Transcript from CIPD Edge Talk on 04/09/15

JANET WILDMAN:
Is anybody from the school on the line, do they want to raise their hand or say hello?
PAUL WOODLEY:
Everyone is muted, they can post a message in the chat or raise their hand.
JANET WILDMAN:
What does it look like now, do we have quite a few people in the chat room, or raising their hands?
PAUL WOODLEY:
We have a few people responding in the chat now.
JANET WILDMAN:
Fantastic, we will just wait a couple more minutes and then make a start.
Good morning to everyone. Shall we make a start? My name is Janet. Welcome to this Edge Talk
where we are going to be looking at the School for Health and Care Radicals and the evaluation which
has been undertaken by CIPD.
Specifically, we will be looking at what has been the impact of the school over the last two years.
Before I move on, I want to remind everybody that you will be muted for the session.
In order for you to be involved, you can raise your hand virtually or post in the chat room. In the chat
room we have got Jodi and Dom Cushnan who will be looking after that today. We will be hearing from
them later on in the session.
Before moving on, I just want to say welcome to CIPD and the team there. The CIPD were
commissioned by NHSIQ last year in December, to really undertake this evaluation for us.
This is an independent and real-time evaluation into the effects and impact of the school. CIPD has a
strong record in supporting individuals and organisations in terms of the development.
So, before I move on, I would just like to introduce Jonny Gifford who is leading this evaluation, he is a
research adviser working with CIPD.
He has 10 years' experience researching people management and organisational development,
including in the NHS. He's going to be talking about his involvement in the research. And also
introducing his team. Over to you, Jonny, I look forward to hearing your presentation.
Edge Talk Webinar (UKEDGE2707B)
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JONNY GIFFORD:
Great, thank you very much, Janet, for your introduction. It is great to be joining everyone today to be
presenting our work which is the culmination of a year's work.
It is really nice to be here today. As Janet says, we are going to be talking about the work we have
been doing. We being the CIPD, with the NHSIQ to review the School for Health and Care Radicals.
And to evaluate its impact.
I work in the CIPD, the research arm there, and for those of you not familiar with us, the CIPD is a
professional body for people management and learning and development.
So, I'm going to be joined today, if I can get my slides… Paul, can we get my slides?
PAUL WOODLEY:
I'll take the presenter board back for a second. Then I will pass it back.
JONNY GIFFORD:
Are my slides are now? OK, great. There we go. I'm going to be joined today I two of my colleagues
from the research team, Stella Martorana, and Ksenia Zheltoukova. Stella is going to talk about
qualitative research we have been doing, and Ksenia is going to talk about survey research we have
done to measure the impact of the school more quantitatively.
To gauge the scale of its impact. I'm also going to be joined by Adrian Osborne and David Ellis, two of
the participants who we interviewed, and they're going to be telling their stories of how the school
helped them and their work.
I'll introduce them all in a bit. Just to say as well, we will be publishing the report our findings with
NHSIQ, that will hopefully be later this month.
What you're getting today is a sneak preview, with more details to follow. It is worth very briefly
refreshing people's memory about the school. Or give a brief overview for anyone not familiar with it.
I'm not going to go into detail on the content of the school, but it is important to say it brings together
much of the insight that you can find on the Edge website, the podcast and articles.
It includes, for example, the idea that change in organisations start from the edge. It is essentially a
question of liminal practices, or outliers becoming more mainstream.
It also covers ideas about the need for a mix of bottom-up and top-down change. So, we need

emergent change within organisations.
And crucially, it covers what makes a good change agent. What are some of the key characteristics of
people who, regardless of their seniority in the organisation, make effective leaders in helping improve
healthcare services.
So, that includes the social aspect of building momentum for change, building bridges for people,
getting people on board. For example, using storytelling to make sure the message you want to
convey is landing well.
It also includes how to be resilient in the face of resistance to change. How to keep going, and to try
and get people on board. Those two areas are summarised in this phrase which is often used in the
school of, "rocking the boat while staying in it", challenging people, trying to initiate change, but at the
same time keeping people on board and maintaining relationships.
So, five modules in the school that run from the end of January, through into February this year. This is
the second year that the school ran in this online format.
Before we go into thinking about the impact and evaluation that we did, just some of the numbers to
give you an idea of the level of engagement in the school.
As you can see there, over 3,000 people registered on the school this year, up from last year. And that
translates to 1,700 logins to the live modules. Nearly 5,000 views of YouTube recordings of the school.
Over 20,000 views of actual other materials as well. And then there is also the social engagement side
of it. Nearly 8,000 tweets, just over 1,000 people tweeting. And then the Twitter impressions, the
number of people who have seen or engaged with other people's tweets.
Finally, for people who have undertaken the whole school and given a submission to become certified
change agents, they can get their certificate afterwards.
Currently there is about 230 of those, and counting. So, to summarise, we have lots of engagement in
the schools. From one element, it has been a success.
Obviously, the real question we have been trying to grapple with, what is the actual impact of the
school? In order to go about this impact assessment and a review of the school, it is helpful to think
briefly about the nature of the School for Health and Care Radicals.

