California presentation march 2015 final 2 - jackie lytnon

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

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

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

@HelenBevan @JackieLynton #mixmashup
Agenda
1. Building a social movement
2. Why programmatic and target-driven
approaches to change aren’t enough
3. Leading contagious commitment to
change
4. A disruptive case study: NHS Change
Day

Community
Call to attention Stay with the process

@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
Activity
Today you will be working as a community with
others on your table so it’s important to find out
who is in your community.
Introduce yourself to others at your table. Tell a
quick story that demonstrates why you chose to
come to this workshop today.
Time allowed: 10 minutes for the whole table

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

The National Health Service is the closest thing
the English have to a religion, with those who
practice in it regarding themselves as a
priesthood. This makes it quite extraordinarily
difficult to reform
Nigel Lawson, politician
“
“

Where are we?
The dominant NHS approach [to leadership] is
typified by laying down demanding targets, leading
from the front, often being reluctant to delegate,
and collaborating little – and is the consequence of
the health service focusing on process targets, with
reward dependent on meeting them.
Source: Kings Fund Leadership for engagement and improvement in the NHS
http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/leadership-for-
engagement-improvement-nhs-final-review2012.pdf
“
“

Building on a legacy of social movement
thinking for the NHS

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

SEISMIC SHIFTS
Change from the edge

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

Leading change in a new era
Dominant approach Emerging direction

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

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

“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

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
‘If people give to a cause, they expect a
relationship, not a transaction.’
Nilofer Merchant

Why am I a radical?

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

Six characteristics of people or groups within
effective social movements
1. They share a sense of PURPOSE: There is purposefulness about
collaborations, discussions, actions, decisions and a sense of forward momentum
2. They are UNITED: They have learned to manage their differences well enough
that they can unite to accomplish their purpose. Differences are openly debated,
discussed, and resolved.
3. They share UNDERSTANDING: There is a widely shared understanding of
what's going on, what the challenges are and why what is being done has to be
done
4. People PARTICIPATE: Lots of people and organisations in the system are
active - not just in discussions and meetings, but getting the work done.
5. They take INITIATIVE: Rather than reacting to whatever happens in their
environment, they are proactive, and act upon their environment.
6. They ACT: People do the work they must do to
make the things happen that need to happen
Source: adapted from Wellstone Action

We need rebels!
•The principal champion of a change
initiative, cause or action
•Rebels don’t wait for permission to lead,
innovate, strategise
•They are responsible; they do what is
right
•Without rebels, the storyline never
changes
Source : @PeterVan http://t.co/6CQtA4wUv1

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)

Three components of framing
• Diagnostic – what is the problem that we are
addressing? What is the extent of the problem?
What is the specific source or sources?
• Prognostic – what could the future look like? What is
our “plan of attack” and our strategy for carrying out
the plan?
• Motivational – why is this urgent? What is our call
for action that connects with the motivational and
emotional drivers of the audience?
Source: Benford and Snow

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

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5Source: Rebelsatwork.com

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

My first experience of being in large
scale change in the NHS 1986
The story of Fredrick……

Leaders ask their staff to be ready for change,
but do not engage enough in
sensemaking........
Sensemaking is not done via marketing...or
slogans but by emotional connection with
employees
Ron Weil

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

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

Why programmatic
and target driven
approaches to change
aren’t enough in our
system?

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

Four keys to collaboration
• Lean into your discomfort
• Listen as an ally
• State your intent
• Share your “street corner”
Source: Judith Katz and Fred Miller

@HelenBevan
John Kotter: “Accelerate!” most influential thought leader
globally, recognises new approaches are needed
• We won’t create big change
through hierarchy on its own
• We need hierarchy AND network
• Many change agents, not just a
few, with many acts of leadership
• Changing our mindset
TO
FROM

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

@helenbevan
“Tomorrow’s
management systems
will need to value
diversity, dissent and
divergence as highly as
conformance, consensus
and cohesion.”
Gary Hamel
Source of image: www.fastcompany.com
Embracing difference to change the
conversation

Less change programmes More change platforms
Change Programmes:
• utilise systematic “change
management” approaches
• Too often, leaders prescribe
the outcome and the
method of change in a top-
down way
• change is experienced by
people at the front line as
“have to” (imposed) rather
than “want to” (embraced)
Change Platforms
• enable everyone in the
organisation/system
(including service users) to
help tackle the most
challenging issues
• value diversity of thought
• leadership attention on
creating an environment
receptive to transformational
change
http://www.hsj.co.uk/resource-centre/scrap-the-programme-successful-change-starts-with-
a-change-platform/5078014.article?blocktitle=Blogs-and-videos&contentID=16031

@helenbevan
Conclusions
• The way that change is changing means that traditional
policy levers (targets, payment incentives, regulation etc)
will be increasingly less effective
• They don’t have the track record in delivering the sort of
transformational change now required across the NHS
New Health Foundation report: 10% impact on overall performance
• Transformation needs frontline staff to learn from the
wider world, build shared purpose and have the freedom
to take action
• We have to find ways to:
• Build organisations that are activist at their core
• marry innovation with complexity and scale
• balance control and freedom

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

Leading contagious commitment
to change in the workplace

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

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

Connecting to other people values and emotions

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

Building contagious commitment
Shared understanding leads to
Action
Narrative
why?
Strategy
what?

