leaders must wake people out of
inertia. They must get people excited
about something they’ve never seen
before, something that does not yet
exist”
Rosa Beth Moss Kanter
Source of image: www.linkedin.com/company/activate-brand-agency
100. #SHCR @HelenBevan @FreerMary
Effective framing:
what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
Source of image: woccdoc.org
101. #SHCR @HelenBevan @FreerMary
Effective framing:
what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us”
is)
Source of image: woccdoc.org
102. #SHCR @HelenBevan @FreerMary
Effective framing:
what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us”
is)
5. Build in a call for urgent action
Source of image: woccdoc.org
104. #SHCR @HelenBevan @FreerMary
Talk to the person next to you
• Tell your story about why the change you are
involved in now is so important to you
• Relate it to a personal experience
You have:
• 2 minutes to prepare your story
• 3 minutes each to tell your story
107. #SHCR @HelenBevan @FreerMary
What proportion of the radiologists who
reviewed this scan actually saw the gorilla?
90%
25% 17%
80%
9%
60%
108. #SHCR @HelenBevan @FreerMary
What proportion of the radiologists who
reviewed this scan actually saw the gorilla?
90%
25% 17%
80%
9%
60%
http://www.npr.org/blogs/health/2013/02/11/171409656/why-even-radiologists-can-
miss-a-gorilla-hiding-in-plain-sight
109. #SHCR @HelenBevan @FreerMary
How do we create a sense of
“us” to build momentum for
change?
Source of image: www.tannerfriedman.com
111. #SHCR @HelenBevan @FreerMary
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
112. #SHCR @HelenBevan @FreerMary
strong ties (cohesive)
v.
weak ties (disconnected)
Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml
113. #SHCR @HelenBevan @FreerMary
When we spread change through strong ties:
• we interact with “people like us”, with
the same life experiences, beliefs and
values
• Change is “peer to peer”; GP to GP,
social worker to social worker, nurse to
nurse, community leader to
community leader
• Influence is spread through people
who are strongly connected to each
other, like and trust each other
114. #SHCR @HelenBevan @FreerMary
When we spread change through strong ties:
• we interact with “people like us”, with
the same life experiences, beliefs and
values
• Change is “peer to peer”; GP to GP,
social worker to social worker, nurse to
nurse, community leader to
community leader
• Influence is spread through people
who are strongly connected to each
other, like and trust each other
IT WORKS BECAUSE: people are far
more likely to be influenced to
adopt new behaviours or ways of
working from those with whom they
are most strongly tied
116. #SHCR @HelenBevan @FreerMary
When we seek to spread change through weak
ties
• we build bridges between groups and
individuals who were previously different and
separate
• we create relationships based not on pre-
existing similarities but on common purpose
and commitments that people make to each
other to take action
• We can mobilise all the resources in our
organisation, system or community to help
achieve our goals
117. #SHCR @HelenBevan @FreerMary
Why we need to build weak ties AS WELL AS
strong ties
• Weak ties are more likely to lead to change at scale
because they enable us to access more people with
fewer barriers
More on weak ties: https://www.youtube.com/watch?v=w7AzRVxhEXA#t=45
118. #SHCR @HelenBevan @FreerMary
Why we need to build weak ties AS WELL AS
strong ties
• Weak ties are more likely to lead to change at scale
because they enable us to access more people with
fewer barriers
• In situations of uncertainty, we have a tendency to
revert to our strong tie relationships
yet the evidence tells us that weak ties are
much more important than strong ties when it
comes to searching out resources in times of
scarcity
119. #SHCR @HelenBevan @FreerMary
Why we need to build weak ties AS WELL AS
strong ties
• Weak ties are more likely to lead to change at scale
because they enable us to access more people with
fewer barriers
• In situations of uncertainty, we have a tendency to
revert to our strong tie relationships
yet the evidence tells us that weak ties are
much more important than strong ties when it
comes to searching out resources in times of
scarcity
• The most breakthrough innovations and most
radical change will come when we tap into our weak
121. #SHCR @HelenBevan @FreerMary
Three components of a great narrative
• Diagnostic – what is the problem that
we are addressing? What is the extent
of the problem? What is the specific
source or sources?
