The School for Health and Care Radicals Victoria

#SCHR @HelenBevan @FreerMary
A one day

Welcome to the School for Health
and Care Radicals: a global
community of change agents

100,000
2,000
20,000
65
348
25,000+
120 14,000
inc

The school is being formally evaluated
by the Chartered Institute for
Personnel and Development

http://www.slideshare.net/Downes/connectivism-and-personal-
learning?next_slideshow=1

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

Joining in today and beyond
• 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

Everyone has gifts and strengths
What superpower do you have?

Source: @NHSChangeDay

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

“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

Starts on the fringe
(at the edge)
Starts with the activists
Gary Hamel
always

So why do we keep reinventing the past
and calling it the future?
Image used under Creative Commons licence: Kicki

Tomorrow belongs to those who
can hear it coming
David Bowie
“ “

SEISMIC SHIFTS

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

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

SEISMIC SHIFTS
Change from the edge

http://www.slideshare.net/Openpolicymaking/policy-lab-slide-
share-introduction-final

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

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

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

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

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

Source: Gary Hamel

Source:@Alfacarlo

John Kotter, the most influential thought leader
globally, recognises new approaches are needed
FROM

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

From “have to” to “want to”
Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-
of-the-cipd-online-community

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
‘

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

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

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

What happens to
heretics/radicals/rebels/mavericks
in organisations?

#SCHR @HelenBevan @FreerMary#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

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

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

#SCHR @HelenBevan @FreerMary#NHSChangeDay #SHCRchat
Source : Lois Kelly www.foghound.com
There’s a big difference between a rebel
and a troublemaker
Rebel

Reflection
• What are your insights around “rebels” and
“troublemakers”?
• What moves people from being “rebel” to
“troublemaker”?
• How do we protect against this?

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

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

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

“Being” as a change agent
Personal characteristics and
qualities

Change starts with me
Source of image: jasonkeath.com

#SCHR @HelenBevan @FreerMary#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
"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

‘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

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

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

What’s the difference between
self efficacy
and
self esteem,
self belief,
self-confidence?

Source: @NHSChangeDay
What is the issue here?
“permission” ?
(externally generated)
or
Self efficacy ?
(internally generated)

#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

Being a great change agent is about knowing, doing,
living and being improvement

Avedis Donabedian
“Ultimately, the secret of
quality is love.
…… If you have love, you
can then work backward
to monitor and improve
the system”.

Key tactic :
Out-love everyone else
Source of image: Bradley Burgess

What is a
RCT?

Randomized Coffee
Trial!

Outcomes of randomised coffee trials

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/wor
ldwide-employees-engaged-work.aspx

Persistent application of power
and authority drains energy
from those in its wake
Dan Rockwell

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?

#SCHR @HelenBevan @FreerMarySource of image: outskirtsbattledome.wikispaces.com
The easiest way to thrive as an
outlier
...is to avoid being one
Seth Goodin

#SCHR @HelenBevan @FreerMaryFor more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW

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

“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

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

Calls to Action

Leadership is….
…the art of mobilising others
to want to struggle for shared
aspirations
Jim Kouzes
Source of image: environmentvictoria.org.au

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)

What’s the
financial incentive?
Who is
performance
managing?
What’s the
project plan?
Source: @RobertVarnam

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

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
Source: Peter Fuda
http://www.peterfuda.com/2014/10/30/traditional-comms-fail-engage/
Four gaps between
how we
communicate
change
how people
engage with that
communication

#SCHR @HelenBevan @FreerMary#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton
“I have some Key
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam

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

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

‘‘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

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

http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-
crafting-visual-stories-with-data?sf3881865=1

Vivid details

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

How do we create a sense of
“us” to build momentum for
change?
Source of image: www.tannerfriedman.com

Moving beyond us and them
to us and us
Source of image: www.delta7.com

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

strong ties (cohesive)
v.
weak ties (disconnected)
Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml

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

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

The pros and cons of strong ties
Pros Cons

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

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

strong ties
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

strong ties
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

Sources of weak ties

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

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

112
http://weneedsocial.com/blog/2013/8/25/disr
upted-disruptors-unite

Source of image: http://switchandshift.com/transactional-or-
transformational-which-leadership-style-is-best

“You don’t need an engine when you have
wind in your sails”

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?

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

“
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
“

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

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
‘‘

Cultural change
is a million
subversive acts
of resistance
Brene Brown
Source of image: zazzle.com
‘‘

#SCHR @HelenBevan @FreerMary#SCHR #Quality2015 @HelenBevan @BoelGare @jackielyntonImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SCHR @HelenBevan @FreerMarySource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SCHR @HelenBevan @FreerMarySource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal
PERFORMANCE target.