Essentially it is what is called a MOOC, a massive open online course, which means it is freely
available online. It is typically integrated with social media, as the school very much is.
What does that mean in practice? It means, for a start, anyone can join. There are no criteria for
whether you are an official staff member of the NHS. You could be working as a volunteer in the health
care system in the UK.
In fact, you could be not even working in healthcare, or not even in the UK. That is reflected in the
number of people who joined the school this year. We had people from around the world, in particular,
people joining us from Australia, America, and also from other sectors than health care.
It also means people can join a course like the School for Health and Care Radicals with their own
particular objective. It is not set out for people with prescriptive aims in mind.
Having said that, there is obviously this core theme of the programme which is about helping people to
become more effective change agents.
Also, people can dip in and out of the course as they want. That means in order to gauge what
success means, it needs to be relative to individuals.
So, we need to consider that when we are thinking about what a successful, impact for programmers.
It needs to be relative to how much people wanted to get involved in it, what they wanted to get out of
it.
And then, of course, there is a social activity. Our hypothesis here was really that, the more people put
into it, the more they will get out of it. The more people build their networks and connections through
social media and other channels, then it is more likely they were going to learn.
This is the theory of social learning as opposed to just consuming education.
Our core focus for the evaluation was to look at individuals as change agents as opposed to looking at,
for example, impacts on the organisation because the impacts on the organisation could be so far-
flung and so divergent that it would be difficult to get a handle on that in the evaluation.
Whereas the theme of the change agent for so-called to it that that is what we focused on.
Moving onto a brief overview of the methods, the research started last November, and we finished it in
July. Initially, we did some background research, so we did interviews with participants from the 2014
school. We also did interviews with people within the Horizons team in NHSIQ, people involved in

running and designing the course, and we looked at document analysis as well.
The aim of that was to think about what is the thinking behind the school, what does it really aim to
achieve, and what is the potential?
From that, we designed a survey. This was a pre and a post-survey so we took measurements before
the school started in January, and we took measurements six months later. Ksenia is going to talk
about that more later. During the school itself, we ran a Facebook forum that some of you may also
have taken part in, to get people's reflections on the learning during the five-week period when it was
happening.
Also in the summer, we conducted in-depth interviews, and here we used a technique called the
critical incident technique, where you take a really deep dive into specific instances that shed light on
how people worked before, how it is different from how they work now, and consequently what they
have gained as a result of taking part in the programme.
The survey that we undertook was based on an impact model that we developed through the
background research, and I will show you what this impact model looks like. Brace yourselves
because it looks a bit complicated. I am not going to talk it through in detail, but this is just to highlight
our thinking.
If you look at the five boxes along the left-hand side, you have got the different levels of our model. We
are assuming there are a range of different activities involved in the schools that people got involved
with. We had a number of assumptions, for example, that people were self-motivated, that they would
have different levels of engagement, that they would be facing different situations in their
organisations.
The key thing we were looking at was this intermediate outcomes, where we developed a number of
survey items that tested these, and that filtered through to an outcomes level and the thinking was this
would be feeding through into overall goals which ultimately lead to patient outcomes, although, as I
said, because of the wide-ranging nature of what people are doing, we couldn't actually look at patient
outcomes in a rigorous way.
The different levels of the intermediate outcomes, we were able to analyse with a statistical technique
called factual analysis, and we could see how they clustered. Although we had 20 or so different
intermediate outcomes that we were testing for, please clustered in the five core themes or factors,
and that is what Ksenia will focus on later.
I am going to hand over to Stella Martorana now. Stella was involved in the qualitative research we did

and is a colleague of mine at CIPD. Over to you, Stella.
STELLA MARTORANA:
Hello, everyone. I will share the findings of our qualitative interviews and also analysis of
conversations and interactions in the online community.
What did these interactions look like? This image illustrates the structure of the network. The lines are
connections. Can we go back to the image?
Community and shared pathways are the main thing and relationships is another area for
development. (inaudible). The school made me realise how many people there are similar to me and
that gives a sense of the surroundings (inaudible).
The building blocks for the development of change agents are self awareness and empathy or
openness to other people's viewpoints. In fact, the first module is entitled "Change starts with me", and
explores the difference between being a change agent and being a troublemaker. This is the one that
resonated the most with people.
As a result, there were other outcomes, such as foster involvement and support, inspire and motivate,
encourage and support others. In particular, supporting others emerged as a radical action, something
new. Individuals felt like they brought about change.
These learning achievements might seem obvious but we have to keep in mind the context. In the
context of a work culture of bureaucracy and huge workloads forced individuals to focus on their
individual work. Connecting with others and supporting them is a block to change. (inaudible) disability
nurse at a hospital, when we spoke to her, she said "I think when it comes to change, I listened better,
which means that I will take into consideration everybody's perspective". Karen Jenkins (inaudible)
coordinator at Greater Glasgow and Clyde NHS said, "I would have labelled them resistors to change
but now I think of them to try and understand their viewpoints".
(inaudible) as a tool to resonate with others and build alliances for change. (inaudible) relationships
which I discussed (inaudible) communicating with others. (inaudible) services as NHS (inaudible). One
of the things that I learned from the school is (inaudible) instead of engaging with people (inaudible).
The head of quality at (inaudible) said, "The school has taught me how to put my argument across two
different groups."
We can say that relationships are at the heart of learning (inaudible), knowledge (inaudible) confidence
and self-efficacy and resilience. They are all connected. (inaudible) West Stafford Clinical Commission