• Prognostic – what could the future look
like? What is our “plan of attack” and
our strategy for carrying out the plan?
• Motivational – why is this urgent?
What is our call for action that
connects with the motivational and
emotional drivers of our audience?
Source: Benford and Snow
Source of image: www.ecommercedefense.com
122. #SHCR @HelenBevan @FreerMary
Four keys to collaboration
• Lean into your discomfort
• Listen as an ally
• State your intent
• Share your “street corner”
Source: Judith Katz and Fred Miller
124. #SHCR @HelenBevan @FreerMary
Four keys to collaboration
• Lean into your discomfort
• Listen as an ally
• State your intent
• Share your “street corner”
Source: Judith Katz and Fred Miller
128. #SHCR @HelenBevan @FreerMary
Questions for reflection
1. What learning and inspiration can you take
from social movement leaders to help you in
your role as an agent of change in health and
care?
2. How will you attract the attention of the people
you want to call to action?
3. Who are the people who are currently
disconnected that you want to unite in order to
achieve your goal for change? How can you
build a sense of “us” with them?
129. #SHCR @HelenBevan @FreerMary
Employee resistance is the
most common reason
executives cite for the
failure of big
organizational-change
efforts
Scott Keller and Colin Price
(2011), Beyond Performance: How
Great Organizations Build Ultimate
Competitive Advantage
Source of image:
Businessconjunctions.com
130. #SHCR @HelenBevan @FreerMary
“
Thousands of patients have died
needlessly because of a
damaging reluctance amongst
doctors and the public to accept
changes in the NHS, according to
the country’s top emergency
doctor
“
131. #SHCR @HelenBevan @FreerMary
Leaders ask their staff to be ready for change,
but do not engage enough in
sensemaking........
Sensemaking is not done via marketing...or
slogans but by emotional connection with
employees
Ron Weil
132. #SHCR @HelenBevan @FreerMary
Resistant behaviour is a good
indicator of missing relevance
Harald Schirmer
http://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-
role-of-hr-driving-social-adoption-and-change-in-the-enterprise
Source of image: driverlayer.com
‘‘
141. #SHCR @HelenBevan @FreerMarySource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal
PERFORMANCE target.
143. #SHCR @HelenBevan @FreerMary
Research from the sales industry:
How many NOs should we be seeking to get?
• 2% of sales are made on the first contact
• 3% of sales are made on the second contact
• 5% of sales are made on the third contact
• 10% of sales are made on the fourth contact
• 80% of sales are made on the fifth to twelfth
contact
Source: http://www.slideshare.net/bryandaly/go-for-no
144. #SHCR @HelenBevan @FreerMary
“Papers that are more likely to contend against
the status quo are more likely to find an
opponent in the review system—and thus be
rejected —but those papers are also more
likely to have an impact on people across the
system, earning them more citations when
finally published”
V. Calcagno et al., “Flows of research manuscripts among
scientific journals reveal hidden submission patterns,”
Science, doi:10.1126/science.1227833, 2012.
—
147. #SHCR @HelenBevan @FreerMary
• smoking cessation
• exercise adoption
• alcohol and drug use
• weight control
• fruit and vegetable intake
• domestic violence
• HIV prevention
• use of sunscreens to prevent skin cancer
• medication compliance
• mammography screening
The model is mostly used around
health-related behaviours
148. #SHCR @HelenBevan @FreerMary
• smoking cessation
• exercise adoption
• alcohol and drug use
• weight control
• fruit and vegetable intake
• domestic violence
• HIV prevention
• use of sunscreens to prevent skin cancer
• medication compliance
• mammography screening
It works for
organisational and
service change too!
