S4CA 2017 Programme Guide

PROGRAMME STUDY GUIDE
‘Never doubt that a small group of thoughtful, committed
citizens can change the world.
Indeed, it is the only thing that ever has.’
Margaret Meade
http://www.theedge.nhsiq.nhs.uk/school/
@Sch4change #S4CA
www.facebook.com/sch4change/

School for Change Agents Programme Study Guide
http://www.theedge.nhsiq.nhs.uk/school/ 2 SCA 2017
Contents
The School for Change Agents ................................................................................................................. 3
Introduction............................................................................................................................................. 4
A short history of the School................................................................................................................ 4
Who is it for? ....................................................................................................................................... 6
What’s in it for me? ............................................................................................................................. 6
How does it work? ............................................................................................................................... 8
Programme outline.............................................................................................................................. 8
After School….to The Edge and beyond............................................................................................. 10
Is there any formal recognition or qualification?............................................................................... 10
Introducing some Change Agents .......................................................................................................... 11
Getting the most from the School ......................................................................................................... 13
Social learning........................................................................................................................................ 13
Communities of practice.................................................................................................................... 14
School Learning Groups ..................................................................................................................... 15
Case study: New Zealand class of the School for Health and Care Radicals....................................... 17
Sharing your experiences................................................................................................................... 18
Finding support...................................................................................................................................... 20
Keeping a learning journal ..................................................................................................................... 21
Drawing up a learning plan .................................................................................................................... 23
Getting to know yourself: the Johari Window ....................................................................................... 25
Becoming a reflective practitioner......................................................................................................... 26
Theories and models of reflection ......................................................................................................... 29
Kolb’s experiential learning cycle....................................................................................................... 30
Critical incident analysis..................................................................................................................... 30
Johns’ model of structured reflection................................................................................................ 31
Tripp’s model of structured reflection............................................................................................... 32
Stories and transformation.................................................................................................................... 33
Glossary ................................................................................................................................................. 36
Resources............................................................................................................................................... 38

The School for Change Agents
'If you want to build a ship do not gather men together and assign tasks.
Instead teach them the longing for the wide endless sea.’
Antoine de St Exupery
Core team
Helen Bevan
@HelenBevan
Kathryn Perera
@KathrynPerera
Kate Pound
@KateSlater2
Olly Benson
@ollybenson
Pip Hardy
@PilgrimPip
Joanna Hemming
@joannahemming
Leigh Kendall
@leighakendall
The School for Change Agents is an initiative of the Horizons Team, NHS England.
This Programme Study Guide was prepared for the School for Change Agents by Pip Hardy, Pilgrim Projects Limited.

WELCOME!
Introduction
‘Be the change you want to see in the world.’ MK Gandhi
Welcome to the School for Change Agents. This Programme Study Guide will help you make the most
of your studies and your time. We will try to anticipate – and answer – some of your questions, and
offer some tools and suggestions that will help you translate your learning into action.
We can imagine how busy you are, but we are pretty sure that you will find it helpful to skim through
this study guide before beginning your work on the first module you have chosen. As well as
explaining a bit more about the programme, we will introduce you to some other change agents and
share with you some of their stories of change. We will also encourage you to engage with the School
and the learning in a number of different ways.
A short history of the School
The School for Change Agents is not just another new initiative. The first seeds of the School were
sown back in 2002 and took the form of a one-day school for organisational Change Agents – that is,
people who wanted to bring about constructive change in their own organisations. Over the years,
these ideas have taken root in the world of healthcare quality improvement, have been nourished by
the application of social movement thinking and have spread by means of community organising
principles and the use of public narrative.
The first School for Healthcare Radicals was held in 2012, partly in
preparation for, and in support of, the first NHS Change Day in
March 2013. NHS Change Day has been hailed as ‘the largest
simultaneous improvement initiative in the history of the NHS’,
resulting in nearly 200,000 pledges from people throughout the
NHS and beyond: people of all ages, at all levels, doing a wide
variety of jobs and extending to patients, families and carers. It has
demonstrated yet again that grassroots movements really can make
a difference and, in this case, improve care for all of us.
http://changeday.nhs.uk/
In 2014, the School was renamed The School for Health and Care
Radicals to acknowledge the close relationship between health and
social care and to reinforce the idea that anyone, whoever they are,
can participate in the School and contribute to bringing about
positive changes in care. Once again, the School ran during the lead-up to Change Day 2014 and
participants were encouraged to link their work in the School with their Change Day pledges.
In 2015, the School ran again for the five weeks leading up to Change Day and welcomed even more
participants from around the globe. Social learning came to the fore with School learning groups
springing up all over the place. An external evaluation of the School was carried with the 2015 cohort

and it was no surprise to discover that the School really does help to give people the skills, knowledge
and confidence they need to bring about transformational and sustainable change. If you are
interested, you can read the evaluation report here: http://theedge.nhsiq.nhs.uk/school/school-
evaluation/
The 2016 School for Health and Care Radicals was as successful as previous years, and several hundred
people sought (and were awarded) certification as Change Agents. Local School groups were springing
up not only in the UK, with particularly active groups in the USA, Australia and New Zealand.
2017 brings another change of name to the School, with the intention of reinforcing the overarching
goal of bringing about constructive change in health and social care and beyond while removing any
ambiguous associations in relation to radical activities.
In keeping with the founding principles of the NHS, the School for Change Agents is also free at the
point of access, non-hierarchical and open to all. Staff working at every level in the NHS, together with
patients and carers, have been joined by people from around the world, united by their common goals
to improve the quality of care for everyone, to share learning and to support one another in their
efforts to bring about positive change.
The overarching aims of the School are to equip people across the health and care system with the
core skills to become effective change agents. Through the effective use of social media as a means to
connect, communicate, shape and share, the School works to:
 equip people across the health and care system with
the core skills to become change agents
 ignite people’s passion to improve services
 promote a grassroots change movement
 provide a robust underpinning in new ways of thinking
about improvement
 operate to help people implement and sustain change
 promote connection and communication via many
different channels
 create a national and international community of practice sharing leading-edge change
methodology and thinking.
So, by joining the School, you will become part of its past and its future. If you want to know more
about the history of the School, you might like to read a light-hearted blog about the early days of the
SHCR, here: https://www.linkedin.com/pulse/reflections-reluctant-radical-short-history-school-health-
pip-hardy
We hope that you will join the growing number of people who are committed to making changes –
large and small – and that you will also find support and encouragement from this community of
practice and learning.
‘Beauty and the sense of belonging it evokes introduces us to a new standard of
care--a quality of attending-- which we may extend to our sense of stewardship
in creating communities of care. Perhaps in the future a well-lived life will involve
the shift from a focus on utility to the combined search for signs of the beautiful.’
Michael Jones, 2004