said that (inaudible).
Regarding the confidence and self-efficacy (inaudible) a healthcare assistant said that it doesn't matter
at what level I work. "If I have the right quality and intentions, I can make change happen." (inaudible)
more confident because the school helps them understand that change can start from actions which
can be initiated at any organisational level.
Lastly, resilience. (inaudible) who will be speaking later, communications director at (inaudible) NHS
trust, said, "It is easy to stop at the point of rejection. Some of the conversations dealt with tactics
about how to deal with no." Some participants engaged with this concept (inaudible) practically look for
solutions to overcome barriers instead of giving up as they would have done in the past.
I would like to mention some stories of some participants who thought about changing their
organisation. I will tell you about change. She is a clinical audit facilitator at Darent Valley Hospital.
She promoted information sharing and co-operative working within the surgical team. Her relationship
with this team was challenging. She told us that two years ago nobody (inaudible) and she wanted to
change the way they were working because (inaudible) who has finished them, and they were ready to
present their results.
What difference did it make? Firstly, the school boosted her confidence and resilience. She started
meeting the clinical team regularly as well as other colleagues. She took the habit of meeting the chair
before the meeting to go over the content (inaudible) and she invited a few people to the presentation
before (inaudible) project.
She said there are lots and lots of years of experience in the meeting, so we try to go on that and give
everyone a chance to comment and discuss the methodology and objectives. Sometimes, the team
revised what they intended to do based on the outcome of the discussion.
Information and collaboration is the new way of working.
Now, I will tell you about Anita. She is a learning disabilities nurse at Barnsley Hospital. She applied
her learnings from the school (inaudible) risk management systems (inaudible). In fact, a few months
ago, in February, (inaudible) in her team discussed the case (inaudible) recently admitted to hospital.
(inaudible) as well as clarity around (inaudible) and information sharing between professionals, such
as (inaudible) and police officers.
It was important to ensure patient care and so patient safety. So, what did she do? She followed what
she learned from this course, such as how should she approach people. (inaudible) developed
understanding of the importance of information sharing (inaudible) techniques and networking. The

school also increased her (inaudible) ability.
She said, "(inaudible) great to learn from each other". There was this social learning component.
(inaudible) final stage. (inaudible) awaiting final approval.
**Audio lost**
JONNY GIFFORD:
We seem to have lost Stella little bit there. We lost you about 30 seconds ago. Not long.
SPEAKER:
Did you hear about Anita?
JONNY GIFFORD:
Yes, we did. Perhaps I can just come in at that point, Stella? Thank you very much talking that
through. One of the things that struck me most about the qualitative work that we did, was just how
difficult the situations were that people were facing when they came into the school.
A lot of people are facing problems they really felt were impractical, they could not see a way through.
What kind of insight did you get into that from conducting these interviews and doing the analysis?
STELLA MARTORANA:
(inaudible) loneliness and isolation, it gave them a community, a social group, and identity. For sure,
as I was explaining earlier, the achievement of learning objectives was very important. Sometimes
they did not have the time or realise (inaudible).
JONNY GIFFORD:
What do you think it was about the design of the school that made a difference? The School for Health
and Care Radicals, as I was saying before, particularly social learning. What do you think it is about
the school that helps people?
STELLA MARTORANA:
First of all, it was e-learning. The exchange of views and supporting other people in the online
community. There was plenty of opportunity for connecting.
(inaudible)
In other NHS countries or other organisations, not only in the workplace.

JONNY GIFFORD:
Yes, great. Thank you very much, Stella. I'm going to be joined now by Adrian Osborne. Adrian is
communications director at Shrewsbury and Telford Hospital. He is going to talk in particular about the
use of social media in a project called breaking the cycle. Over to you.
ADRIAN OSBORNE:
Hello, everybody, really delighted to join you today. I'm a board and exec member of an acute hospital
trust in the Midlands. One of the big messages from me in my learning is if you are a health care
radical, look for radicals everywhere.
We are here as part of the executive team and we need your help. We can provide a lot of support as
well.
My experience was I got involved in the school, nationally, but I found it tough to fully get involved.
What kickstarted it for me was we started our own local school within the trust. We have had 24 people
get involved in the school, specifically within the trust and our local partners.
It was so successful that we are relaunching it, we're going to do another one starting at the end of this
month. It has been really good to help people develop their ties across the organisation. And to make
sure we harness our radicals, rather than them being troublemakers.
My particular experience, some of you may be aware of the initiative known as Breaking the Cycle. If
not, I will put some tweets out later with some links to what I have mentioned today. The idea of
Breaking the Cycle is to disseminate healthcare systems to do something different.
Primarily to improve the flow, but overall that aims to reduce delays, reduce cancellations, improve
patient experience. It involves one week of concerted action to try and change care for the better.
For me, at the heart of a successful Breaking the Cycle initiative is staff engagement. I don't mean
involvement, I mean true engagement, you've got to work with people's hearts and minds. People
feeling enthused, empowered.
When I spoke to people in the country about what they had tried, the things that shone through making
a successful was when it truly had been a social movement.
What I started to see locally, and my heart sank a bit, I started to see traditional planning process.
Writing a detailed project plan, it felt very top-down about what was going to happen in the week.
I was asked to write a project plan and a Gantt chart about how I was going to turn into a social

