California presentation March 2015 final version used in Disney

@jackielynton
Jackie Lynton
Creating a contagious
commitment for change
…..

@HelenBevan #SHCR #QF15
The Horizons Group
within NHS Improving Quality
Aim of the group: to stimulate new and ‘disruptive’ approaches in
support of health and care transformation, operating at the edge of
current thinking and practice:
1. how to create radical, system-wide
change
2. working with emerging leaders, clinical
trainees, students
3. open innovation, open source, digital
connection, social media, change
platforms, hacking
“You
can’t cross a
chasm in small
steps”
David
Lloyd George

@helenbevan#SHCR @School4Radicals
http://www.theedge.nhsiq.nhs.uk/school/
1. Change starts with me
2. Forming communities: Rolling with resistance
3. Building alliances for change
4. Making change happen
5. Moving beyond the edge

• Being an effective
change activist
• Transformational
leadership
• Thought diversity
and disruptive
innovation
• Scale and spread of
change
• The new methods
for change

@HelenBevan @JackieLynton #mixmashup
Four ways to connect with us!
1. Follow on Twitter @Jackie Lynton
2. Subscribe to
3. The School for Health and Care Radicals:
@School4Radical
4. Engage with NHS Change Day
www.ChangeDay.nhs.uk
www.usachangeday.org
TheEdge.nhsiq.nhs.uk

@HelenBevan
Five enabling themes in change and
transformation www.nhsiq.nhs.uk/whitepaper

Agenda
1. What is happening in the world of
change?
2. Rocking the boat and staying in it
3. What is your story?
4. A disruptive case study: NHS Change
Day
5. Twitter: @jackielynton @transformkp

The NHS is the 5th biggest employer on
the globe
Source: BBC

Community
Call to attention Stay with the process

@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Activity
Introduce yourself to others at your table. Tell a
quick story that demonstrates why you chose to
come to this workshop today.
Time allowed: 10 minutes for the whole table

What is happening in the world
of change?
Source of image: from guardiansprayerwarrior.com

SEISMIC SHIFTS
Change from the edge

is the new normal!
“By questioning existing ideas, by
opening new fields for action, change
agents actually help organisations
survive and adapt to the 21st Century.”
Céline Schillinger
Image by neilperkin.typepad.com

#NHSChangeDay #SHCRchat
Why is change needed and what needs
to change?

Why do we need to change
and what needs to change?
Discuss in your community
ACTIVITY

@HelenBevan Source of image: Whatsthebigideascwartzy.blogspot.com

@HelenBevan
Most large scale change doesn’t fully
deliver its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
70%
25%
5%
Gets anywhere near
achieving the
change and
delivering the
benefits

@HelenBevan
Most large scale change doesn’t fully
deliver its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
70%
25%
5% Delivers and
sustains the change

@HelenBevan
Many of the ways we go
about improving health and
care were designed in a
different mindset
for a different set of
circumstances
We are operating with
20th century change
practice in a 21st
century world
Source of images : http://www.slideshare.net/dachisgroup/dave-gray-
the-connected-company

Leading change in a new era
Dominant approach Emerging direction

@HelenBevan
Most change efforts are built upon the shaky foundation of five
flawed assumptions;
1. that change can be managed
2. that human beings are objective
3. that there are ‘X’ steps to change
4. that we have a neutral starting point for change
5. and that change, itself, is the goal
Peter Fuda
http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-
Change-Efforts-Fail.pdf
Source of image: Whatsthebigideascwartzy.blogspot.com

Leading change in a new era
Dominant approach Emerging direction
Most policy efforts
are driven from this
side

John Kotter: “Accelerate!” most influential thought leader
globally, recognises new approaches are needed
• 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
• Changing our mindset
TO
FROM

Must
do
Want to
do
Kotter: From “have to” to “want to”

“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
Embracing difference to change the
conversation

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

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
strong ties (cohesive)
v.
weak ties (disconnected)
Source of image:brucemacvaresh.com

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”; Physician to Physician,
nurse to nurse, gynaecologist to gynaecologist
• 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, nurse to
nurse, gynaecologist to gynaecologist
• 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
ACTIVITY