Who is it for?
‘Dialogue is the encounter between men, mediated by the world, in order
to name the world.’ Paulo Freire
The School for Change Agents is for anyone and everyone who wants to improve the safety and quality
of health and social care. You may hold a senior post in the NHS or in another health or social care
organisation in another country; you may be a doctor or a nurse, you may be a student doctor or
nurse; you may work on the frontline or behind the scenes; you may be a commissioner, an
administrator or a manager; you may work for the police or for a charity, you may be a healthcare
assistant or an allied health professional, a carer, a patient, a service user or a citizen. Health and care
affects everyone, everywhere, and The School for Change Agents is an opportunity for all of us to
come together to pool our ideas and our resources with the intention of making sure that care will be
as good as it can possibly be for us, our parents and families, and for the generations that follow us.
‘I’ve cared for my husband, who has dementia, for eight years. The number of
people we have to deal with can sometimes be overwhelming – it’s certainly
confusing, especially as they often don’t know what the others have been
doing. My Change Day pledge is about finding a way to co-ordinate all those
different people and different activities so that there is one person carers can
call who actually knows what’s going on – like a case manager. In order to
make that happen, I am hoping to learn more about how to make change
happen so that many other carers can be saved from going through what I’ve
had to go through.’ Carer
In 2014, around 1900 people from 66 countries took
part in the School. Around 10% of those people went
on to graduate and become Certificated Change
Agents, proudly displaying their badges in many
different ways! They connected with each other via the
weekly webinars and Tweet chats and many have
remained in contact, sharing ideas and experiences,
offering support and building a strong sense of
community and connection. Since then, the number of
people who have participated in The School has grown to over 7000 people, and 300 of those became
Certificated Change Agents in 2015 and nearly 300 more in 2016.
What’s in it for me?
If you’ve ever thought to yourself ‘I could do that better’ or ‘I would want to be cared for like that’ or
even ‘I’m so glad that’s not my gran in that bed’, then you probably have some great ideas for how
health and social care could be improved. But, if you are like many other people, you may then think
to yourself ‘Nobody will pay attention to me’ or ‘I wouldn’t know where to begin …’. If you have ever
wanted to make a difference to patient/service user and staff experience, and improve the outcomes
of care, then the School for Change Agents is for you.

The School for Change Agents will provide you with information
and tools to help you identify the kinds of changes you can make
for the better and give you the knowledge to go ahead and make
them. You will gain skills and confidence that will enable you to act
as an effective change agent – you’ll learn how to rock the boat but
stay in it!
‘The moral test of government is how that
government treats those who are in the dawn of life,
the children; those who are in the twilight of life, the
elderly; and those who are in the shadows of life - the
sick, the needy and the handicapped.’
Hubert Horatio Humphrey, US Vice President
You will also have the opportunity to meet other people, not only
from around the UK but around the world – other people who are trying to make health and social
care better. Some of your fellow learners will be experts in bringing about change and some will be
people just like you – wanting to make things better for yourself, your families and friends and for
future generations. You will join an international Community of Practice – other people who are as
passionate as you are about making the world a better place – so you will have plenty of
encouragement and support to carry out your plans and accomplish your dreams.
Along the way, the School will also:
 offer relevant and rewarding skills and learning opportunities
 encourage learners to gain knowledge, skills, abilities and confidence
 provide opportunities for active learning
 offer appropriate coaching and mentoring support
 provide opportunities to relate learning directly to the workplace in order to increase personal
and organisational potential
 acknowledge and value learners’ achievements
 offer opportunities to shape and participate in the School
 encourage learners to form a network of like-minded people (a community of practitioners)
and remain involved with the School as it grows.
‘There are a lot of possibilities for medical students and junior doctors to influence
the NHS and the health and social care system that we work within. We’re often
not taught to think about those things but actually we all have a voice and I think
that we are very powerful change agents. We move around the wards, we meet
people in a lot of different areas, we have a way of talking to patients which
sometimes consultants don’t have time or the inclination to do and because of
that we can sometimes understand their perspectives better. That can be a really
powerful way to get more compassion back into the NHS.’ Medical student

How does it work?
The School consists of the following components:
 this Programme Study Guide
 five weekly webinars
 five weekly learning sets
 five module study guides
 ongoing conversations via
Twitter
 online discussions via
Facebook
 an international community
of learning and practice.
Programme outline
The Programme consists of five modules: these are outlined below.
Module 1: Being a Health and Care Radical: change starts with me
The first module invites you to continue or embark on your journey as a change agent and offers some
new ways of thinking about how you work to bring about change. The module highlights learning from
some of the most effective change agents across the globe, explores the differences between
troublemakers and rebels and helps us to understand how to 'rock the boat and stay in it'.
Module 1 will help you to:
 understand the history of change agents and of The School
 recognise your own values and passions and connect them with your transformation work
 recognise the difference between transactional and transformational learning
 consider the emerging direction for transformation and change
 reflect on what it means to be a change agent
 explore some of the challenges for Health and Care Radicals
 learn how to rock the boat and stay in it
 build self-efficacy
 recognise the importance of community
 clarify your vision and your purpose.
Module 2: From me to we: creating connections and building communities
The golden rule for change activists is: ‘You can’t be a radical on your own’. This module gives us an
understanding of the power of working together by exploring communities of practice and social

movements. We identify techniques for connecting with our own and others’ values and emotions to
create a call to action.
 build your own alliances and create communities for change
 identify the characteristics of effective social movements
 learn from the leaders of social movements
 give some thought to what co-production really means in your own context
 recognise the power of storytelling
 use stories to connect with others through emotions and values
 reflect on your existing networks
 establish and build new networks
 bridge disconnected groups utilising strong and weak ties.
Module 3: Rolling with resistance
It is natural to resist change. Rather than seeing resistance as something negative, here we shift our
perspective so that we see dissent, diversity and disruption as essential components of effective
change. However, we need to build resilience in order to work effectively with resistance. This module
offers some tools and techniques to ensure that we remain strong, adaptable and able to continue our
work as change agents.
 recognise the challenge of resistance
 understand some of the reasons for resistance
 embrace diversity
 recognise the crucial difference between impact and intent
 use the Stages of Change model to help people through change
 build resilience in yourself and others.
Module 4: Making change happen
This module will help us create and sustain the energy we need to make change happen. We will look
at a number of practical ideas, tools and resources to help us change the way we do change.
 recognise the power of politics
 understand why change efforts often fail to achieve their objectives
 examine the need for both extrinsic and intrinsic motivators and balance the tension between
them
 create shared purpose
 build energy for change
 plan for success

 share stories of success
 prepare for the Change Challenge by recognising the need for bottom-up change
 move from testing your ideas to embedding them.
Module 5: Moving beyond the edge
Change always starts at the edge and always starts with activists. This module will help you move
closer to the edge and towards sustainable change; it will help you take your learning from the School
for Change Agents forward, think about what you might do next and where else you might get
support/resources.
 review what we have learned so far about the characteristics of a transformational change agent
 examine Peter Fuda’s Transformation Change Agent framework: Being, Seeing, Doing
 consider emerging directions for change and change agents ‘from the edge’
 recognise some of the change methods suitable for a new era
 reflect on some of the key messages from the School
 plan for the future.
Is there any formal recognition or qualification?
We hope that you will engage with the School and enjoy learning for learning’s sake. If you do want to
engage more deeply with the opportunities provided by the School, there are various ways in which
your work can be recognised, although at the moment there is no formal
qualification.
If you engage with all five modules and submit a reflective statement about your
work, you will be eligible to become a Certificated Change Agent. You can meet
some people who gradated from the School and became Certificated Change
Agents below. We are currently in the process of obtaining CPD accreditation
for the School and UK nurses may be able to use their work on the School to
support revalidation.
After School….to The Edge and beyond
After the five School webinars have finished, you will probably want to visit The Edge
http://theedge.nhsiq.nhs.uk where you’ll find plenty of up-to-date information about change,
including a series of recorded
webinars called Edge Talks
http://theedge.nhsiq.nhs.uk/?s=Edge+
Talks These talks are presented by
experts in their fields on topics of
particular interest to anyone wanting
to bring about change.

