The document summarizes a live session of The School for Change Agents. It introduces the session team and facilitators. It discusses topics like capability and agency for change agents, leverage points to create change, and addressing issues through a complexity lens. The session explores mindsets like self-authoring and self-transforming, working with paradoxes, and the idea that no one operates above a system. It encourages participants to join the online learning community.

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Welcome to the third live session of 2021!

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Today’s live session team:
Facilitated by:
Tech team:
Helen Bevan
Chief Transformation officer
Kathryn Perera
Director
Social media team:
Olly Benson
Production lead
Kerry McGinty
Production/tech
assistant
Zarah Mowhabuth
Chat Box monitor
Paul Woodley
Tech Lead
Bev Matthews
Youtube lead
Leigh Kendall
Social influence
lead
Rupal Johal
Live tweeting

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Join The School for Change Agents group,
or ‘Like’ The School for Change Agents
page
@HorizonsNHS
Keep in touch with the School
community!

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Keep in touch – sign up to our newsletter!
Sign up via the QR code
(open up the camera on your phone)
OR
sign up at horizonsnhs.com/School

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with our weekly podcast!
Find it at horizonsnhs.com/School,
or wherever you get your podcasts

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CAPABILITY AGENCY
Change agents need
CAPABILITY (the quality of being capable; capacity and
skills:) &
AGENCY (able to take action to express their power)
• Improvement skills
• Project/programme management
• Innovation and design methods
• Analytics
• Process facilitation skills
• Influencing skills
• Coaching skills
• Self-efficacy
• Collective action
• Building belonging
• Embracing diversity
• Relationships
• Connections
• Social action

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LEVERAGE
Where a small amount of energy can have
the greatest effect
https://link.springer.com/article/10.10
07/s11625-021-00956-5?

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Source: Waters Foundation
Leverage points: seeing what’s below the surface

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https://link.springer.com/arti
cle/10.1007/s11625-021-
00956-5?
The four top leverage points to change a system
(in increasing order of impact)
Source: Anna Birney

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What type of issues are we trying to address?

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What type of issues are we trying to address?

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1. Since the nature of a complex system is determined by the interaction between its
members, relationships are fundamental.
2. Complex systems are open systems. This means that a great deal of energy and information flows
through them, and that a stable state is not desirable.
3. No health and care system can be understood independently of its context.
4. Along with the context, the history of a health and care system co-determines its nature.
5. The emergent nature of complex adaptive systems often manifests in unintended consequences
or behaviour that may seem irrational.
6. We should be prepared for the unexpected and to be very careful. Something we may think to be
insignificant (a casual remark, a tone of voice) may change everything.
7. Complex systems cannot thrive when there is too much central control.
Source: Adapted from Sonja Blignaut https://agileandchange.com/7-implications-of-seeing-organisations-as-complex-systems-996fd2398d58
7 implications of seeing a health and care system as a complex system

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Complex systems are driven by the quality of the
interactions between the parts, not the quality of the
parts. Working on discrete parts or processes can
properly bugger up the performance at a system
level. Never fiddle with a part unless it also improves
the system
@ComplexWales
Source of image: Eclipse

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Horizontal development:
• Adding more knowledge, skills, and
competencies
• Transmitted through experts
Vertical development:
• Ability to think in more complex, systemic,
strategic and interdependent ways
• Learnt through experience
Vertical development as well as
horizontal development
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• Time and space rules
that are inconsistent
over time
• Logic that allows for the
magical
• Sense of our connected
minds
Image: @PriscillaDuPreez via Unsplash

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Image: @TimEasley via Unsplash
• No grey (us and them, black and
white)
• Focus on what I want
• Inability to consider in a real way
what someone quite different
might want
• Difficulty with abstract concepts
like loyalty
• Comfort with what is known.
Disbelief in what is not
knowable.
Self-sovereign

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Image: @MiinYuii via Unsplash
• Abstract thinking,
capacity for grey on
many dimensions
• Loyalty to a set of
ideas or people
• Reliance on external
(group, theory,
discipline) to know
what’s right or wrong
• Self esteem made up
from external feedback
• No internal compass
• Comfort in what is known and knowable—
discomfort about what is unknowable
Socialised