The model is mostly used around
health-related behaviours
149. #SHCR @HelenBevan @FreerMary
“Stages of change”
Smoking
I am not aware my
smoking is a
problem – I have no
intention to quit
Prochaska, DiClemente & Norcross (1992)
150. #SHCR @HelenBevan @FreerMary
“Stages of change”
Smoking
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
Prochaska, DiClemente & Norcross (1992)
151. #SHCR @HelenBevan @FreerMary
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
152. #SHCR @HelenBevan @FreerMary
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
153. #SHCR @HelenBevan @FreerMary
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
154. #SHCR @HelenBevan @FreerMary
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
156. #SHCR @HelenBevan @FreerMary
• Which stage do most change activities in
health and care focus on?
• Which stage are most people actually at?
Some questions
157. #SHCR @HelenBevan @FreerMary
The reality of our change situation
• Our tools are often not effective at the stage of change
that most people we work with are at
• It’s hard to engage people in change
• It’s hard to get people to make the changes we want
them to make
• People get irritated, defensive, irrational
• We feel powerless in our ability to lead or facilitate the
change
90% of the tools available for health and care change
agents are designed for the “action” stage
158. #SHCR @HelenBevan @FreerMary
• Designed for Stage 4 –
ACTION!
• Mandated it through
targets
• Despite compelling
case for change –
people resisted it – no
values connection
• People did the task
and missed the point
Example – WHO Surgical Safety Checklist
159. #SHCR @HelenBevan @FreerMary
IN A NUTSHELL
• Evidence from observational studies that the use of surgical safety
checklists results in striking improvements in outcomes
• Led to rapid adoption of such checklists worldwide
• Researchers studied effect of mandatory adoption of checklists in
Ontario, Canada
• Use of checklists not associated with significant reductions in
operative mortality or complications
160. #SHCR @HelenBevan @FreerMary
• Lower our ambitions for improvement
• Focus our energies on those who are
already in the “action” stage
• Put negative labels on those who are
not yet at the action stage such as
“blocker” or “resister” or “laggard”
• Blame “the management” for not
enforcing change
So what do we TEND to do when people
resist?
161. #SHCR @HelenBevan @FreerMary
The single biggest problem
in communication is the
illusion that it has taken
place
George Bernard Shaw
‘‘
162. #SHCR @HelenBevan @FreerMary
• Listen and understand
• appreciate the starting point
• elaborate interests
• Roll with resistance (Singh)
• Don’t argue against it
• Encourage elaboration of resistance
•What makes it so hard?
•What would help?
• Build meaning and conviction in the change
So what SHOULD we do?
163. #SHCR @HelenBevan @FreerMary
• The focus should be on
creating awareness for me of
the need to change
• Remember the goal is not to
make me (as a
precontemplator) change
immediately, but to help me
move to contemplation
• I am not thinking about
changing my behaviours,
actions or work processes
• The problem or issue is
outside my frame of
awareness or my perceived
need
164. #SHCR @HelenBevan @FreerMary
Focussing on Prochaska, DiClemente and
Norcross’s Stages of Change model:
• What stage of change are some of the key
people that you need to influence for your
change initiative at?
• What actions can you take to help them move
to the next stage?
Thinking about your own situation
166. #SHCR @HelenBevan @FreerMary
What happens to large scale
change efforts in reality?