The small print
When you take part in the School for Change Agents, please be aware of the following things:
 All the sessions are recorded and made available via YouTube, Slideshare and our own website.
This includes any comments you put in the chatbox. This does not apply to the break-out sessions.
 We may use any comments (audio or chatbox), tweets or emails you create in our reporting and
evaluation documents. We may also use this content in future promotion of the School. Except
where it is already publicly accessible (eg a tweet), we won’t attribute it to you without your prior
permission.
 When you sign up with your email address, we will send you information about the School, and
information about other relevant Horizons offerings and events. You are free to unsubscribe at
any time.
By participating in the School you understand and agree to the above conditions.
Introducing some Change Agents
We would like to introduce you to a few Change Agents – hopefully their stories will give you a flavour
of the great diversity of people who can be Change Agents and inspire you to join them!
Molla Imaduddin Ahmed, Specialist Registrar in Paediatrics, University Hospitals of Leicester
‘The SHCR course has been an eye opener for me and has encouraged me to work
towards improving patient care and encouraging others to do so as well. I have learnt
the importance of networking with like-minded people and the power of a community
to change things. As a part of the community, I have been able to share experiences
and support others and this course gave ample networking opportunities to liaise with
other change agents. The course was extremely well conducted with excellent study
materials enabling me to learn about various aspects of being a change agent.’
Jon Bryant, Video director and software developer of disruptive technologies, UK
‘Going back to school after 45 years was a personal challenge, so when I started to
engage with the SHCR team, it came with a lot of preconceptions and a strong sense
that I would be an outsider as a “citizen radical/rebel”. How wrong I was! From the
very first contact with SHCR, I was welcomed by all, and I very soon felt part of
something important and valuable. A lovely surprise was to discover we were all
there for the same reason: “we care” and want to challenge the conventional wisdom in positive and
innovative ways to improve health and care at all levels.’
Rebecca Lacey
The School has a lot to answer for: I spent a lot of 2015 out of my comfort zone! It
was challenging and exciting; taking part in the School gave me the confidence and
inspiration to achieve some very small changes in me and also to be part of much
bigger change events. Participating in the School was a breath of fresh air and the
energy and positivity gained last January is still with me now. The School has
inspired me to put creative thinking into practice. It’s the best thing I have done in education, ever!’

CJ Graham, Project Manager, Imperial College Healthcare NHS Trust
‘SHCR started off as a way to build a bit of confidence as I embarked on a new job,
but it became a lot more. I met like-minded, inspirational change agents from all
over the world and learnt a huge amount about being the best change agent I could
be. The energy of the School sessions was electrifying and sustained well beyond the
end of term. Now, two years and three jobs later, I owe a huge amount of my self-
efficacy to SHCR, which taught me that I am in charge of my comfort zone, I am in
charge of my limitations, and I am in charge of overcoming both!’
Dr Sabira Mohammad, Project Manager, Urgent Care, Herts Valleys Clinical Commissioning Group
‘I found being a part of the School for Change Agents completely life-changing.
The process sent me on a journey of self-discovery and empowerment. It was
liberating to spend time learning and sharing with like-minded people, to know
that I am not alone in refusing to settle for the status quo.
Since the SHCR, my entire approach to my role within the NHS has changed. I get it
now: if change is going to happen, it’s up to me.
So I have started to speak up, sit at the table where decisions are being made,
question when things are being done that are not in patients’ best interests.
I found a voice through the process and the confidence to undergo a career change that has taken me
from the frontline of healthcare delivery to the centre of redesigning out-of-hours services!’
Dr Maxine Craig, Visiting Professor ( Sunderland University ) and Independent OD practitioner
‘I think the greatest impact for me was being in the community during the School. I
found it enlightening and heartening to work with so many enthusiastic learners
from all over the world. It made me proud of our NHS. It helped me think about how
we could create The Great North School of Health and Care Radicals! It gave me
energy.’
Wendy McIntosh, Acting Director Safety and Quality, WA (Western Australian) Country Health
Service
‘The SHCR has really enriched my work. I've realised that to engage and
influence others, I needed to change. I've listened more. Been braver about
making new connections. Stepped outside my comfort zone: set up an SHCR
learning group; promoted Change Day Australia within our organisation and
published my first blog and YouTube! Participating in the SHCR has changed
my approach and behaviours more than any other course.’
The rest of this Programme Guide will suggest ways in which you might get the most from the School –
some of these suggestions might be particularly helpful if you haven’t done any studying or learning
for awhile.

Getting the most from the School
As with most things in life, the more effort you put in, the
more you are likely to benefit from your efforts. Having said
that, the School has been designed to be flexible and we
invite you to engage with it in whatever way works best for
you. You might decide to:
 dip in and out of the weekly webinars
 enlist the support of a coach or mentor to support your
learning
 work through the reflective and other activities in the programme and module study guides
 keep a learning journal
 set up an Action Learning Set or a School Learning Group in your organisation to spread the
learning more widely
 share your own experience of change with others, perhaps by becoming a mentor
 any combination of the above.
However you engage, we encourage you to:
 ask your own questions
 set your own goals
 plan your own time
 decide what you want to learn, and how you want to learn it
 become a reflective practitioner
 assess your own progress
 share your learning – and put it into practice – with others.
Social learning
‘All change starts when people get together and talk about the things they care
about. We move in the direction of the questions we ask.’ Margaret Wheatley
It is difficult to find your way in the darkness if you have only one candle; but many candles will
illuminate even the darkest of paths. Similarly, sustainable change comes about when groups or teams
of people work together to bring about the desired change.
So, while the desire for change may begin with you, The School for Change Agents is founded on the
principle that large-scale, sustainable change happens when many people share the desire for change;
this collective energy can then be harnessed to bring about the changes you want to see in the world.
By creating a resource that can be used flexibly but that also encourages a social approach to learning,
we hope to increase the potential for real change and improvement.
Learning is changing as people become busier and virtual learning replaces face-to-face learning.
We are connected in myriad ways, communicating via email, Facebook, Twitter, Google+, LinkedIn; we

