the power of one: the power of many: what healthcare improvement can learn from social movements

@HelenBevan #Quality2017

The power of one: the power of manyWhat healthcare improvement can

learn from social movements

Dr Helen Bevan, OBE@HelenBevan @HorizonsNHS #Quality2017


The Horizons team:Change agents and change agency

• A small, diverse team of people within the English National health Service that supports change agents and builds change agency

• We tune into the latest change thinking and practice in healthcare and other industries around the world

• The team has emerged through years of supporting change in the NHS and the wider health and care system


“When we talk of social change, we talk of movements, a word that suggest vast

groups of people walking together, leaving behind one way and travelling towards

another”

Rebecca Solnit


What do successful social movements do?

• Define the change they want to see

• Identify the pillars of power

• Create a spectrum of allies

• Seek to attract not overpower

• Build a plan to survive victory

Source: Satell G (2017) How to create

transformational change, according to the world’s

most successful social movements

http://www.digitaltonto.com/2017/how-to-create-transformational-change-according-to-the-worlds-most-successful-social-movements/?ct=t(Transformational_Change3_12_2017)


“We must act with all due alacrity [speed/swiftness], yet also with the thoughtfulness

and seriousness of purpose appropriate to meaningful action”

Dr Martin Luther King Jr.


If we want people to take action, we have to connect with their emotions through values

action

values

emotion

Source: Marshall Ganz


“I have some

KPIs for you”

or

“I have a

dream”

Source: @RobertVarnam


Makin sure that only people who should be in hospital are in hospital• The number of hospital beds occupied by

patients whose transfer of care has been delayed should be reduced to 3.5%

• Less than 15% of assessments [for continuing care] should take place in an acute hospital setting;

• a performance dashboard is being introduced


Royal Devon and Exeter Hospital


East Sussex Healthcare


“Because we want to, not because we have to”

Starts on the fringe

(at the edge)

Starts with the activistsGary Hamel

always

14,000 contributions identified 10 barriers to change:

Confusing strategies

Over controlling leadership

Perverse incentivesStifling innovation

Poor workforce planning

One way communication

Inhibiting environment

Undervaluing staff

Poor project management

Playing it safe

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge”

http://www.hsj.co.uk/leadership/change-challenge/


Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on

Increasing number of messages as information cascade through

the organisation

Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx

http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx


Identify the pillars of power


We still organise health and care like the Tabulating Machine Co. of 1917

Source of image: @corp_rebels


Jeremy Heimens, Henry TimmsThis is New Power

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

http://thisisnewpower.com/


Create a spectrum of allies

Source of image: Greg Satell


WHO will make the change happen?

List A• The Delivery Board

• The programme sponsors

• The Programme Management Office

• The Delivery Board work streams

• The Clinical Leads

• The Directors of participating organisations

• The Change Facilitators

Source: adapted by Helen Bevan from Leandro Herrera

http://leandroherrero.com/people-who-perform-and-live-in-formal-org-land-and-people-who-have-makebreak-power-two-different-lists










List B• The mavericks and rebels

• The deviants (positive). Who do things differently and succeed

• The nonconformists who see things through glasses no one else has

• The hyper-connected who spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on

• The hyper-trusted. Multiple reasons, doesn’t matter which onesSource: adapted by Helen Bevan

from Leandro Herrera











List B• The mavericks and rebels

• The deviants (positive). Who do things differently and succeed

• The nonconformists who see things through glasses no one else has

• The hyper-connected who spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on

• The hyper-trusted. Multiple reasons, doesn’t matter which ones

Source: adapted by Helen Bevan from Leandro Herrera



What’s the evidence?The failure of large scale

transformational change projects is rarely due to the content or

structure of the plans that are put into action

To make transformational change happen we need to connect networks

of people who ‘want’ to contribute

http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-257163-Campaign+-+01%2F09%2F2016

Source: David Dinwoodie (2015)

It’s much more about the role of informal networks in the organisations and systems

affected by change

http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-257163-Campaign+-+01/09/2016


Mark Jaben on the science behind resistance

What NOT to do

But what we do do

Engage people here


Mark Jaben on the science behind resistance to change

What NOT to do (but what we usually do)

We don’t need buyers (who “buy-in” to change)We need investors

What TO do

Engage people here

Engage people here

@HelenBevan #improvedischarge

Seek to attract not overpower


To enable change, connect with the 3%

Just 3% of people in the organisation or

system typically drive conversations

with 85% of the other people

Source: research by Innovisor


• Did we accomplish the goal we were trying to accomplish?

• Did our community grow stronger? (create capacity; new power – power we didn’t have before)

• Did individuals involved in the whole effort learn, grow and develop their capacity to organise with others?

How would we know if our digital transformation efforts were successful from a social movement perspective?

14,000 contributions identified 11 building blocks for change:

Inspiring & supportive leadership

Collaborative working

Thought diversityAutonomy & trust

Smart use of resources

Flexibility & adaptability

Long term thinking

Nurturing our people

Fostering an open culture

A call to action

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

Challenging the status quo

http://www.hsj.co.uk/leadership/change-challenge/


After years of intensive analysis, Google discovered that the key to high

performing teams that deliver change is being nice

Project Aristotle: https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-

xoaZybvz9f0b1_6bJyG7zZO6L

https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-xoaZybvz9f0b1_6bJyG7zZO6L

@HelenBevan #improvedischarge

“If we take care of the relationships, the results will

follow”Chip Bell

Bridge building leaders

http://leadchangegroup.com/are-you-a-bridge-building-leader/