The document discusses lessons that healthcare improvement can learn from successful social movements. It notes that social movements define the change they want, identify pillars of power, create a spectrum of allies, seek to attract rather than overpower, and build a plan to survive victory. The document also discusses the importance of connecting with people's emotions through values to inspire action, and the need to engage a diverse range of changemakers beyond just formal leaders. It suggests healthcare can learn from how social movements organize and drive social change.
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The power of one: the power of many: what healthcare improvement can learn from social movements
1. @HelenBevan #Quality2017
The power of one: the power of many
What healthcare improvement can
learn from social movements
Dr Helen Bevan, OBE
@HelenBevan @HorizonsNHS #Quality2017
2. @HelenBevan #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
3. @HelenBevan #Quality2017
“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
4. @HelenBevan #Quality2017
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
5. @HelenBevan #Quality2017
“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.
7. @HelenBevan #Quality2017
If we want people to take action, we have to
connect with their emotions through values
action
values
emotion
Source: Marshall Ganz
9. @HelenBevan #Quality2017
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
15. Starts on the fringe
(at the edge)
Starts with the activists
Gary Hamel
always
16. 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”
17. @HelenBevan #Quality2017
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
20. @HelenBevan #Quality2017
Jeremy Heimens, Henry Timms
This 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
22. @HelenBevan #Quality2017
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
23. @HelenBevan #Quality2017
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
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
24. @HelenBevan #Quality2017
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
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
25. @HelenBevan #Quality2017
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
27. @HelenBevan #Quality2017
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
29. @HelenBevan #Quality2017
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
30. @HelenBevan #Quality2017
• 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?
31. 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
32. @HelenBevan #Quality2017
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
So Emotions help us understand what we value in the world.
Why did the story of Alice work ?
So why was this story powerful?
Why do we respond differently when we hear about Alice rather than when we see the policy data and financial balance sheet?
So public narrative when used intentionally for a purpose to connect with others to move to action is a powerful skills set and leadership gift. When we hear stories that make us feel a certain way those stories remind us of our core values. We experience our values through emotions. Then we are prepared to take action on those values. Through our emotions we are more likely to take action
Research by Martha Nussbaum a Moral philosopher, tells us that people who have a damaged (a-mig-da- la) Amygadla the part of the brain which controls emotions, when faced with decisions can come up with many options from which to choose but cannot make a decision because the decision rests upon judgements of value. If we cannot feel emotion we cannot experience values that orient us to the choices we must make
Shortly we will be thinking about the lived experiences that have moved you to action…we’ll be drawing on those a few minutes as you start to craft your own stories.
Link belowhttp://www.bbc.co.uk/news/magazine-23790147http://www.bbc.co.uk/learningzone/clips/martin-luther-king-i-have-a-dream-pt-1-2/1293.html
With the brooding statue of Abraham Lincoln peering down at him, King began by telling protesters that their presence in the symbolic shadow of the "great emancipator" offered proof of the marvellous new militancy sweeping the country. For too long, he complained, black Americans had been exiles in their own land, "crippled by the manacles of segregation and the chains of discrimination".
The whirlwinds of revolt would continue to shake the very foundations of the country: "And those who hope that the Negro needed to blow off steam and will now be content will have a rude awakening if the nation returns to business as normal," King said. It would be fatal for the nation "to overlook the urgency of the moment and to underestimate the determination of the Negro".
“He's good - he's damned good”
Kennedy on King
Wearied by the suffocating heat, the crowd's initial response was muted. The speech was not going well. "Tell 'em about the dream, Martin," shouted Mahalia Jackson, referring to a rhetorical riff that King had used several times before, but which had not made it into his prepared speech because aides insisted he needed fresh material. But King decided to cast aside his prepared notes, and launched extemporaneously into the refrain for which he will forever be remembered.
"I have a dream that one day this nation will rise up and live out the true meaning of its creed," he shouted, his out-stretched right arm reaching towards the sky. Soon he was hitting his rhythm, invigorated by the chants and cries of the crowd. "Dream on!" they shouted. "Dream on!"
With his voice thundering down the Mall, King imagined a future in which his children could "live in a nation where they will not be judged by the colour of their skin but by the content of their character". Then he reached his impassioned finale.
King asked the crowd to yell so it was heard the world over
Watching at the White House, the president was riveted. Like so many Americans, it was the first time he had heard the 34-year-old preacher deliver a speech in its entirety - the first time he had taken its measure, listened to its cadence. "He's good," Kennedy told one of his advisors. "He's damned good." The aide was struck, however, that the president seemed impressed more by the quality of King's performance rather than the power of his message.
SASHA
Experience of working in both worlds
Balance between two ways of conceiving change