blog and vlog, sharing photos, hopes, ideas, experiences, aspirations and knowledge more widely and
more rapidly than ever before.
Certain characteristics of learning in the 21st
century can be thought of as ‘social learning’. One of the
people who has clearly articulated the characteristics of social learning is Jane Hart. Here is how she
describes ‘Guided social learning’:
 It is social – you are learning – not simply with
others but from the shared experiences and ideas
of others – in the professional learning networks
of trusted connections that you have developed.
 It is continuous – you are benefiting from a
constant drip-feed or flow of information or
resources, or conversations with colleagues, all of
which over time builds up into a large amount of
knowledge and shared experiences
 It happens in short bursts – you tend to have
short interactions with others and read bite-sized pieces of content
 It is autonomous – you are in control of what you do, the relationships you build, and how much
time you spend time on any activity – based on what value it gives you and to what extent it meets
a personal interest or professional need.
 It is often serendipitous – although some of what you learn is planned, you are also learning just
by hanging out in social networks, gradually assimilating new ideas and experiences, in many
instances without even realising it (Hart 2014).
You can find a number of resources about guided social learning on Jane Hart’s website:
http://c4lpt.co.uk/
Communities of practice
Most people have a deep desire to be part of a community. This longing was recognised by Etienne
Wenger when he coined the term ‘Community of Practice’ to describe a group of people who wish to
be connected in order to share learning and skills as a way of deepening, improving and expanding
their practice. In fact, Wenger, and his colleague, Jean Lave, made a rather radical proposal in the
1990s, suggesting that learning actually takes place as a result of engaging in a community of practice.
As change agents, it is common to feel isolated. There may be a lack of
peers with whom we can talk, or a lack of opportunity to get together to
share experiences or there may be what Habermas (1972) describes as
technical rather than emancipatory interests – in other words, a reluctance
to discuss anything that is not directly and practically related to the task at
hand.
But our work as change agents is emancipatory – intending to free us from
the constraints of old power structures and facilitate movement and change for the better.
So it is vitally important for our work as change agents to make connections, have conversations,
explore ideas and feelings and share common purpose. This is one of the reasons that we are
encouraging you to join a School Learning Group and we will be reinforcing this aspect of social

learning through the introduction of virtual Learning Sets during the five weekly School webinars. We
hope that these smaller groups will provide an opportunity to explore and discuss the content of each
week’s presentation.
A very succinct introduction to the concept of communities of practice is here:
http://infed.org/mobi/jean-lave-etienne-wenger-and-communities-of-practice/
The theory is borne out in practice in the School for Change Agents, as one of the things that people
value most about the School is the opportunity to connect with like-minded people. But the journey to
School can be long and arduous, as Kate Pound describes:
In 1993 I qualified as a nurse, I had to work hard for 6 years to find what I believed to
be the best job in the world, however it wasn’t long before I became disillusioned. I
felt overwhelmed by the pressures, such as time and health inequalities. I had gone
into nursing with my core values of always doing my best for patients and making a
difference to improve their lives. I felt I was becoming disconnected from what was
important to me, but I refused to let go.
In 1999, I qualified as an advanced nurse; this was a changing point for me in my life. I
got a job at Nottingham University Hospitals and I started to connect with others who
also had the same values and beliefs about wanting to make a difference. I had found
hope! My managers were supportive and inspired me, their leadership approach was
relational, not power-based. I had found a place where I could make a difference.
The big learning for me was the School for Change Agents, where I was able to
connect across the world with people with the same core values. This gave me energy
and hope to keep on going.
Please click on the Word Cloud below to watch Kate’s digital story: Finding my niche.
Kate Pound 2015
School Learning Groups
The design and delivery of the The School for Change Agents aims to nurture the conditions that
support both planned and serendipitous opportunities for learning. In seeking to establish a
community of learning and practice, the School promotes the sharing of knowledge by all those who
engage with the School. We would like to encourage you to set up or join your own local School
Learning Group where you can reflect on the ideas put forward in the School Webinars, engage your
colleagues with your hopes for change and engage in activities designed to be thoughtful, thought-

provoking and relevant to people’s jobs. We will support your efforts by providing content that is
generated by experts, practitioners and users.
The philosophy of the School encourages you to become more autonomous by providing some choices
around when you learn and how you apply your learning at
work while also providing guidance and support for
individual and collective learning journeys.
The School will provide plenty of opportunities for you to
connect with others from around the world. We also
encourage you to establish your own local School Learning
Group, where you can connect with other change agents
from your own organisation. If you’d like some suggestions
or help with setting up your own School group, please get in
touch with us: england.si-horizons@nhs.net
ACTIVITY: SHARING YOUR PASSION FOR CHANGE
It can be a daunting prospect to think about setting up a learning group, so we would like to
encourage you to adopt a slightly more radical approach – one that has been successfully used by the
Star Wards Programme http://www.starwards.org.uk/
Star Wards has brought about great changes in mental health care, partly by appealing to people’s
passion, and harnessing the energy that prompts people to do the things they love doing.
1 Begin by thinking about something you really like to do – it doesn’t have to be work-related. Make a
note or two here.
2 Now think about how you could share your passion – whether it is for cooking, reading, running,
listening to music, repairing motorcycles, making quilts, gardening, walking dogs – whatever it is – with
others.Try to visualise how you could bring your passion to work. Make a few notes.
3 If you are feeling really brave, make a poster, send an email, let people know that you will be
meeting at a particular time in a particular place and see what happens!
You may be surprised to find others where you work sharing your passion – whatever it is.

Some great examples include:
 setting up a weekly running club
 establishing a reading group
 promoting healthy eating through ‘Come Dine with Me’ activities
 founding a gardening group
 preparing a cookery book
 organising a singing group.
When people have the opportunity to share their passions, unexpected things may happen.
Undoubtedly something will change. Trust is built up, attitudes shift, the energy of resistance can be
harnessed, diversity can be embraced and conversations can move towards other kinds of changes
that may have a more direct result on the way care is designed and delivered. You can find some great
examples of changes in care delivery on the Star Wards website: http://www.starwards.org.uk/
And, if that is not enough to inspire you, please read about how one group of committed, enthusiastic,
excited and eager Health and Care Radicals shared and deepened their learning from the 2014 School.
Case study: New Zealand class of the School for Health and Care Radicals
Dr. Lynne Maher, Director for
Innovation, Ko Awatea & Associate
Honorary Professor of Nursing, The
University of Auckland
Alex Nicholas
Project Coordinator
Community Organising,
Ko Awatea
Alex Twigg
Campaign Manager,
Ko Awatea
Excited, enthusiastic, committed and eager. This is how ‘we’, Alex, Alex and Lynne, felt as we joined the
School for Health and Care Radicals in 2014. We are all change agents and were keen to extend our
knowledge and ability to become more effective in our roles.
New Zealand is around 11,7682 miles (18,800 km) away from England and it is
ahead in time zones by around 12-13 hours depending on the time of year. We
worked out that most of the Web Based Learning sessions would take place on
Friday evenings our time which initially posed a challenge in our ability to join
the sessions ‘live’ without disruption to family lives. We added the word
‘determined’ to our vocabulary and worked out a slightly different way of
participating; the ability to be autonomous in our method of joining the School
was highly successful. We were able to access recordings and a transcription of
the discussions held during the web sessions in addition to the slide deck used;
these tools provided all of the basic learning material we needed.

