The power of one, the power of many: applying social movement principles to healthcare improvement

@HelenBevan #DSRIPLearning
The Power of One, the Power of Many:
Applying Social Movement Thinking to
Health Care Improvement
Helen Bevan

The Horizons team:
Change agents and change agency
• A small, diverse team of people within
the English National health Service that
supports change agents and builds
change agency
• We tune into the latest change thinking and
practice in healthcare and other industries
around the world
• The team has emerged through years of supporting
change in the NHS and the wider health and care system

As a result of this session, you’ll be able to:
• Apply five success factors from social movements
to your healthcare innovation efforts
• Understand how social movement principles can
unleash the creativity and energy of service users,
patients, families, communities and people who
work in the healthcare system
• Build strategies for improvement on a platform of
commitment as well as compliance
WE CAN DO IT!

What are you passionate about?
What lights the fire in your belly?
Source of image: http://www.ignitepeterborough.co.uk/fire-in-your-belly/

“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

“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.

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

Every movement for change, whether it
is in a social or a corporate setting,
begins with shared values because
values are what drive action.
Greg Satell
WE CAN DO IT!

Stories are the most powerful way to connect
Graphic by @scriberian

Short-term treatment (up to six weeks) of
persistent aggression in patients with
moderate to severe Alzheimer’s dementia,
unresponsive to non-pharmacological
approaches and when there is a risk of harm
to self or others.
The
guidance
‘

The reality
• Estimated 180,000
people in England with
dementia were being
prescribed antipsychotics
• Only 36,000 get any
clinical benefit from the
drugs
• Negatives far outweigh
the positives
Source: Bannerjee report

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

Who are our people?
• People living with
dementia, their families
and advocates
• Family physicians
• Psychiatrists
• Pharmacists
• Hospital nurses and
doctors
• Leaders of care homes
• Senior decision makers

What do they want?
All people with dementia who are receiving
antipsychotic drugs will have undergone a
clinical review to ensure that if they are
receiving these drugs they are doing so
appropriately and that alternatives to their
prescription have been considered and a shared
decision has been agreed regarding their future
care by March 2013

Each group created an ask
Example: pharmacists’ group
I (we) commit to:
reviewing the people under my
care to identify those who are
prescribed antipsychotic
medication and working in
partnership with my prescribing
and other healthcare colleagues
to review each individual

Who are our people?
• 120 hospital systems engaged
• 700 active members of our virtual community
• 1,800 registrants to our online webinar series
• 2,000 attendees at the national and regional launch events
• 5,000 GPs via and the Royal College of GPs
special interest group
• 25,000 Nurses recruited via the Chief Nursing Officer’s
bulletin and linked via the hospitals group
• 40,000 Pharmacists via the development of the Royal
Pharmaceutical Society resources

Over the next three years
Across the whole of England, a 51% reduction
in prescriptions for antipsychotics for people
living with dementia
Linked with
other
initiatives

The learning review/evaluation
To download goo.gl/XsKZ25

“The truth is that change that is imposed never
sticks, because it asks those who must affect
change to betray themselves. You must first
change minds before you can change actions”
Greg Satell
“When your beliefs are entwined with your
identity, changing your mind means changing
your identity. That’s a really hard sell.”
Osan Varol
WE CAN DO IT!

@HelenBevan #DSRIPLearning Source: The Online Privacy Foundation
Don’t assume that facts & data change minds

Identify the pillars of power

Co-design
Source: adapted from Design for Europe
Source of image: Penny Hagen
• Participatory, co-creating and open
• A wide range of people can make a creative
contribution to formulate and solve problems
• Goes beyond consultation by building and
deepening equal collaboration between users,
patients, families and citizens affected by a
particular challenge
• Users, as experts of their own experience, are
central to the design process

Where social movements
meet co-design
Engaging the key people not just in mapping and
analysing the problem but also in action to solve
the problem

Where social movements
meet co-design
Engaging the key people not just in mapping and
analysing the problem but also in action to solve
the problem
A step further: engaging people in action to
solve problems 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

Many PFAC members I’ve talked to say that staff
members only ask them to do superficial tasks (like
reviewing patient brochures or food menus) or involve
them in meaningless conversations. It’s not that menus
and brochures aren’t important, but if that’s all you’re
asking your PFAC members to do, you’re not using this
resource to its full potential. Great ideas, organizational
energy, and goodwill may be going to waste.