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• An internal set of rules and
regulations—a self-governing system
• A belief in their own opinions and
ideas that comes from their own
experiences
• May construct organisations and
systems to reflect own strengths (and
weaknesses)
• Might resist evidence that their beliefs
or assumptions are wrong
Image: @itsjaredtomasekagain via Unsplash
Self-authored

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• Openness to new ideas and perspectives—even those that actively challenge their own
• Ease with complexity, ambiguity and change
• A resistance to simple answers in complex situations
• Comfortable with chaos and paradox, understanding that the two ends of the poles
actually create one another, that to deny the truth of one is to deny the truth of both
Image: @andyjh07 Unsplash
Self-transforming

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Subject Object

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Derived from the work of Professor Bob Kegan (Minds at Work) and Dr Jennifer Garvey-Berger (Cultivating Leadership)
NOT HOW WE LOOK, BUT HOW WE SEE

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Complexity: creating simple rules
“Simple rules” is a core principle for transforming mindsets that drive behaviours and
actions in large complex systems.
If we want to get a very large group of people, across an organisation or system, to behave
differently, with everyone moving in a coherent direction we can do this in one of two ways:
Principles: adapted from General Stanley McChrystal Team of Teams
1. Policies, approvals and
top-down cascade
Create clear polices
and operating
systems & hold
formal leaders to
account
2. Alignment through
simple rules
Identify a few simple
rules that everyone
is accountable for,
operating in
conditions of greater
individual freedom

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Background: why simple rules?
• Rather than compliance to sets of standards and policies, we seek to identify
a few simple rules so that everyone understands why and what we are doing
• We want a situation where everyone understands the simple rules and
delivers them in their own way
Our goal with the simple rules is not to exercise control but to
establish the high level principles within which we all operate
What we are NOT saying:
• This is how you should do it
or
• Do whatever you like
What we ARE saying:
• these are the ways we
want to work– express
yourself using those
elements

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Oldham: simple rules for Covid-19 response
*Note: the NCA is the Northern Care Alliance, the local NHS system of which Oldham is part
*

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In Jönköping, Sweden, the system
for “health” starts a long way
upstream of primary care
3. Predict and prevent: start at an earlier stage (upstream)
in the intervention or care process

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Jeremy Heimens, Henry Timms New Power: How it’s changing the 21st Century and why you need to know (2018)
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The pandemic response has exposed many
polarities(paradoxes / competing tensions) in the system
• Commanding leadership vs relational approaches
• Health equity vs pathways of care
• Work vs family
• Lives vs economy
• Wellbeing of our NHS people vs wellbeing of
patients
There is rarely a
“right”, “wrong”
or “best” for all
contexts. We
have to work
comfortably with
the contradictions
of “both/and”
Adapted from: COVID-19 and Its Resulting Paradoxes: The Importance of Paradoxical Leadership, Oxford Review (2020)

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Overwhelmed? Adopt a paradox mindset
• Identify the paradox or tension
• Reframe the question
• Develop comfort with the discomfort
• See the big picture, connect and search for new possibilities
https://knowledge.insead.edu/leadership-organisations/overwhelmed-adopt-a-paradox-mindset-
14026#comment-31821
Ella Miron-Spektor and Wendy Smith,

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No one operates above the system
Source of graphic: Adapted by Helen Bevan from Reos Partners
Others
I am co-creating
the change:
I am part of
(within) the
system of
change
I am leading or enabling
change in the system
I am helping others to
change
I am apart from
(above or outside) it
• Anything you intervene
in changes the system
• Come up with as many
leverage points beyond
your own ideas
• Thoughtful interventions
that work with the
system’s own dynamics
• Think about the
potential rather than the
goal (Anna Birney)
• Work with the agency
Source:Systems Innovation
Network
www.systemsinnovation.ne
twork/

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“Whether we march with banners or
without - the important thing is
that we march together. All of us.
That’s what this thing has been
about from the beginning. And that
is absolutely how it is going to end.
Together. Us. United”
(Joe in Pride by Stephen Beresford)
What next?
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Not joined the online learning community on FutureLearn yet?
We look forward to welcoming you! horizonsnhs.com/School

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Let’s tweet our favourite part of the
School for Change Agents 2021!
Don’t forget to tag us and use the hashtag 👇

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2021