By arranging to meet after each of the web teaching sessions, we set a pace for our learning which was
in step with the programme and incorporated time to reflect. At our meeting one of us would lead a
review of the learning session and each of us committed to
feedback on our individual interpretation and to provide
examples and additional learning from our own practice.
This was fascinating; we had all committed to ‘do’
something and the diversity of our discussion brought a
richness that vastly increased our understanding and
knowledge.
After each session we developed a short update to share
with others in our organisation, this started to create much
interest. As the weeks progressed we turned our attention to how we might more deeply share our
learning with others, we wanted many people to have the opportunity that we had.
The three of us pledged to bring 400 other passionate change agents together and enable them to also
learn. Through eleven half-day foundation workshops we have achieved our pledge.
We know that a fundamental principle of being a Health and Care Radical means that change starts with
‘me’. Through participating in the learning modules we have achieved the knowing. This has now lead
to doing a number of things including raising awareness through five articles shared on our
organisations newsletter (The Daily Dose) and putting into action a plan to achieve our pledge. This has
enabled others to experience our learning and has resulted in a
new community of 400 change agents. We are living the
principles of being effective boat rockers through our conviction
that this will make a difference, and creating a sense of hope as we
go.
Excited, enthusiastic, committed and eager. We, together with
our 400 colleagues are now part of ‘us’ a global learning
community of change agents. Together we can radically improve
health and care around the globe; ‘we’ are starting in Auckland, New Zealand.
Sharing your experiences
Whatever you decide to do and however you decide to do it, we would love to hear from you about
what you’ve done, how you’ve done it and what’s happened as a result.
‘I think the SHCR is for everyone who wants to make a difference and hasn’t
known how to. I think it will give you the tools to really engage with the NHS,
to really impact and do those things that you’ve always dreamt of doing.’
‘If you feel that the system is too big, too confusing, that you’re alone, I think
if you get involved with the SHCR you’ll find other people who feel like that
too, but also people who have already made change happen in whatever area
you’re looking at and by networking together and forming that community,
coupled with the resources that the School will provide, then we will be able
to make some real change.’ Learner, SHCR

REFLECTION: THE ONCE AND FUTURE STORY
Before going on, you might like to give a few moments’ thought to the future story you might like to
tell about your involvement in the School. What would you like to be saying to your
colleagues/friends/family by the time you have graduated from the School?
1 It might help you to think about what made you decide to register with the School in the first place.
Note your thoughts here. If you have a particular problem or issue that you are hoping to change or
solve, write that down too.
2 Next, consider what you hope to gain from the programme? Consider, for example, how you would
know whether you have solved your problem or answered your question.
3 Finally, what would you be doing differently in say, six months – one year’s time, to indicate to
yourself and others that the School has been successful?
4 Now write your own ‘quotation’ summarising what you hope to gain from the School.
If you find it difficult to visualise your own future story, you might be inspired by this digital story,
created by Helen Bevan, anticipating the change agents of the future:
https://www.youtube.com/watch?v=9WFcWgO9D5M
Helen’s story looks at The Five Enablers, which are explained in the recently published White Paper:
The new era of thinking and practice in change and transformation.
The Five Enablers are:
1. Activate disruptors, heretics, radicals and mavericks
2. Lead transformation from ‘The Edge’
3. Change your story
4. Curate rather than create knowledge
5. Build bridges to connect the disconnected
You can read more about the five enablers in the White Paper here:

http://www.nhsiq.nhs.uk/resource-search/publications/white-paper.aspx
Finding support
‘Learning and teaching should not stand on opposite banks and just watch the
river flow by; instead, they should embark together on a journey down the
water. Through an active, reciprocal exchange, teaching can strengthen
learning how to learn.’ Loris Malaguzzi (1920-1994)
Now that you are part of the School for Change Agents, you never need to feel isolated. We have
suggested the possibility of setting up or joining a local School Learning Group, but there are many
other opportunities for support, including people involved with the School who want to work with you
and support you.
Consider your needs for:
 personal support
 professional support
 coaching support
 mentoring support
 practical support.
ACTIVITY: FINDING SUPPORT
You might like to note down here the names of people who may be able to support you – and the type
of support they could offer others. Be as specific as you can.

In terms of personal support, friends and family can be good sounding boards for new ideas. Tell them
about your involvement with the School and share your experiences with them – they can encourage
you and support your efforts.
Professional support comes in many forms. There will be people from your past or present who can
help you, by talking over ideas, reading your work, helping solve day-to-day problems at work. It’s
good to have the support of your manager and immediate team members. Let as many people as
possible know what you are learning with the School. Ideally your colleagues will work with you to
provide peer support and perhaps even some peer assessment. It is helpful to gain the views of your
colleagues as to what’s changing at work – they may even notice changes in you! We also encourage
you to involve your colleagues in some of the activities and
to draw on their thoughts and reflections.
It’s not always easy to ask for support, as you will probably
know from your own experience. Rebecca Lacey, who
completed the 2015 School, made a short video about
some of the challenges she faced as a change agent. Click
on the Word Cloud to play her video, A little bit awkward.
Practical support can also take a variety of forms. In
addition to the weekly webinars and this Programme Study
Guide, there will also be a Study Guide for each module.
These will contain lists of additional resources that you can use
to deepen your learning: books, articles, papers, films, blogs, videos and so on. And, of course, you can
always ask for suggestions from other learners. Remember that you are now part of an international
community of practice, where everyone is encouraged to contribute, and everyone can learn from
everyone else.
Working with a mentor
You may like to formalise this support by arranging to work with a mentor on a regular basis. You
might connect with other learners in the School or be inspired by a former Graduate of the School –
many of these people will be very happy to support you in your change efforts.
On the other hand, if you can’t, or do not wish to, have a mentor, that is absolutely fine. Whatever you
decide it is important, when studying at a distance, not to become isolated. There are many ways of
keeping in touch with other people and sharing some of what you are learning. You will find others
engaged in the School a great source of support and inspiration.
Keeping a learning journal
‘By three methods we may learn wisdom: First, by reflection, which is noblest;
Second, by imitation, which is easiest; and third by experience, which is the
bitterest.’ Confucius
As one of the best ways to learn is to reflect on your experience, we strongly suggest that you keep a
learning journal to help you keep track of your work – it can also form the basis for useful discussions
between you and your mentor or colleagues.
Rebecca Lacey, 2016

Research by Dr Neil Conway and Dr Rob Briner (2001) at Birkbeck University found that keeping a
journal or diary at work can help you survive and thrive.
Not only can learning journals be used to keep track of your time, they can also:
 keep track of both negative and positive feelings
 provide insights into how people relate to one another
 provide a release for things which are bothering you
 encourage reflection
 help you recognise changes in yourself and others
 identify patterns
 make you more efficient by helping with time management
 offer a ‘reality check’ amidst the mysteries of organisational culture and politics.
Source: ‘Why keeping a diary at work can help your career’ by Tola Awogbamiye in The Guardian Saturday July 28, 2001
Your learning journal will give you the opportunity to keep notes on:
 what you are learning
 how you are learning it
 how new skills and knowledge may be
interacting with your work
 your thoughts and ideas for the future
 questions and concerns.
In addition, you can use your learning journal as a:
 critical incident or reflective diary – recording
significant learning and work experiences
 record of written work – published or unpublished, as well as letters, memos, reports, etc.
 private diary for examining personal issues
 log for future learning/training needs.
You may also like to use your learning journal like a scrap book, keeping track of letters, memos,
minutes of meetings, articles, etc. which may stimulate your thoughts and ideas about projects you
want to undertake and how you might like to undertake them.
Some people like to keep a journal in a beautiful (or handsome!) book, while others prefer to keep an
electronic journal. Whatever you do, try to get into the habit of writing in it regularly.
If you are interested in journaling, you may like to look at some of the following resources:
Progoff, I (1982) At a Journal Workshop Dialogue House
Price, D (1999) How to Make a Journal of Your Life Ten Speed Press
Senn, L (2001) The Many Faces of Journaling Pen Central Press