Strong and weak ties
When we seek to 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, nurse to nurse,
gynaecologist to
gynaecologist
• Influence is spread through
people who are strongly
connected to each other, like
and trust each other
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
• our aim is to mobilise all the
resources in our organisation,
system or community that can 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
• 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 will come when we tap into
our weak ties
History suggests that weak ties will probably give us the best
chance to deliver large scale improvements in a challenging
timescale

You get the best effort from others not by
lighting a fire beneath them, but by
building a fire within
Bob Nelson

What lights the ‘fire in your belly’ and makes you feel
passionate and determined to make change happen?
ACTIVITY

Connecting to other people values and emotions

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

What is strategy?
Strategy is the process of turning
the you have into
the you need to win
the you want

Here have
some of mine!
My
Power
Power
Shifting positional
power to relational

Unleashing the energy
The more you do what you love the more energy you have.
Leadership Freak
Vs

Resources to improve health and care
Economic resources
diminish with use
• money
• materials
• technology
Natural resources
grow with use
• relationships
• commitment
• community
Based on principles from Albert Hirschman, Against Parsimony

@HelenBevan #SHCR #QF15#NHSChangeDay #SHCRchat
“Stages of change”
Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)

@HelenBevan #SHCR #QF15 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? 3 Mins
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

@HelenBevan
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)

@HelenBevan
Three components of framing
• 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 the audience?
Source: Benford and Snow

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

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

@HelenBevan
Call to Action
• A call to action assumes that we can end an intolerable
condition by creating a burning platform from which to
organise our resources and seek commitment
• A call to action finds and builds new sources of power
and so enables change through
• collaboration and mobilisation
• developing leadership
• A call to action unites us around a collective vision and
focuses our energy towards a specific and real change and
a measureable goal

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

Why am I a radical, rebel, maverick?

@HelenBevan
Source : Lois Kelly www.rebelsatwork.com
Sometimes other people see radicals/rebels
as troublemakers
Rebel

@HelenBevan
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

@HelenBevan #SHCR #QF15#NHSChangeDay #SHCRchat
If your horse dies,
get off it
Cherokee proverb
Source of image: fenwickgallery.co.uk

@HelenBevan
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

We need rebels!
•They are 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
•Without rebels, the storyline never
changes
Source : @PeterVan http://t.co/6CQtA4wUv1

@HelenBevan #SHCR #QF15 Source: Rebelsatwork.com
Rebels learn to tell their story

"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

It starts
with me….

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

Creating our narrative
• Challenge: What was the challenge? Why was
it a challenge?
• Choice: What were the choices? Why did you
make the choice you did? Where did you get
the courage or hope? How did it feel?
• Outcome: How did the outcome feel? Why did
it feel that way? What do you want us to feel?

Vivid details

Me at 22 years old

Image from: @TheWorldStories
MY GOAL

• Creating a space for getting ready for change
• Invitation to thinking differently about change
• Share the collective wisdom of people in the
room – 5 minutes of wisdom
Overview
MY
GOAL

Strong sense public service and community

1986
1. I did not feel heard,
supported
2. Let down by my profession
3. I was part of a hierarchical
system that didn’t protect
vulnerable people

Always fighting for change an speaking out

Being open to creating
alliances with others,
and not build silos…..

This picture was taken from
the window of my hotel
room in Scotland when I
asked myself one of the most
important questions

Connecting to What’s important to me?
Alone/Me
Together/We
Building connections and relationships for change

Knowing your purpose

[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

30 years on
1. Staff didn’t feel heard –
‘checked out’
2. Compliance over
commitment
3. Staff not feeling
‘permission’ to make to
make changes

‘Can I really make
the change?’
Will ‘the system’ really
ALLOW me?

When you hit up against this wall, how do you feel
and how do staff feel?

Change starts with me

When you start with ‘me’ - you can see ‘we and us’
1. Cut on the dotted line
2. Rotate 180 degrees

Creating change through connections and
building relationships

Reconnecting with my values

Innovation/ideas is not reserved for someone sitting at
the top of a hierarchy, but driven down to unleash new
levels of engagement
Nurse
Doctor Manager
Social worker
Patient
Carer maker Cleaner
Pharmacist

Now I don’t!
Now I bring my authentic self to work
I had to be
someone else
to fit in

Talk to the person next to you ACTIVITY
• 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

Talk to the person next to you
Have a further discussion
• In terms of the people you want to get on
board with your change project, what will
create a sense of “us” rather than “us and
them”?
• How could telling your story help create the
“us”?
You have three minutes for further discussion as
a pair