movement. I just thought, "You have not really quite grasped this, it is only a social movement if it
really is. You cannot tell people to have a shared purpose."
You have got to work with their passions and motivations to create that as part of what they're doing.
What I feared was we were going to be asking colleagues to undertake one week of heroic efforts. To
make all of these efforts to improve flow, it would be based on top-down, prescribed actions.
We would get unsustainable returns, people would feel they worked really hard, may change, come
back from that and never see those benefits lasting in any way whatsoever.
The risk was, instead of breaking the cycle, we would just be breaking the spirit. I thought, "How can I
do something different?"
The first thing I did was have five randomised coffee trials, just tested out where I was. Am I just being
a troublemaker? Getting the right end of the stick or are there other people with me who want to try
doing this a different way?
The short answer was, yes, and that helped to inject some new ideas. Moving on from that, building on
the tools and techniques on what I had learned, I was learning in the school.
I used both in my formal networks and my informal networks to develop ideas further. My core
question was, am I going to be dancing alone on a hillside, or are they going to be other people
dancing with me?
It was so useful having connections from the school to help keep me grounded, really. Again, I have to
recognise, I am a director of an organisation and the risk is it always becomes a leadership message
rather than an engagement approach.
The school helped it feel more like a colleague asking for feedback, rather than, "I am the director,
what I say goes."
It was really important to build on people's own sense of purpose rather than feel it was directed from
above.
Through that, it helped me realise a lot of other people were really keen to make this feel different from
what we felt it was going to turn out to be.
What we decided to do, we just launched a social media channel and use that as a way to encourage
people to share their thoughts and ideas.

And really quickly, it might not seem enormous, but we had well over 200 people participating. Over
500 frontline members of staff sharing their selfies, what they could achieve, what they wanted to bring
about in the workplace.
A lot of human engagement, rather than just being words and ideas. It was colleagues right across the
health care system, talking in real time about how they felt they could make a difference. What they
wanted to change.
I think that sent out a really, really strong message to the hierarchical leadership to say, "Actually, we
have the passion, we have the ideas, let us bring our ideas to the party rather than just do the things
you are telling us to do."
We had hundreds and thousands of timeline impressions. Hopefully we overcame what risked being a
burden of bureaucracy to a bit of a buzz. As an ancillary benefit, the number of people I am now
connected to in my organisation has quadrupled through Twitter. For me, in my job, it has had a lasting
benefit.
So, that, in brief, was the story and experience. Jonny, anything else you would like me to expand on?
JONNY GIFFORD:
Thanks very much, Adrian. Really interesting story. Having read the case study of your summary, I
know that as well as taking part in the school yourself, you are getting other people in your
organisation involved.
You were having face-to-face meetings in the School for Health and Care Radicals, doing Yammer
activities. For anyone not familiar with Yammer, it is an in-house Facebook for your organisation. I
suppose the question in my mind, Adrian, what wider impacts did you see from the school on other
people in your trust?
ADRIAN OSBORNE:
It is really great to have that in our organisational ties. One of my colleagues works in therapies, for
years she struggled to make a case for change in a patient pathway.
So, she used us as a support and challenge network. On the one hand, it ended up actually changing
her ideas for change, and allowing ways for her to rethink it. On the other hand, it developed her
tactics for negotiation, not being scared of "no", recognising the parts of the story she may be was not
telling to people.

That was something I found for myself as well. There is an important part of self-awareness for me in
the school, which is, I will be honest, I'm an INTP, which makes me an egghead. I'm the kind of person
who understood what Pierre de Fermat wrote in the margins of his book.
But trying to explain to people and bringing them along on a change journey, I risk being overly
analytical. For me, the school has reminded me to tell a human story. Not just tell a story, but get
people involved in creating that story and telling it themselves.
Really good insights for me.
JONNY GIFFORD:
I'm trying to think what INTP is. I have a pet theory that there is a type of person who is a bit obsessed
by Myers Briggs. So, that is you? It all fits. So, basically, it worked a bit like, a support and challenge
network. Almost develop an action learning set, or a coaching network.
ADRIAN OSBORNE:
Absolutely. We will start to spread that more widely, and connect more people together in a grass-
roots, grounded way.
JONNY GIFFORD:
If you were to summarise thinking about operating in your role as a board member, what would you
say you have learned most from your experience at the school?
ADRIAN OSBORNE:
I think... It might seem strange in the leadership role, but it is easy for me to be a little bit cautious
about making the wrong decision. So, there is that they seem about going for no, but using the
strength of ties, nonhierarchical conversations to test ideas to give me the confidence to say, "Yes, it is
a good idea. We're going to go with this."
Also, it was a real reminder to encourage and support my own team to focus less on doing things, and
focus more on enabling others as well. It is about that change in mentality. My own background is in
community development, health promotion.
That feels like a good couple of decades ago now, and the school really reconnected me with exactly
why I do this job.
JONNY GIFFORD:
That is great. Looking at the chat, there are a couple of comments. Someone is saying, "Let us bring
our ideas via social media. It is a great idea for staff."

What you have done certainly relates to previous research we have done at CIPD looking at the
potential for using social media within organisations. Organisations are good at using social media to
reach out to customers but not necessarily good at using it to harness the ideas within the organisation
from employees.
Would you say this has helped you as an organisation take you on a journey towards being a bit more
socially enabled in general, not just about breaking the cycle program?
ADRIAN OSBORNE:
Exactly. That, for me, has been an enormous benefit from doing this piece of work. As I said, I am now
connected with hundreds of my colleagues through social media. Some dip their toes in and out, some
are much more ever present. I will be honest, trying to share an idea or develop thoughts or ideas
across an organisation, I can connect far more quickly with far more people through Twitter than I can
through traditional team briefs and staff meetings and things like that.
Because, actually, I can have a very human, real-time conversation with people on our own terms, and
then they are having a much more real conversation to take back to their colleagues, and it is not
about hierarchies and top-down team briefings, it's about, "This needs to be an organisation that
encourages conversations for change".
JONNY GIFFORD:
You talked about the weak ties, can you expect a bit more what you mean by that?
ADRIAN OSBORNE:
As a director, I can easily see sideways relationships with other directors and more vertical
relationships with my team members. But I can only do my job if I am able to have a very equal
conversation with anybody.
I take it back, to be honest, to my days as a smoker. My conversations in the smoking shed put me
more in touch with what was going on than anything else. I miss it in some respects but not in others.
Just being able to connect with anybody in any role outside of formal things that sometimes can tie an
organisation down.
JONNY GIFFORD:
Yeah. Thank you very much. Just looking again at the chat box. I think we have sparked a whole flurry
of debate on Myers Briggs types, which is interesting! Jodi, do we have anything on the Twitter feed
you would like to pitch in with at this point?