Drawing up a learning plan
‘To know how other people behave takes intelligence, but to know myself
takes wisdom. To manage other people’s lives takes strength, but to manage
my own life takes true power.’ Lao Tzu
Now that you have begun thinking about what you would like to get from the School, it may be helpful
for you to draw up a learning plan. If you have a mentor, a learning contract is a useful basis for your
relationship. If you are working with other colleagues or people in your team, you may like to share
and review each other’s plans. Or you may just decide that you will make an agreement with yourself.
Your learning journal may be the ideal place to keep your learning plan.
A learning plan is really just a way of clarifying your expectations, especially in relation to:
 what you hope to gain from the School
 what you expect from yourself, your colleagues, your mentor
 what others expect from you.
You don’t have to complete the plan all at once – it can change over time but it does put a peg in the
ground as you begin your work with the School and will help you to organise your work and your
learning in the way that is most helpful to you in your particular circumstances. Your learning plan
should start with where you are now and a realistic assessment of the things you already know and
the things you are good at.
ACTIVITY: WHERE ARE YOU NOW?
1 Give some thought to your own strengths and weaknesses. Be as honest as you can – especially in
relation to your strengths!
2 Looking back at the programme outline, you may know something about some (or many!) of the
topics already. Jot down some notes relating to the content headings and learning outcomes.
Many of us find it challenging to talk about our strengths so you may find it helpful to talk to a friend
or colleague and try to see yourself through his or her eyes. And remember that you don’t have to do
everything at once: taking the first step can sometimes be the most daunting but it is always the most
important, as this poem by David Whyte reminds us:

START CLOSE IN
Start close in,
don't take the second step
or the third,
start with the first
thing
close in,
the step
you don't want to take.
Start with
the ground
you know,
the pale ground
beneath your feet,
your own
way of starting
the conversation.
Start with your own
question,
give up on other
people's questions,
don't let them
smother something
simple.
To find
another's voice, follow
your own voice,
wait until
that voice
becomes a
private ear
listening
to another.
Start right now
take a small step
you can call your own
don't follow
someone else's
heroics, be humble
and focused,
start close in,
don't mistake
that other
for your own.
Start close in,
don't take
the second step
or the third,
start with the first
thing
close in,
the step
you don't want to take.
David Whyte (2012)
River Flow: New and selected poems
In the rest of this Programme Study Guide, we will offer some ideas, theories, tools and techniques
that may help to deepen your learning and make your time spent on the School more fruitful. You can
pick and choose what you like and leave the rest but we hope that you will find something that
resonates with you and your particular approach to learning.

Getting to know yourself: the Johari Window
The Johari Window is a technique designed to improve your self-awareness and your understanding of
others in your group or team. It’s particularly useful for developing self-awareness, improving
communications and interpersonal relationships, understanding group dynamics and inter-group
relationships, particularly in relation to behaviour, empathy, cooperation, inter-group development
and interpersonal development.
The model consists of a grid made up of four squares (like a window with four panes).
http://en.wikipedia.org/wiki/Johari_window
The arena
The upper left quadrant, usually labelled open self/area; free area; public area or arena, represents
those behaviours, attitudes, feelings, emotions, knowledge, skills, experience, views, etc. that are
known to the person and to others. This is the most productive area for individuals and groups, where
there is good communication, co-operation and trust. This is obviously the area that most teams
should concentrate on developing.

The blind spot
The upper right quadrant, known as ‘blind self’, ‘blind spot’ or ‘blind area’ represents what is known
by others but unknown to the individual. The person may lack self-awareness or be deluded or may be
deliberately hiding things from others. It is helpful to gain sensitive and non-judgemental feedback
from others to reduce the size of the blind spot and increase the open area.
The façade
The lower left quadrant is known as ‘the façade’, ‘hidden self’, ‘hidden area’ or ‘avoided area’ – these
are the things that are known to an individual but are kept hidden from others. This area may include
fears, insecurities, sensitivities, hidden agendas, secrets – anything that a person does not want others
to know about. Obviously there are personal things that are private and not relevant to work, but
there are other things that could more usefully be brought into the open area for the benefit of the
individual and the team.
The unknown
The lower right quadrant, or ‘unknown self’, ‘area of unknown activity’ or ‘unknown area’ relates to
information, feelings, abilities, aptitudes, experience, etc. that are unknown to the individual and to
the group. This area tends to be larger in younger people with less experience, but can also cover
abilities that are underestimated, perhaps through lack of confidence or training.
Using the Johari window
There are many opportunities for using the Johari window and it is an excellent tool for developing
skills in delivering constructive feedback as well as promoting trust in teams. All team members, but
especially leaders, should try to increase their open areas and reduce hidden and unknown areas.
Give some thought to ways you could use the Johari Window to increase understanding and self-
knowledge within your team or between teams in your organisation.
You can find more on how to use the Johari Window here:
http://www.businessballs.com/johariwindowmodel.htm
Becoming a reflective practitioner
‘We learn not from experience but by reflecting on experience.’ John Dewey
There is a great deal of emphasis within the NHS and other
health and care systems on becoming a reflective
practitioner…. but it is not always clear what this means. We
hope that, by joining the School for Change Agents, you will
take the opportunity to learn from reflecting on your
experience.
Some people regard the ability to reflect as the hallmark of a
professional, as opposed to someone who simply does their
job. Academics and theorists have written a great deal about
reflection and reflective practice and we will summarise some of this below.

In essence, the practice of reflection is not difficult, and it is quite likely that you are already doing it in
your work and in your everyday life. The fact that you have registered with the School indicates that
you have given some thought to what you do well – or at least to what you don’t do so well – and this
is the basis of reflection.
ACTIVITY: PRACTISING REFLECTION
Think of an incident which has occurred during the last few days. It doesn’t really matter whether it
was at home or at work – the main thing is to take some time to reflect on what happened.
Briefly describe the incident: what happened?
How did you feel?
What did you do in response to the incident?
What was the outcome?
If it was successful, what did you do to contribute to the success?
If not, what would you do differently next time?

Here is an example that might help to illustrate the process of reflection.
Case study: How are you?
A medical student is working with his clinical partner doing psychiatric triage. The patient is depressed,
confused, disengaged, barely responding to questions, however hard they try to engage with him.
When the assessment is finished the patient goes out to the waiting room.
After a few minutes, they hear him announce that he wants to leave. The doctors are remonstrating
with him, fearing that he is at risk of self-harming or even suicide. He makes no eye contact, gives no
response to their questions.
After many minutes of fruitless attempts to engage with him, or even to get him to speak, they
threaten to detain him under the Mental Health Act.
Just then he looks up and asks ‘How much is the treatment going to cost?’
The man was an NHS patient, and there would be no cost.
Our medical student reflects on the conduct of the assessment.
‘If we hadn’t been so engrossed with getting all the clinical details, we might have paid more attention
to his concerns, his anxieties, especially as money worries were a huge contributing factor to his
depression.’
‘I would like to think that the next time I am assessing someone, I would ask a simple question like “Is
there anything you are concerned about?” Or even, simply “How are you?”
That would save so much anxiety for the patients and so much time for the clinical staff.’
You can watch How are you?, the reflective digital story made by the medical student, by clicking on
the word cloud below.
David Gill, 2014
There are a number of other reflective digital stories created by medical students, which might help
you to think more deeply about the value of reflection:
http://www.patientvoices.org.uk/pkt.htm

