Pre-summit workshop on Wedesday, April 10 at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.
Much of the redesign effort in health care is focused on the “anatomical” or technical aspects of improvement; how we transform processes, pathways and structures of care. There is growing recognition globally among leaders that we need to give more credence to the “physiological” aspects of redesign; how we capture the imagination and energy of frontline teams, leaders, and patients and families and mobilize them for system-wide transformation. Individuals and teams can weather the inevitable challenges presented by change, and they will sustain energy for change if they have an intrinsic sense of purpose, hope, and possibility about what the change will achieve.
At this one-day workshop, Helen Bevan – she is energy personified! - took us through some of the latest thinking and practice on how to build this ‘contagious commitment’ to change. She illustrates why energy is such a critical factor in successful change efforts. Learn about the different kinds of energy required for change, and the skills for assessing and building energy levels in yourself and in your team members.
7. @helenbevan #Quality2013 #Qradicals#QS13
Are you a boat rocker?
• One who challenges the status
quo when they see that there
could be a better way
• Energise their organisation by
working from their true self
• Capable of working with others
to create success NOT a
destructive troublemaker
• Walk the fine line between
difference and fit, inside and
outside, rock the boat but
manage to stay in it
10. @helenbevan #Quality2013 #Qradicals#QS13
Valuing radicals
• “New truths begin as heresies” (Huxley, defending
Darwin’s theory of natural selection)
• big things only happen in organisations because of
heretics and radicals
11. @helenbevan #Quality2013 #Qradicals
The contrarians and rebels, the people on the
fringes of organizations who question and
deviate from the status quo, which so often
leads to inertia and inflexibility, are huge
assets for any organization
Tim Leberecht
13. @helenbevan #Quality2013 #Qradicals#QS13
The 90/30 conundrum
90% senior leaders
say to improve a
corporate culture
involve radicals/
rebels in finding ways
to improve
90% senior leaders
say to create more
innovation, activate
the radicals/rebels
37% senior leaders
very satisfied that
radicals/rebels can
provide this value in
their organisations
http://www.slideshare.net/Foghound/corporate-rebel-ebook#btnNext
15. @helenbevan #Quality2013 #Qradicals#QS13
Four tactics for organisational radicals
1. Start with myself
2. Work out what might help others to change
3. Build alliances
4. Don't be a martyr
16. @helenbevan #Quality2013 #Qradicals#QS13
Four tactics for organisational radicals
1. Start with myself
2. Work out what might help others to change
3. Build alliances
4. Don't be a martyr
17. @helenbevan #Quality2013 #Qradicals#QS13
“There is nothing more
difficult to carry out, nor
more doubtful of success,
nor more dangerous to
handle, than to initiate a
new order of things. For the
reformer has enemies in all
those who profit by the old
order, and only lukewarm
defenders in all those who
profit by the new”
Niccolo Machiavelli 15th century
20. @helenbevan #Quality2013 #Qradicals#QS13
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
21. @helenbevan #Quality2013 #Qradicals#QS13
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
24. @helenbevan #Quality2013 #Qradicals#QS13
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
25. @helenbevan #Quality2013 #Qradicals#QS13
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
26. @helenbevan #Quality2013 #Qradicals#QS13
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
27. @helenbevan #Quality2013 #Qradicals#QS13
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
28. @helenbevan #Quality2013 #Qradicals#QS13
1. convictions and values – driven
2. strong sense of “self-efficacy”
belief that I am personally able to create change
belief in others
3. action orientated
ignite collective action
mobilising others, inspiring change
4. able to join forces with others
work as a collective body for commonly valued changes
5. able to achieve small wins which create a sense of hope, self-
efficacy and confidence
6. optimistic in the face of challenge
see opportunities
take account of obstacles
What do we know about successful boat rockers?
29. @helenbevan #Quality2013 #Qradicals#QS13
The most effective boat rockers….
‘ …..bear no banners: they sound no trumpets.
Their ends are sweeping, but their means are mundane.
They are firm in their commitments, yet flexible in the ways they
fulfil them.
Their actions may be small but can spread like a virus.
They yearn for rapid change but trust in patience.
They often work individually yet pull people together.
Instead of stridently pressing their agendas, they start
conversation
... to do all this, [they] understand revolutionary change for what it
is – a phenomenon that can occur suddenly but more often than
not requires time, commitment and the patience to endure.’