JODI BROWN:
Hello, Jonny, can you hear me OK?
JONNY GIFFORD:
Yes, thank you.
JODI BROWN:
Twitter is in awe of what Adrian has been talking about. Just hearing from somebody from the board I
think is really important. For a lot of people, it gives them hope that things can be different. There is
somebody who is listening at that level. So, thank you to Adrian. I think it has made a big impact.
Generally, we are including a few people in the Twitter chat who are not in the WebEx itself. We have
a few clinical staff tweeting in between their clinics and sessions. Just really positive responses. It's
great there has been an evaluation, it's great we can see these outputs and impacts. Let's keep it
going. There's a real energy out there.
Thank you to everyone who has spoken so far. It is really appreciated in the Twitter world.
JONNY GIFFORD:
Thanks very much for that. Thank you, Adrian, for your time and for joining us this morning.
I will now bring in David Ellis. David is a public governor at Birchwood, Rixton and Woolston
Warrington and Halton Hospitals NHS trust. Are you there?
DAVID ELLIS:
I am here, Jonny. Thank you for the intro. Everybody might not be familiar with what the public
governor is, so in a moment I will give a very quick summary of what we do as governors. It goes from
the board to the other here because public governors are really in a voluntary role, and we are not
staff.
I am really pleased to be able to present this particular case to you. The story today is about
identifying, involving and supporting unpaid family carers in a hospital environment, and it's something
which I am extremely passionate about. It's a very important project, really, for the hospital, which can
bring huge value.
A quick bit of background about myself because this is a bit of an unusual one, as I said. I am a
volunteer. I retired several years ago from a global marketing management position with the large
American multinational General Electric. But since then I have been involved with a range of

consultancy positions with charities, and I had my position as a public governor at Warrington
Hospitals as well. It is voluntary work that I do but I try to do things that can add as much value as
possible.
Our function as governors is to hold the Trust board to account. We are there as representatives of the
public. We are not operational in any way whatsoever. Those are the responsibilities we have, and we
have a responsibility for seeking views from the public and feeding back information about the trust to
them.
I have a special interest in this project of supporting unpaid family carers, really, through my wife who
actually works for the national charity, Carers Trust. My story today is about how the School for
Radicals was critical in helping us to relaunch a strategy because we had started on it and made some
good progress, but then the thing came to a little bit of a halt.
The story started about three years ago when I was chatting with a director of nursing at the Trust
about carers. He asked me if I would be prepared to lead a project to create a carers strategy for the
Trust and to put together some kind of an action plan which would help to implement it.
So, I got to work on that. We got together a multiagency steering group and will involve a wide range
of people in that from the Trust, from the local authority, from local carers organisations, etc. I was
trying to involve as many different people and groups as we possibly could to get the best input and
also to look for best practice across the country wherever we could find it, and we made some visits to
some other trusts to see what they were doing.
As a result of all of that, we put together a detailed carers strategy and an action plan, and that was all
approved by the board and became an official hospital document, etc.
But then I handed it over to the Trust because one of the issues, in a way, was as a governor we not
operational so I couldn't actually do anything within the Trust once it was handed over. But, in some
ways, that was perhaps a bit of a mistake because it really perhaps still needed the leadership for a
while.
I just wanted to say something about this whole question of supporting carers because I am really
passionate about it because it's a project that can produce lots and lots of wins because it is a win for
the patient. If the hospital is getting input from the family carer, it means they can be looked after
better, their condition can be better understood, and it can improve outcomes.
It is a win for the carer because they can be put in contact with support that is vital to help them
continue in their role and to stay well because many carers and up quite ill because of their caring

responsibilities.
It is a win for staff as well because it makes their job just that little bit easier. It is finally a win for the
Trust because it can help reduce length of stay and readmissions.
There are wins all round. It is a no-brainer in many ways. We talk a lot about person-centred care, and
if you are not involving family carers in the process, then we are really missing out.
So, when I handed over the project to the Trust, there were a few actions that took place. We did some
presentations and things, etc. But after a number of months, not much really had happened. We had
generated a few pockets of best practice. But it really hadn't taken off as I would have hoped.
I think partly because it was not approached in quite the right way, and people have so many
conflicting demands in the NHS today. It is really, really tough. So, it is not an easy one.
I actually had some significant experience of change management at General Electric. I wouldn't like to
say I am an expert because I am not, but the thing in General Electric was there was always an
expectation that change would take place following discussions. It just happened. It was a place where
change was just a constant, really. People expected it, and when things needed to be done, they were
just done.
I wasn't really quite sure how to proceed. As a governor who is not operational, I think it may get that
little bit more difficult. But the answers came to me from the School for Radicals, and it was actually
my wife who pointed it out to me, and I attended the modules and really learned a lot from it.
What did I do to change the situation, how did I approach it? Well, I needed really to reignite a sense
of urgency that change was needed. So, the first thing I did was to approach our deputy director of
nursing at the time, Alison Lynch, and she is really the kind of person who is a change agent herself. I
knew she would be quite receptive to what I had to say.
What I did was I took a story to her, a story about a carer who had been very unhappy about being
excluded from discussions about the care of his mother, who had been a patient on our best practice
dementia ward. We have an absolutely fantastic dementia ward but this guy hadn't been involved in
discussions about his mother. As a result, the care that she got wasn't what it could have been.
This story really struck a chord with the deputy director of nursing. It rocked the boat, really, and she
really understood what I was getting across, but I went to her with some solutions as well. I went to her
with what I thought needed to be done.