Most of us go through this process many times each day, both at work and at home, and it is one of
the ways we learn best.
The key stages of the process are:
1. Identify the incident or problem. (The experience)
2. Think about what happened: who was involved, what each person did, what the outcome was
and how you felt about it. (The description and its effect on you)
3. Now consider what might have been differently to produce a different outcome. (Your
reflection and analysis of the situation – can also include your thoughts and feelings about the
knock-on effects, what led to the situation arising in the first place and what is really going
on?)
You can also use this process to help you keep track of what you are learning:
1. What have you learned?
2. How do you know you have learned it, i.e. what are you doing differently now to indicate that
there has been a change in your skills, knowledge or attitude?
3. How is this affecting your work and what might be the implications for the future?
This process is one that you can use throughout the School and beyond and it will stand you in good
stead throughout your life and career.
‘Mere activity does not constitute experience…. To learn from experience is to
make a backward and forward connection between what we do to things and
what we enjoy or suffer from things in consequence. Under such conditions,
doing becomes a trying: an experiment with the world to find out what it is
like: the undergoing becomes instruction – discovery of the connection of
things.’ Dewey 1916
Theories and models of reflection
Many models and techniques have been
developed to assist the reflective process.
They all have a similar aim: to provide a way
of thinking about and recording experience
so that it becomes possible to learn from
that experience. Three of these models are
set out below. They are not intended to
constrain you but to help you begin to
structure your thinking in the most effective
way. All the models described here share
crucial similarities. Feel free to mix and adapt
them to your own situation or learning style
– the important thing is that you take time to reflect upon your work and your learning and learn from
your experience.

Kolb’s experiential learning cycle
David Kolb (1983) identified four key stages in learning:
1. Concrete experience – learning begins when something happens – there must be active
involvement and felt experience. So here is where you identify the problem, situation or
incident.
2. Reflective observation – standing back and observing or reviewing the incident. Has it
happened before? How was this time different? How did it make you feel? Why is this aspect
of your work particularly important or particularly troublesome? It can be helpful to involve
others here.
3. Abstract conceptualisation – this is when you make sense of what has happened and involves
your deeper analysis and interpretation of events. What caused a problem or what made it
work well? What are the knock-on effects? How did it arise in the first place? What is really
going on here?
4. Active experimentation – engaging in this process helps us learn from experience in a very
effective way by considering how to translate new learning into planning and doing. This is
where we set out the possibilities for change and better practice.
Kolb’s learning cycle from: http://www2.le.ac.uk/departments/gradschool/training/eresources/teaching/theories/kolb
Critical incident analysis
Critical incident analysis is another well-known way of establishing a
structure for your reflections. Critical incident analysis as a technique
originated during World War II, when the US Army Air Force needed
to select and train air crews quickly. Instructors were asked to answer
four questions about their trainees in an attempt to discover why
pilots failed the training programme.
 When was the last time you saw a trainee pilot do something effective or ineffective?
 What led up to this situation?
 Exactly what did the trainee do?
 Why was it effective or ineffective?

The questions demanded factual answers – not intuitions or unfocused feelings about particular
individuals.
Today, critical incident analysis is used by professionals in many fields, particularly as part of the
reflective process. It can help identify the areas which professionals themselves recognise as critical.
Critical incident analysis should take into account questions like the following:
Where did the event occur: what were the relevance of the place and its impact on the situation?
When did it happen: was this an important factor?
Who was involved?
A detailed description of what happened.
Why the incident was critical or significant to you?
What you were thinking about as it was taking place?
What was most satisfying or dissatisfying?
What you might have done differently?
Why you might have done this differently?
What action, if any, you will take as a result of this learning?
Johns’ model of structured reflection
Christopher Johns (1994) devised his model of reflection for use by nurses and other health care
professionals. With slight adaptation, it is as suitable for any professional – or anyone at all – who
wishes to learn from experience.
1 Description
- Describe the incident or problem or issue.
- What are the key issues within this description which you need to pay attention to?
2 Reflection
- What was I trying to achieve?
- Why did I act as I did?
- What were the consequences of my actions?
- How did I feel about this experience when it was happening?
- How did others involved feel about it?
- How do I know how they felt about it?
3 Influencing factors
- What internal factors influenced my decision-making and actions?
- What external factors influenced my decision-making and actions?
- What sources of knowledge did or should have influenced my decision-making and actions?
- Could I have dealt better with the situation?
- What other choices did I have?

- What would be the consequences of those other choices?
4 Learning
- How can I make sense of this experience in the light of past experience and future practice?
- How do I now feel about this experience?
- Have I taken effective action to support myself and others as a result of this experience?
Source: Johns, C. (1994) ‘Nuances of reflection’ IN Journal of Clinical Nursing 3: 71-75
Tripp’s model of structured reflection
Finally, here is Tripp’s model of structured reflection.
Questions used to examine a critical incident
Kind of judgement Information required Questions asked People involved
Practical Procedural What should I do?
How?
When?
Where
For and/or with
whom?
Diagnostic Descriptive
Causal
Effectual
Affectual
Semantic
Explanatory
What happened?
What made it happen?
What does it do?
What does it feel like?
What does it mean?
Why did (does) it occur?
Who was involved?
Who acted?
For whom?
For whom?
To whom?
With whom?
Reflective Personal
Evaluative
Do I like it?
Is it a good thing?
Do others like it?
For whom?
Based on Tripp, D. (1993) Critical Incidents in Teaching. London: Routledge
Despite the many different models of reflection, it is not always clear that what we are really seeking
to do in the process of reflection is to develop a felt understanding of an experience. This is
particularly important when working in the context of care,
when those with whom we come into contact are often ill,
vulnerable and needy. We need to understand their situation,
their life experiences, as well as our own, in order to provide
care that is kind and humane as well as clinically effective.
The creative arts offer opportunities to explore meaning, to
see light and shadows and to use our imagination, especially
when trying to understand others. This kind of reflection can
also deepen our capacity for empathy and compassion.
‘The culture of the mind must be subservient to the culture of the heart.’
Mahatma Gandhi
We would like to end this section by drawing your attention to the power of stories and storytelling as
a way of engaging hearts as well as minds, and reflecting on others’ experiences as well as our own.

Stories and transformation
‘Storytelling is the mode of description best suited to transformation in new
situations of action.’ Schön, 1988
Storytelling is one of the oldest – and most pervasive – of human activities. Stories help us make sense
of experiences – our own and those of others. It is through stories that we learn to be part of a family,
a group, a society, an organisation or a culture. Stories convey tacit knowledge – the things we know
but don’t necessarily know we know. Stories can be educational and instructive as well as
entertaining. A story is so much more than just a list of events: stories carry our values and our
passions, allowing us to encourage, motivate, inspire, celebrate, enthuse and engage – all vital when
we are trying to effect change.
‘How can I help people if I don’t know the right stories to tell them?’
Jack Cash in Walk the line
However, as Schön warns us, ‘Stories are products of
reflection, but we do not usually hold on to them long
enough to make them objects of reflection in their own
right.’ (Schön, 1988) So, if we want to use stories to carry
our dreams and aspirations into reality, it’s necessary to
find a way of preserving them. There are many, many
different ways of sharing stories and you may be more
adept at some than others. Some people love to tell
stories, some write poetry, some draw or paint pictures,
some take photos, some make films, some write plays,
some act in them, some throw pots, some compose music
(or play it), some make quilts, knit scarves, work with wood, decorate cakes, arrange flowers, while
still others dance…
All these activities are ways of expressing and sharing our common human experience. So, it’s helpful
not only to the think of the stories you want to tell, but how you will tell them.
You may be thinking that you are not very creative; most of us, however, are more creative than we
think.
ACTIVITY: THINKING ABOUT STORIES AND CREATIVITY
1 How do you express your own creativity?
2 How would others – friends, family and colleagues – describe your creative gifts?