Debra Meyerson, Tempered Radicals
34. @helenbevan #Quality2013 #Qradicals#QS13
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
35. @helenbevan #Quality2013 #Qradicals#QS13
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
36. @helenbevan #Quality2013 #Qradicals#QS13
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
37. @helenbevan #Quality2013 #Qradicals#QS13
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking
38. @helenbevan #Quality2013 #Qradicals#QS13
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking
40. @helenbevan #Quality2013 #Qradicals#QS13
90% of the tools available for healthcare change
agents are designed for the “action” stage
The reality of our change situation
• Our tools are often not effective at the stage of change
that most people we work with are at
• It’s hard to engage people in change
• It’s hard to get people to make the changes we want
them to make
• People get irritated, defensive, irrational
• We feel powerless in our ability to lead or facilitate the
change
• We take resources away from the stage when support
most needed - maintenance
41. @helenbevan #Quality2013 #Qradicals
Healthcare Example - Surgical Checklist
• Designed for Stage 4 –
ACTION!
• Mandated it through
targets
• Despite compelling case
for change – people
resisted it – no values
connection
• People did the task and
missed the point
42. @helenbevan #Quality2013 #Qradicals#QS13
So what do we TEND to do?
• Lower our ambitions for improvement
• Focus our energies on those who are already in the
“action” stage
• Put negative labels on those who are not yet at the
action stage such as “blocker” or “resister” or “laggard”
• Blame the leadership for not enforcing change
• Withdraw support from the critical “maintenance”
phase when we need it most
• Overestimate the motivation of those who say they’re
ready to change and underestimate the motivation of
those who indicate no interest in change (Lundberg)
43. @helenbevan #Quality2013 #Qradicals#QS13
So what SHOULD we do
• Listen and understand
• appreciate the starting point
• elaborate interests
• Build meaning and conviction in the change
• Roll with resistance (Singh)
• Don’t argue against it
• Encourage elaboration of resistance
• What makes it so hard?
• What would help?
• Build shared purpose
46. @helenbevan #Quality2013 #Qradicals#QS13
Our shared purpose – our overall aim
‘Everyone approaching established kidney failure will receive timely,
personalised decision support and unbiased information from their
clinical team to ensure that they can choose the treatment and care
that best meets their individual needs’
47. @helenbevan #Quality2013 #Qradicals#QS13
So what did we do?
• We clarified our ambition for improvement
• We focused our energies on a few people that
where already in the “action” stage
• We labeled people involved in the programme
who are where not yet at the action stage
• We blamed others for not taking up leadership
roles and building commitment for change
• We made huge assumptions in respect of
commitment and motivation – and read signals in
the way that we wanted to read them.
48. @helenbevan #Quality2013 #Qradicals#QS13
What did we learn?
• The need to listen and understand from all our
stakeholders – not misunderstand signs in the first
stages of change
• The need to build strong foundations of commitment –
and work out whether commitment was compliance
• Take time to really build the shared purpose with the
whole community
• Use resistance as an opportunity to understand and
build commitment
• The opportunity that using a blended approach to
change brought – and how this can build commitment
and energy
49. @helenbevan #Quality2013 #Qradicals#QS13
Talk to the person next to you
• Have a conversation with the person next to
you:
– Do you recognise the ‘stages of change’ in your
improvement work?
– What approaches have you found helpful in the
‘stages of change’?
– How might you use the stages of change to
improve your improvement work
50. @helenbevan #Quality2013 #Qradicals#QS13
Three assumptions for organisational
radicals
1. Assume that everyone has a noble intention
2. Motivation and behaviour in a change
process are due to interpersonal interaction
(not just innate character trait)
3. My role as a change agent is about
alignment, not judgement
54. @helenbevan #Quality2013 #Qradicals#QS13
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)
55. @helenbevan #Quality2013 #Qradicals
If we want people to take action, we have to
connect with their emotions through values
action
values
emotion
Source: Marshall Ganz
60. @helenbevan #Quality2013 #Qradicals#QS13
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
64. @helenbevan #Quality2013 #Qradicals#QS13
Talk to the person next to you
• Tell your story about why your change
initiative is so important to you
• Relate it to a personal experience
• In terms of the people you want to get on
board, what will create a sense of “us” rather
than “us and them”?
• How could telling your story help create the
“us”?
66. @helenbevan #Quality2013 #Qradicals#QS13
Corporate Rebels United
We are architects and scouts into the future, and we want to
guide our organisations in navigating a safe path from now to
then:
Relentlessly
Challenging the status quo
Changing the rules
Saying the unsaid
Spreading the innovation virus
Seeding tribal energy
With no fear
With a cause to do good
Leading by being from our true selves
Going after the un-named quality
Relentlessly