In order of frequency:
1. the effort effectively “runs out of energy” and
simply fades away
2. the change hits a plateau at some level and no
longer attracts new supporters
3. the change becomes reasonably well established;
several levels across the system have changed to
accommodate or support it in a sustainable way
Source: http://www.nhsiq.nhs.uk/8530.aspx
167. #SHCR @HelenBevan @FreerMary
Research shows that more than almost
any other factor affecting an
organisation, energy can lead to either a
wellspring of corporate vitality or the
destruction
of its very core
Source: Bruch and Vogel
168. #SHCR @HelenBevan @FreerMary
Bruch and Vogel research
Organisations with HIGH productive
energy scored higher on:
• overall performance - 14% higher
• productivity – 17%
• efficiency – 14%
• customer satisfaction – 6%
• customer loyalty – 12%
170. #SHCR @HelenBevan @FreerMary
Energy for change
The capacity and drive of a team,
organisation or system to act and
make the difference necessary to
achieve its goals
http://www.institute.nhs.uk/tools/energ
y_for_change/energy_for_change_.html
172. #SHCR @HelenBevan @FreerMary
Social energy
Energy of personal
engagement, relationships and
connections between people
It’s where people feel a sense of
“us and us”
rather than
“us and them”
173. #SHCR @HelenBevan @FreerMary
Spiritual energy
Energy of commitment to a common
vision for the future, driven by shared
values and a higher purpose
Gives people the confidence to move towards a
different future that is more compelling than
the status quo
174. #SHCR @HelenBevan @FreerMary
Psychological energy
Energy of courage, resilience and feeling
safe to do things differently
Involves feeling supported to make a change and
trust in leadership and direction
175. #SHCR @HelenBevan @FreerMary
Physical energy
Energy of action, getting things done and
making progress
The flexible, responsive drive to make things
happen
176. #SHCR @HelenBevan @FreerMary
Intellectual energy
Energy of analysis, planning and thinking
Involves gaining insight as well as planning and
supporting processes, evaluation, and arguing a
case on the basis of logic/ evidence
177. #SHCR @HelenBevan @FreerMary
High and low ends of each energy domain
Low High
Social isolated solidarity
Spiritual uncommitted higher purpose
Psychological risky safe
Physical fatigue vitality
Intellectual Illogical reason
178. #SHCR @HelenBevan @FreerMary
Some questions
• Which group likely to have
higher spiritual energy
scores (clinicians/non
clinicians?)
• Nearer to CEO, higher or
lower energy scores?
179. #SHCR @HelenBevan @FreerMary
• Are particular
energy domains
more dominant
than others for
our team at the
moment?
• Is this the
optimal energy
profile to help
us achieve our
improvement
goals?
Energy for change profile
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual
180. #SHCR @HelenBevan @FreerMary#IQTGOLD#SCHR @HelenBevan @freermary
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual
Team 1: what’s your assessment of
their energy for change?
181. #SHCR @HelenBevan @FreerMary#IQTGOLD#SCHR @HelenBevan @freermary
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual
Team 2: what’s your assessment of
their energy for change?
183. #SHCR @HelenBevan @FreerMary
There has never been a time in the history
of healthcare when this advice has been
more pertinent
“Leadership is not about making clever
decisions and doing bigger deals. It is about
helping release the positive energy that
exists naturally within people”
Henry Mintzberg
185. #SHCR @HelenBevan @FreerMary
1. Follow on Twitter
@HelenBevan
@BoelGare
2. Subscribe to
3. Get materials from The School for Health and Care
Radicals: www.theedge.nhsiq.nhs.uk/school
4. Sign up to our MOOC (Massive Open Online Course)
on “Improvement Fundamentals”)
TheEdge.nhsiq.nhs.uk
Five ways to connect!
@JackieLynton
@School4Radicals
@TheEdgeNHS
186. #SHCR @HelenBevan @FreerMary
References and links
Baron A (2014) Preparing for a changing world: the power of relationships
Battilano J, Casciaro T (2013) The network secrets of the great change agents
Harvard Business Review, July-August
Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A
Practical Guide
Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript
Bevan H, Fairman S (2014) The new era of thinking and practice in change and
transformation, NHS Improving Quality
Change Agents Worldwide (2013) Moving forward with social collaboration
SlideShare
Diaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontier
Fuda P (2012) 15 qualities of a transformational change agent
Grant, M (2014) Humanize: How people centric organisations succeed in a social
world http://prezi.com/usju20i0nzhd/humanize-how-people-centric-
organizations-succeed-in-a-social-world/
Hamel G (2014)Why bureaucracy must die
Jarche, H (2013) Rebels on the edges
187. #SHCR @HelenBevan @FreerMary
Jarche H (2014) Moving to the edges
Kotter J (2014) Accelerate! Harvard Business Review Press
Merchant N (2013) eleven rules for creating value in the social era
Llopis G (2014) Every leader must be a change agent or face extinction
Meyerson D (2001) Tempered Radicals: how people use differences to inspire change
at work Harvard
Meyerson D (2008) Rocking the boat: how to effect change without making trouble
Harvard BP
Perkins N (2014) Bats and pizzas (agility and organisational change)
Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated
School for health and Care radicals (2014) www.changeday.nhs.uk/healthcareradicals
Shinners C (2014) New Mindsets for the Workplace Web
Stoddard J (2014)The future of leadership
Williams B (2014) Working Out Loud: When You Do That… I Do This
Weber Shandwick (2014) Employees rising: seizing the opportunity in employee
activism
Verjans S (2013) How social media changes the way we work together
References and links
Editor's Notes
Examples form the NHS of social movements often called a call to action
Large scale action - Not requiring large leadership team or compliance framework
Definition used in “The Power of One, the Power of Many” = a voluntary collective of individuals committed to promoting or resisting change through co-ordinated activity.