We put together a plan for a workshop which could help start things. We came up with different roles
and people who we thought could form an alliance for change. The alliance came together in the
workshop in July, and I enlisted the help of Juliet Ellis of Carers Trust, who happens to be my wife, to
help me design and deliver a workshop programme.
She is actually a School for Radicals attendee. She is a fellow radical. We used some really powerful
stories to engage the attendees at that workshop and encourage ideas on not just what needed to be
done but how it would be done as well.
So, the content of that workshop was very much driven by the training that we had at the school for
radicals. As an example of that, we started off the workshop with a really powerful video of a carer's
story who had had some really serious problems in a hospital environment. It really got people
engaged, and we basically asked people in the workshop to put themselves into the position of that
carer and say what they thought went wrong and what they would have liked to have happened if they
had been that carer.
I think that engagement that we got from that was really powerful. We followed it up with another video
of another story from another carer, which was a positive one, and it really concerned to them that the
points that they had brought out in their own workshop discussions… So, I think it worked extremely
well. At the end of it, every single one of the 18 attendees at the workshop agreed that it was critical
that we drive the project forwards together.
We are still at an early stage of the project, but I am absolutely confident now that we have a number
of change agents in the organisation who are going to make sure that the whole thing happens, moves
forward now. If it hadn't been for the school, I don't think it would probably have happened. So, thanks
to the school. Jonny, have you any questions you would like to ask me?
JONNY GIFFORD:
Thanks very much, David. Just seeing some of the comments coming in here. It is really interesting
hearing you coming from a very different background from General Electric in your career. What would
you say are the core lessons you have taken away from your experience that is new and different from
the kind of change management approach that you learned in a private-sector career?
DAVID ELLIS:
In General Electric, they have a change management process, it is a very structured thing. That is
probably true of a lot of things at GE, they are very process driven.
But, of course, the NHS is a very different animal in many ways. The softer elements of engaging
people, the emotional engagement, are much, much more important in a way.

Having said that, I think they could learn from it as well. I think when you have people emotionally
engaged with something, they're much more likely to drive the change, and drive it more quickly.
I think that is a really important learning, really. The school really, for me, made a huge difference.
When the thing started to stall, I think I got a little bit disheartened in some respects. Because I was
using change management techniques in a way, but it was missing the emotional connection.
Once I got that and attended the school, it really did change the approach we were taking and it really
did have an immediate impact and convinced people of the need to change.
JONNY GIFFORD:
It is interesting. It is a bit of a mantra, a cliche, that the private sector has much to show the public
sector. The public sector need to learn from the efficiency of the private sector. Really, there is a great
deal that private sector organisations could learn from a lot of what goes on in the public sector as
well.
I think the School for Health and Care Radicals is one of those such thing.
DAVID ELLIS:
Definitely, I don't think there's any doubt about that. It is not there was anything wrong with the process
at GE, but by adding those extra elements, it really makes it so much more powerful.
Things happen very quickly. Sometimes, as an outsider to the NHS, you can think things are quite
slow. There, they're very quick, but I think they could have been even quicker had those elements
been incorporated into the change management process.
So, yeah. Anybody that is interested, the whole aspect of carers' support is a really important one in
the hospital and violent. It is one which is perhaps, it has not been looked at as much as it could be
across the country.
If anybody wants any help or support on that front, please don't hesitate to get in contact. My Twitter
handle is @david_m_ellis.
My wife and I, there's quite a lot we can do. She leads projects in primary care for Carers Trust. She is
also working with pharmacists, and working with the pharmaceutical services negotiating committee to
help identify carers through pharmacy.
It would be great if we could identify more carers and put them in touch with support through hospitals

as well.
JONNY GIFFORD:
Thank you, David. I noticed one of the comments earlier was saying, what a fantastic idea to have a
public board. Perhaps you could also put out a tweet or two later with the SHCR hash tag so people
can connect with you.
DAVID ELLIS:
I will indeed. Incidentally, following on from Adrian's presentation before, one of the things we're trying
to set up at the moment is a Yammer account for all the people involved in this carers change
management project, as they means of communicating more effectively.
I think that can really work well.
JONNY GIFFORD:
Thank you, David. Anything else from Twitter that you are seeing that you would like to chip in with,
Jodi?
JODI BROWN:
Sorry, I couldn't take myself off mute there for a minute. Really echoing the discussion you have just
had. Tim Wilson, our friend in the USA, said, "You change culture with the stories that are told."
I came from a trust last year as a staff governor, and I really wish I had it public governor working
alongside me like you, David. Thank you for the offer of support, I will feed that back.
JONNY GIFFORD:
Thank you. I'm going to be joined now by Ksenia, a colleague of mine at CIPD. I think it is very fitting
we have been hearing stories about the school.
The school itself highlights the value of storytelling. We all know we need, as well, more representative
data if we are to understand the impact within organisations.
People will say it is all good and well hearing individual cases, but what is the overall, wider scale
impact? That is the survey research that Ksenia is going to talk us through now.
KSENIA ZHELTOUKHOVA:
Hello, everyone. One of the objectives we had was to quantify the impacts that the school could have
on individuals in the organisation. The way we did it, we ran two quantitative surveys. One was run
before the school started.