Which kind of activists are most successful at creating
agency & delivering results?
Lone wolves
Build power by expertise and information — through
advocacy, oversight, contributing to committees, public
comments and other forms of consultation
Mobilisers
Build power by mobilising people – being able to call
on large numbers of people to contribute, engage in
change and take action
Organisers
Build power by growing leaders – identifying, recruiting
and training future leaders in a distributed network:
building a community and protecting its strength
Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

Patient leaders as “lone wolves”
“What I am ranting about is the way in which patients are
being streamed into advisory sub committees, the way we are
being used as tokens and to help tick off the right box…..
Where is the attitude that patients are part of the team in
healthcare, that we are partners? Why are we always asked
to participate inside a pre-determined frame? When will we
see co-design of new policies, and ultimately co-production?”
Annette McKinnon

Strategy for
power
Structure
Types of asks
Communication
More numbers
Centralised
responsibility
Independent
Pitches for action
What do they do differently?
Transformative
leaders
Decentralised
responsibility
Interdependent
Relationships
Mobilising Organising
Source: Hahrie Han (2016) Organising for transformational change

Which kind of activists are most successful at
delivering change?
Lone wolves
Build power by expertise and information — through
advocacy, oversight, contributing to committees, public
comments and other forms of consultation
Mobilisers
Build power by mobilising people – being able to call
on large numbers of people to contribute, engage in
change and take action
Organisers
Build power by growing leaders – identifying, recruiting
and training future leaders in a distributed network:
building a community and protecting its strength
Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

Focus on the “We”
“Great social movements get their
energy by growing a distributed
leadership”
Joe Simpson

Create a spectrum of allies
Source of image: Greg Satell

WHO will make the change happen?
List A
• The Delivery Board
• The senior sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Working Groups
• 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
onesSource: adapted by Helen Bevan
from Leandro Herrera

WHO will make the change happen?
List A
• The 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

“Staff and patients want more
conversations for change.
What top-down improvement
programs give them is more
paperwork”
Mary Dixon Woods
Source of image: clipartfest

What is the best way to
spread new knowledge?
Source of data: Nick Milton
www.nickmilton.com/2/2tOjE
Social connection/discussion is
14 times more effective
than written word/
best practice
databases/ toolkits etc
Source of image: happiness-one-quote-time.blogspot.com

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
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/
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

“Our leadership behaviour results
in about 65% of the information
that people take in.”
Source: Towers Watson
https://t.co/8dV6utQXSr
Source of image: collections.infocollections.org

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

How is this approach different (or additional) ?
• Project team
• Senior sponsorship
• Engages key stakeholders
• Seeks buy-in to change
• Project resources
• Key performance indicators
and milestones
• Accountability through
programme hierarchy
• Recruits a broad constituency and
creates a sense of “us” rather than
“us and them”
• Mobilises through a compelling
narrative
• Builds many leaders
• Relational commitment
• Creates commitment to take specific
actions
• Seeks to utilise resources to shift
power to achieve outcomes

• 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 we are
successful from a social movement
perspective?

@HelenBevan #DSRIPLearning Copyright: <a href='http://www.123rf.com/profile_iqoncept'>iqoncept / 123RF Stock Photo</a>
Beyond top down and
bottom up change…….
Beyond the service lens
through which systems
leaders typically conceive
the problems we’re trying
to solve….
Bringing positive
disruption into the system
for faster change & bigger
outcomes
Disruptive co-creation
Adapted from SOLACE

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WANT
TO
MAKE A CHANGE…..
ROCK THE BOAT BUT
NOT FALL OUT?
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• Starts Thursday 15th February 2018
• For 5 weeks
• Every Thursday 15.00-16.00 GMT
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• Completely free and open to all
• Handbooks and study guides
• Meet fellow change agents from
across the globe
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#S4Change
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