If you are able to bring your creativity into your work in such a way as to engage with others, you are
likely not only to find greater satisfaction in your work, but also to be a more effective change agent.
‘Telling this story has reminded me of how our creativity connects with part of
our soul - how wonderful it is to be part of something that does not have
measurable targets or hard matrices.’ Patient Voices storyteller
ACTIVITY: CELEBRATION
1 Think of something you have done that you are really proud of. Jot down a few notes.
2 Now turn that experience into a story – one that will engage, entertain and possibly even inspire or
motivate your audience.
You might find it interesting to watch some stories of celebration made by colleagues in the health
and care sector – they may inspire you to share your own stories of success and transformation!
The chief officer of the NHS Heart Improvement Programme wants to make a difference and with a
little help from his friends he does so.
http://www.patientvoices.org.uk/flv/0050pv384.htm
A small voluntary organisation that provides free counselling for those who would not otherwise have
access to such a service is struggling to survive in the face of funding cuts. If the prevailing attitude
does indeed prevail what future is there for voluntary organisations in the co-production of care?
A brief history of the Heart Improvement Programme celebrates the real improvements in services to
patients that are the result of working collaboratively and building networks of doctors nurses and
patients.
Val Leggett, Infection Control Nurse for Norfolk and Waveney Mental Health NHS Foundation Trust,
describes how lateral thinking, teamwork and use of colleagues' expertise achieved an award-winning
facility.
A chance remark made Katie determined to return to the nursing job she loved. But it wasn't until she
was sent on a Montessori for dementia patients training course that she realised the direction she now
wanted to take. Today she is really making a difference to people's lives.

As you progress through the School, you may find it helpful to pay particular attention to the different
ways in which people tell stories and how you respond to them. If you haven’t already done so, begin
to develop your own storytelling style – and you can see from the examples above that it is possible to
say a great deal in a very short space of time!
‘Narrative is radical, creating us at the very moment it is being created.’
Toni Morrison, 1994

Glossary
Every field of endeavor creates its own language or jargon to describe the people, activities, tools and
skills that are particular to that field. The field of change, transformation and improvement is no
different and we know that there are some words and terms that may be a little unfamiliar. By the end
of School, we are confident that you will be bandying around terms like ‘self-efficacy’ with confidence
but, to begin, it might be helpful to have a bit of guidance as to how these terms will be used in the
School.
Advocate
Someone who speaks or writes in support of another person or cause. As a radical, you may be
advocating for positive change, or you may be advocating, for example, for people with dementia.
Apathetic
When you are feeling apathetic, you have no interest or enthusiasm for anything. This can happen
when you are exhausted, overworked, unwell or feel taken for granted.
Autonomy
If you have autonomy, you have the power to make decisions and to act on
those decisions.
Disparate
When things are disparate, they are completely different, separate and
distinct.
Diversity
Diversity refers to the unique difference that we all bring into the world. Diversity is essential for
growth, development and survival, in nature as in society. The concept of diversity relies on accepting
the value of each individual, whatever their race, ethnicity, gender, sexual orientation, socio-economic
status, age, physical or mental abilities, religious beliefs or political stance. Here are a couple of short
videos that might bring the concept of diversity to life.
https://www.youtube.com/watch?v=8taWGfkVvTg
https://www.youtube.com/watch?v=C1lxTJyrCls
Extrinsic
When something is outside or external, it is extrinsic. We
use the term to describe the kind of motivation that comes
from outside, in the form of targets, KPIs or even salaries….
Heretic
A heretic is someone who does not believe in the prevailing system of
belief; he or she may be referred to as a dissident, a non-believer a
non-conformist, a renegade, a rebel – or perhaps even a radical! In
the past, people who did not comply with the rules established by the
Christian Church were considered to be heretics and were often
burned at the stake.

Hierarchy and hierarchical
In a hierarchy or hierarchical system, people or things are ranked
according to their importance (or perceived importance) or their status.
‘Old power’ relies on the notion of hierarchy where the people at the top
of the hierarchy have power over the people beneath them.
Inherent
When something is inherent, it is an essential characteristic or aspect. So, inherent in the School for
Change Agents is the goal of giving people confidence to bring about transformational change.
Innovative
When something or someone is innovative, they are involved in new and original thoughts, ideas or
designs. Many of the initiatives that emerge from the School for Change Agents are innovative
approaches to improving health and care.
Interprofessional
Interprofessional working and learning refers to activities that take place when people from one or
more professions work together. It is the opposite of working in silos and is, actually, essential for 21st
century healthcare. The School for Change Agents is a good example of interprofessional learning,
where people learn from, with and about each other. (See www.caipe.org.uk)
Intrinsic
Intrinsic is the opposite of extrinsic and refers to the essential nature of something. We talk about
intrinsic motivation as being something that comes from within you and relates to your core values or
aspirations.
Maverick
A maverick is a bit like a rebel – mavericks are unorthodox or independently-
minded person determined to do their own things in their own ways.
Non-conformists
Non-conformists don’t do what society expects of them; they think and possibly
live in a way that is quite different from other people. in the middle ages, people who did not agree
with the established church were referred to as non-conformists.
Radical
Radical has a number of meanings: it can refer to the root of something or, in chemistry, to a
particular kind of chemical reaction. People who are referred to as radicals want to bring about radical
(or extreme) change from the traditional ways of doing things; in the School for Change Agents, we
use the term to describe those of us who are passionate about bringing about significant change in
health and care and recognise that we need to do things differently in order to achieve the changes
we want to see.
https://www.youtube.com/watch?v=XKeilf1Fp5c&spfreload=10
Self-efficacy
If you have self-efficacy, you believe in your own capacity to influence your
situation; you have control over your motivation, your behaviour and your
ability to influence your environment.

Silos
In the world of health and care, silos refer to systems, processes, departments, etc. that operate in
isolation. This tends to be a traditional way of working and makes it difficult to bring about change
across organisations. Part of the work of the SHCR is to reduce the number of silos and encourage
people to work across professional boundaries.
Status quo
Status quo is Latin for ‘the state in which’, in other words, the existing state of affairs, especially
regarding social or political issues. The School for Change Agents offers opportunities and skills to
enable people to challenge the status quo in constructive ways that will result in sustainable change.
Resources
Each module will contain a list of resources that are particularly relevant to that module.
You will also find a collection of resources at www.theedge.nhsiq.nhs.uk/school/
This collection will grow as we update it so please do check back often and, if you have a favourite
resource, please do share it with us all!
Email: england.si-horizons@nhs.net Telephone: +44 2476 627543
Facebook: www.facebook.com/sch4change Twitter: @Sch4change #S4CA

S4CA 2017 Programme Guide

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