Key messages
• Create a “burning ambition” and imperative
for action around quality, improvement and
cost
• Make a relevant case that makes both a
rational case for change and a connection to
emotions, through values
• Frame to connect with hearts and minds and
identify levers for commitment rather than
compliance
• Build a strategy for both strong and weak ties
• Ask people to commit to specific actions

NHS Change Day
Making a change for
better together.
Disruptive Case Study

Do something better together….
Audacity to imagine we could mobilise
the 1.3m people in the NHS

Must
do
Want to
do
Shared purpose
Goal – 65,000 (500k)
pledges
Core leadership team
Personal pledge
Set a date
Website
Social media
Took risks
Courage & belief
Kept it simple!

Holding each
other to
account rather
than
performance
management

Change Day pledges and stories
‘…the floodgates of change open’
from front line to senior leaders

Change
starts
with
me..
Maker
...Making
a
difference
Anyone can pledge – it’s personal to you!
Change
Activist

Volunteers – leaders everywhere
98% of activity via volunteers

My pledge/action…..
Not let hierarchy get in
the way of patient care
What I did
Worked with the
hierarchy at an early
stage.
Seeking their support
with an explicit
understanding that they
respected the grassroots
nature of Change Day.

Bottom up approach with top down support
I urge as many people as possible to give their
support“
"NHS Change Day is a fantastic
opportunity to join a movement of
young leaders who want to make a
difference in the NHS
Jeremy Hunt
Health Secretary
Chief Nursing
Officer - England
Professor Sir Bruce Keogh
National Medical Director
It's especially an opportunity for the next
generation of junior doctors to effect change
in a practical and sustainable way"

Fun day for children Support group
with a stomas

NHS CEO personal National
pledge campaign

30% shift in staff survey:
‘Would you feel confident your hospital
would address your concern?’
Ashley Brooks
Patient Champion
‘Change Day gave me the
permission to use my energy in the
direction I wanted to use it’

Students swap places
with patients in
mock ward
Change in University
nursing curriculum
Louise Trowse – Second year student

Tasting common
medicine for children
Discussing pharmacy
methods of improving
the taste
Dr Damian Roland
“The single most
important skill I learned
from improvement leaders
was narrative. It connects
us to the reasons we were
called to work for
the NHS. It will stay with
me the rest of my career.”

Jeharna sings for
children’s ward to
say thank you
‘I wanted to say thank
you to NHS staff for
the way my brother
was looked after when
he got knocked over,’
Staff feel
appreciated

Smile Feedback Wednesday
Ellie Milner

2013 2014 2015

Google Searches Twitter
Google Searches and Twitter posts
tell the same story: 50% bigger
than last year at peak
Online mentions: 4x bigger than
last year (Source — OLR) 9,274 vs
1,869 in 2014
Changeathon:
Changeathon peaked
on Twitter around
09:00 and 11:00
46 Million Twitter Impressions
14 Thousand Tweets
9 Thousand online mentions
4,859 individuals tweeting
200 events flagged on Twitter
60 events notified to team
Biggest
ever
Events across
England
Twitter:
50% bigger
than 2014
(tweets & searches
— online is 400% bigger)
CHANGEATHON

Quote from Chloe
I was inspired by the caring,
creative and committed
individuals I met in the NHS and
realised I need to fulfil a sense of
purpose in using my skills and
passion in helping others.
I want ……

A global movement was born
https://www.youtube.com/watch?v=inHc1NgohuA

OCTOBER 2015

@helenbevan #IQTGOLD#SHCR @School4Radicals
“You don’t need an engine when you have
wind in your sails”

• We must activate the mavericks, radicals,
rebels and heretics
• There is a massive untapped reservoir of
energy and talent out there and the
potential is outstanding
SO GO OUT AND CAUSE TROUBLE!
SUMMARY

Four ways to connect with us!
1. Follow on Twitter @Jackie Lynton
Jackie.lynton@nhsiq.nhs.uk
2. Subscribe to
3. The School for Health and Care Radicals:
@School4Radical
4. Engage with NHS Change Day
www.ChangeDay.nhs.uk
TheEdge.nhsiq.nhs.uk

California presentation March 2015 final version used in Disney

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California presentation March 2015 final version used in Disney