Link belowhttp://www.bbc.co.uk/news/magazine-23790147http://www.bbc.co.uk/learningzone/clips/martin-luther-king-i-have-a-dream-pt-1-2/1293.html
With the brooding statue of Abraham Lincoln peering down at him, King began by telling protesters that their presence in the symbolic shadow of the "great emancipator" offered proof of the marvellous new militancy sweeping the country. For too long, he complained, black Americans had been exiles in their own land, "crippled by the manacles of segregation and the chains of discrimination".
The whirlwinds of revolt would continue to shake the very foundations of the country: "And those who hope that the Negro needed to blow off steam and will now be content will have a rude awakening if the nation returns to business as normal," King said. It would be fatal for the nation "to overlook the urgency of the moment and to underestimate the determination of the Negro".
“He's good - he's damned good”
Kennedy on King
Wearied by the suffocating heat, the crowd's initial response was muted. The speech was not going well. "Tell 'em about the dream, Martin," shouted Mahalia Jackson, referring to a rhetorical riff that King had used several times before, but which had not made it into his prepared speech because aides insisted he needed fresh material. But King decided to cast aside his prepared notes, and launched extemporaneously into the refrain for which he will forever be remembered.
"I have a dream that one day this nation will rise up and live out the true meaning of its creed," he shouted, his out-stretched right arm reaching towards the sky. Soon he was hitting his rhythm, invigorated by the chants and cries of the crowd. "Dream on!" they shouted. "Dream on!"
With his voice thundering down the Mall, King imagined a future in which his children could "live in a nation where they will not be judged by the colour of their skin but by the content of their character". Then he reached his impassioned finale.
King asked the crowd to yell so it was heard the world over
Watching at the White House, the president was riveted. Like so many Americans, it was the first time he had heard the 34-year-old preacher deliver a speech in its entirety - the first time he had taken its measure, listened to its cadence. "He's good," Kennedy told one of his advisors. "He's damned good." The aide was struck, however, that the president seemed impressed more by the quality of King's performance rather than the power of his message.
So Emotions help us understand what we value in the world.
Why did the story of Alice work ?
So why was this story powerful?
Why do we respond differently when we hear about Alice rather than when we see the policy data and financial balance sheet?
So public narrative when used intentionally for a purpose to connect with others to move to action is a powerful skills set and leadership gift. When we hear stories that make us feel a certain way those stories remind us of our core values. We experience our values through emotions. Then we are prepared to take action on those values. Through our emotions we are more likely to take action
Research by Martha Nussbaum a Moral philosopher, tells us that people who have a damaged (a-mig-da- la) Amygadla the part of the brain which controls emotions, when faced with decisions can come up with many options from which to choose but cannot make a decision because the decision rests upon judgements of value. If we cannot feel emotion we cannot experience values that orient us to the choices we must make
Shortly we will be thinking about the lived experiences that have moved you to action…we’ll be drawing on those a few minutes as you start to craft your own stories.
LIST some emotions
Remember the power of “Killer Facts”
Have one that really illustrates this for you.
JG – I often use one from Kath Evans. If we had the health care system in England that matched the best in Europe 1500 children a year, would not die in our care.
I thank you for being here and doing what you do.
Have a wonderful three days in Birmingham.