We sent out links to everyone who signed up to the school. What we wanted to do with that data
collection was establish a baseline.
Where were people before the school, what was their level of knowledge about change, what was their
confidence to lead change in their organisation?
Six months after the start of the school, we ran the survey again, sending out the same questions, plus
a few measures around the process to the same individuals.
We compared the results of the second wave with the baseline data, it allowed us to see whether any
change in individual outcomes had happened six months since the beginning of the school.
In total, we managed to get 113 responses. It was quite crucial for us that we got the same people
responding to both surveys. In that way, we would be able to see the change that happened to a
particular individual.
One of the first things we are interested in was the satisfaction on the experience of the school. The
process of how the school is set up, the delivery of the modules and the content of the online webinars
and material.
Overall we had a very high level of satisfaction. The experience of webinars and other aspect of the
course. Eight out of ten respondents said they would recommend the school to others. They have
actually talked about the school to their colleagues in a positive way.
Three quarters of the respondents shared learning with others in their organisation. What that tells us
is not only is the learning of the school useful, it is something worth sharing.
And it is spreading within the communities where the learners are operating. One interesting insight
with regard to content and satisfaction with the experience of the school was the different types of
participants found different value from the school experience.
For example, we knew those who started the school with lower levels of change leadership skills,
those less confident in their ability to lead change, or who did not know much about change theory,
they found they got more out of the school content compared to some of the learners who were
probably more experienced in this area.
In particular, this was obvious in the comment of people returning to learn for the second year.
Potentially, they did not get as much in terms of new content, but that had the value they gathered
from the school was in terms of community, and reminding and refreshing the knowledge they already

had.
We recommended that in the future, the team considered three specific areas that came out as part of
the feedback on the school experience. One was the timing of the modules.
All of the modules happened at a certain time, in UK time zones. We know some of the participants
found it not very convenient for them to dial into the modules at that particular time.
We also know that people who could not access modules live could listen to the recordings of the
webinars, and they found that useful. It is something to consider in the future of the school. Another
thing to raise is access to technology.
We discovered in some organisations, even the NHS, access to WebEx and social media is
impossible from your workplace. In the future, the school could consider different channels of
interacting with participants and delivering material via different formats.
Finally, a lot of learners told us about the value of the social aspect of the school. The ability to link
with others via social media, in particular, Twitter, but also through online chat like the one we are
using now.
That wasn't the same for everyone. What we found through the survey, some people are less
comfortable engaging with social media, particularly if there is already an established community of
healthcare radicals.
Entering that conversation might be daunting. Some of the learners requested the school provide more
guidance on how to start conversations on social media and how to share ideas and experience with
other learners in that social community.
But overall, a very positive experience with the school. One of my favourite comments, "It did not feel
like a course, it felt like an experience as a whole."
In the main section of the evaluation, what we were interested in was the change of individual
outcomes as a result of participation in the school.
We measured those outcomes across five areas. If you listened to the modules or took part in any of
the school experience. What we see here is the positive increase, an incremental increase in all of the
five areas that were measured.
I wanted to draw your attention, in particular, to three of these areas. The greatest outcome was in

knowledge, theory of change. From 4.5 out of 7 to 5.6. Participants found useful the theories from
leaders.
The sense of purpose and motivation. The bars on the very left show perhaps not as much of an
improvement, preparing the baseline data to after six month.
What is interesting is the type of people who joined the school. The high levels of motivation before the
school started, showed us it is a particular type of learner who wants to participate in the School for
Health and Care Radicals. People join this community because they're already motivated to make a
difference in their organisation.
The final area of change was staying in the boat. Here the change is very slight, we did not find a
considerable change in this area comparing before and after survey data.
It is possible because of the main focus of the school is on radical change and engaging people with
the idea of leading from the edge. The staying in the boat part is not actually visible as part of the
school learning, as some of the other aspects of the course.
We recommend in the future that the school focuses more, and perhaps there is more discussion
around this very important area of leading change. Not being a troublemaker, but being a rebel.
The same way we measured the five outcomes at the individual level, we also looked at the levels of
energy before and after the school. We focused on three levels. It was social energy, for dealing with a
sense of community, whether you feel isolated or connected to the community of radicals.
Psychological energy, so feeling safe to initiate change in your organisation. And also having
resilience to persevere with change. Funnily, spiritual energy. Everything to do with having a sense of
shared values with the organisation and with the radical community.
We have seen significant change in all of these three areas as a result of the school. The greatest
improvement in terms of incremental change was in the area of psychological energy. From 4.67 to
5.1. It looks at resilience and feeling safe and confident to initiate change.
This might be linked to the idea of rocking the boat and the motivation we talked about before. Clearly,
the school has the ability to galvanise the motivation to start change and also provide a sense of
feeling safe around this through engaging people in a community of like-minded individuals.
A few comments on the next slide that again demonstrate that different types of learners have different
types of value through the school experience. For some, this was more to do with self awareness and
understanding better how you, as an individual, can lead change and engage with others in the