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

“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.
—

“Stages of change”
Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)

• 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

• 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

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)

• Which stage do most change activities in
health and care focus on?
• Which stage are most people actually at?
Some questions

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

• 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

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

• 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?

The single biggest problem
in communication is the
illusion that it has taken
place
George Bernard Shaw
‘‘

• 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?

• 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

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

If your horse dies,
get off it
Cherokee proverb
Source of image: fenwickgallery.co.uk
‘‘

Intrinsic motivation
People engage in the
activity for the pleasure
and satisfaction of doing it
Invokes many positive
behaviours
Extrinsic motivation
People engage in the
activity for the rewards or
avoiding punishment
Any external influence is
referred to as extrinsic
motivation
Images: pixgood.com

The power of extrinsic drivers

Three types of levers for large scale change
‘Prod mechanisms’
targets
performance
management
price & payment incentives
regulation
competition
‘Proactive support’
relies on building
‘intrinsic motivation’ in
staff to make
the right changes to
improve
‘People focused’
education and training
national contracts
professional
regulation
Clinical quality
Type one:
Type two: Type three:
Source: Health Foundation report Constructive
comfort: accelerating change in the NHS 2015
Less than 10%
of the
potential for
improvement
at system
level can be
delivered
through type
one change

Emotion is the fuel for
change;
data and information
provide direction
Dan Heath
(author of Switch)

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

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%

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

Psychological
Physical
Spiritual
Social Intellectual
Energy for change

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”

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

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

Physical energy
Energy of action, getting things done and
making progress
The flexible, responsive drive to make things
happen

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

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

Some questions
• Which group likely to have
higher spiritual energy
scores (clinicians/non
clinicians?)
• Nearer to CEO, higher or
lower energy scores?

• 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

1
2
3
4
5
Social
Spiritual
Intellectual
Team 1: what’s your assessment of
their energy for change?

1
2
3
4
5
Social
Spiritual
Intellectual
Team 2: what’s your assessment of
their energy for change?

Where is your team?
1
2
3
4
5
Social
Spiritual
Intellectual

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

#SCHR @HelenBevan @FreerMary Source: Helen Bevan
Compliance
States a minimum performance
standard that everyone must
achieve
Uses hierarchy, systems and
standard procedures for co-
ordination and control
Threat of penalties/ sanctions/
shame creates momentum for
delivery
What is our approach to change?
Commitment
States a collective goal that
everyone can aspire to
Based on shared goals, values
and sense of purpose for co-
ordination and control
Commitment to a common
purpose creates energy for
delivery

Leaders who
focus on meaning also
get compliance,
without focusing on it
@JeremyScrivens

We know that ...
• Shared purpose is a common thread in successful
change programmes*
• Organisations and change initiatives with strong
shared purpose consistently outperform those
without it.**
*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)
**Management Agenda 2013 Boury et al (Roffey Park Institute)

#SCHR @HelenBevan @FreerMary#NHSChangeDay #SHCRchat
A 3-word concept

[Shared] purpose goes way deeper than
vision and mission; it goes right into your gut
and taps some part of your primal self. I
believe that if you can bring people with
similar primal-purposes together and get
them all marching in the same direction,
amazing things can be achieved.
Seth Carguilo

The power of shared purpose:
Perhaps the single most important influence on program
response by individual units—either in promoting or
resisting change—was the extent of consensus and
coalition among the senior medical and nursing staff on
individual Intensive Care Units….
[Consultant says] ‘I think it’s been successful because it’s
a unifying program, it’s one of the few things that we’ve
done that hasn’t been just a doctor thing, or just a nurse
thing, it’s involved the doctors and the nurses together.’
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/

Avoiding “de facto” purpose
• What leaders pay attention to matters to staff, and
consequently staff pay attention to that too
• Shared purpose can easily be displaced by a “de facto”
purpose:
 hitting a target
 reducing costs
 eliminating waste
 completing activities within a timescale
 complying with an inspection regime
• 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
Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector

#SCHR @HelenBevan @FreerMary@SimonJGuilfoyle Police Inspector and systems thinker

Police
@SimonJGuilfoyle Police Inspector and systems thinker

Education

Healthcare

....the last era of management was about how
much performance we could extract from
people
.....the next is all about how much humanity we
can inspire
Dov Seidman

“Tomorrow’s
management systems
will need to value
diversity, dissent and
divergence as highly as
conformance, consensus
and cohesion.”
Gary Hamel
Source of image: www.fastcompany.com

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”)
5. Come to the #Folkslab on Wednesday, Thursday or
Friday
TheEdge.nhsiq.nhs.uk
Five ways to connect!
@JackieLynton
@School4Radicals
@TheEdgeNHS

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

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

The School for Health and Care Radicals Victoria

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