change process. Others valued more the social aspect of the school and being able to share their own
experience and learn from others.
It is great that the school provides this range of different experiences and the ability for learners to
choose and take the types of values that they are seeking through the school.
Overall, the change we have seen in before and after the school for the individual outcomes showed
us that the main impact of the school is driving this change agent capability that was described through
knowledge about change leadership, the skills to the change, but more importantly the soft aspects,
confidence, resilience, perseverance.
It was important for us to connect that individual level impact to any sort of organisational impact that
might happen as a result of the school. It is too early for us to say there has been considerable
financial savings because of the school.
The main insight we got by trying to understand the type of organisational level change that happened
because the school is that the learners may have started to see their organisation differently.
The first statement on this slide, in my organisation it is acceptable to challenge the status quo. People
became more tolerant to change leadership and it is also likely people see their role in an organisation,
their place in the change that happens in their organisation differently. They see their organisation
environment more open to change leadership.
Another interesting insight here was linked to the statement, "I would recommend care at my place of
work to friends and family." It is interesting that the comments on the chat say that too many people
move on in the NHS, and this is what we found could be a potential impact of increased motivation for
change agents.
"I feel like my change leadership or my motivation to change is there for a bigger purpose, I have a
motivation to make a difference in my organisation." That was negatively linked to recommending care
at my place of work to friends and family. They are less likely to see their place of work as somewhere
they want to engage with. They might want to move on to a different organisation.
It is important that the staying in the boat part compliments the rocking the boat part.
These findings provide a topline of what the evaluation discovered as part of the survey process. More
will be available in the report that will be published later this year.
JONNY GIFFORD:

Great, thank you very much, Ksenia.
Looking back at that last slide, it is interesting, isn't it, how organisational level impacts can be difficult
to interpret because as a result of going through the school, even though we have these pre- and post-
measures, people's perspective on those measures can change. The integration itself can have an
impact on the measurement tools you are using.
KSENIA ZHELTOUKOVA:
Yes, in a perfect experiment, we could control for people who have and haven't attended the school.
We could compare the same individuals who completed the survey before with the same individuals
after. It would have a level of control but not complete.
JONNY GIFFORD:
Theoretically, you could bring in other measures as well, triangulating it by getting people's bosses and
colleagues to rate individuals as well, that it gets messy.
KSENIA ZHELTOUKOVA:
What would help is to get qualitative data as well as case studies and quantitative data. Things like
confidence are not easily captured, but we can try and understand what people experienced as a
result of the school.
JONNY GIFFORD:
That's great, yeah. Overall, just reflecting on the survey, the impact survey findings, what did you find
most striking about them? Was there anything surprising, that stood out as most important as a lesson
to learn?
KSENIA ZHELTOUKOVA:
What was evident was that there was an improvement in all areas of the school's impact, at least some
improvement, and that links to what you were talking about before.
It is not simply people gain skills or they are better at change edition but they stuck to see themselves
and organisations differently. As a result, they might become more confident in how they deal with
different aspects of change leadership.
JONNY GIFFORD:
These five factors are significant, even the small ones, statistically significant.
KSENIA ZHELTOUKOVA:
We can see that change has occurred in all of these areas. In some areas, greater than others, but it is

quite important that the school is having an impact in all of these areas.
JONNY GIFFORD:
It is interesting which areas have had more impact than others. I can't help wondering whether some of
these are naturally harder to shift than others, for example, I suppose it is easy to look in retrospect
and explain in hindsight stuff that is evident from the data you see, but I imagine increases in
knowledge are easy to bring about than the behavioural stuff.
KSENIA ZHELTOUKHOVA:
Exactly. That is evident in the staying in the boat thing. We developed the survey, it was difficult to
express in words what that means. It is even more difficult for participants to reflect on whether change
happened in that area. As you say, any behavioural change would take time. This is something that
the school would like to work on further and perhaps the community of radicals can work on further in
their groups.
JONNY GIFFORD:
We have got 5 minutes left. We have just got a warning from Paul. Jodi , any comments or questions
from Twitter you would like to bring in?
JODI BROWN:
Twitter has been quiet over the last few minutes because they are listening so intently. Just some
comments about Adrian and David's talks earlier.
JONNY GIFFORD:
Great. In that case, we will wrap up there. If I can get back to our slides...
Really, I would just like to say thank you to all of the contributors. Thank you to the NHSIQ, the
Horizons team. It has been a real pleasure to work with you. Get in touch if you have any questions
about the research. Horizons team in the first instance but we would be happy to join conversations.
Look out for the reports which will hopefully come later this month.
I will hand back to Janet, I think, who will pick up now.
JANET WILDMAN:
That's right. Thank you very much, Jonny and the team, and to Adrian and David. Really exciting talk
on the school.
I would like to point everybody to the next Edge Talk which will take place on 4 October. Really

exciting. Please join us then to hear their conversation.
I would like to say thank you to Jodie and Dominic and Carol for their support today. Thank you to
everybody and have a good weekend. It looks like it will be lovely and sunny. Do enjoy. Take care.
PAUL WOODLEY:
Just to quickly let everyone know that the next Edge Talk is on 2 October, not 4 October.
JANET WILDMAN:
Thank you, Paul. Goodbye everyone.

Transcript from CIPD Edge Talk on 04/09/15

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