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

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

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

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

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

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Source: Helen Bevan
Compliance
States a minimum performance
standard that everyone must
achieve
Uses hierarchy, systems and
standard procedures for co-
ordination and control
Threat of penalties/ sanctions/
shame creates momentum for
delivery
What is our approach to change? 3 Mins
Commitment
States a collective goal that
everyone can aspire to
Based on shared goals, values
and sense of purpose for co-
ordination and control
Commitment to a common
purpose creates energy for
delivery

"There’s only one
corner of the
universe you can
be certain of
improving, and
that’s your own
self."
Aldous Huxley
Source of image: timcoffeyart.wordpress.com

It starts
with me….

Effective framing:
what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us”
is)
5. Build in a call for urgent action

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

Vivid details

Me at 22 years old

Image from: @TheWorldStories

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

Strong sense public service and community

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

Always fighting for change an speaking out

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

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

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

Knowing your purpose

A 3-word concept

[Shared] purpose goes way deeper than
vision and mission; it goes right into your gut
and taps some part of your primal self. I
believe that if you can bring people with
similar primal-purposes together and get
them all marching in the same direction,
amazing things can be achieved.
Seth Carguilo

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

“People who think differently
challenge the status quo…. in
difference lies value. They are
what Cass Sustein (2003)
might call
“dissenters”……dissenters
identify new dimensions, and
they force us to abandon our
existing predictive models.
Dissent is useful. Without it
society would falter”
Source: Scott E. Page, Making the difference: Applying a
Logic of Diversity - Academy of Management Perspectives

Change starts with me

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

Creating change through connections and
building relationships

Reconnecting with my values

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

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

Talk to the person next to you ACTIVITY
• Tell your story about why the change you are
involved in now is so important to you
• Relate it to a personal experience
You have:
• 2 minutes to prepare your story
• 2 minutes each to tell your story

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

Talk to the rest of the table
What insight did you get from that exercise?
You have five minutes for a whole table
discussion

How do we create a
sense of “us” to build
momentum for
change?
Source of image:
studentblognmaestics.blogspot.com

strong ties (cohesive)
v.
weak ties (disconnected)
Source of image:brucemacvaresh.com

When we spread change through strong ties:
• we interact with “people like us”, with the same
life experiences, beliefs and values
• Change is “peer to peer”; GP to GP, nurse to
nurse, gynaecologist to gynaecologist
• Influence is spread through people who are
strongly connected to each other, like and trust
each other

When we spread change through strong ties:
• we interact with “people like us”, with the same
life experiences, beliefs and values
• Change is “peer to peer”; GP to GP, nurse to
nurse, gynaecologist to gynaecologist
• Influence is spread through people who are
strongly connected to each other, like and trust
each other
IT WORKS BECAUSE: people are far
more likely to be influenced to
adopt new behaviours or ways of
working from those with whom they
are most strongly tied

The pros and cons of strong ties
Pros Cons
ACTIVITY

Strong and weak ties
When we seek to spread change
through strong ties:
• we interact with “people like
us”, with the same life
experiences, beliefs and
values
• Change is “peer to peer”; GP
to GP, nurse to nurse,
gynaecologist to
gynaecologist
• Influence is spread through
people who are strongly
connected to each other, like
and trust each other
When we seek to spread change
through weak ties:
• we build bridges between groups
and individuals who were previously
different and separate
• we create relationships based not
on pre-existing similarities but on
common purpose and
commitments that people make to
each other to take action
• our aim is to mobilise all the
resources in our organisation,
system or community that can help
achieve our goals

Why we need to build weak ties
AS WELL AS strong ties
• Weak ties are more likely to lead to change at scale because they
enable us to access more people with fewer barriers

• In situations of uncertainty, we have a tendency to revert to our
strong tie relationships
• yet the evidence tells us that weak ties are much more
important than strong ties when it comes to searching out
resources in times of scarcity

• The most breakthrough innovations will come when we tap into
our weak ties

• The most breakthrough innovations will come when we tap into
our weak ties
History suggests that weak ties will probably give us the best
chance to deliver large scale improvements in a challenging
timescale

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

NHS Change Day
2015
Wednesday 11 March
Making a change for
better together.
Disruptive Case Study

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

2013 2014 2015

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

Holding each
other to
account rather
than
performance
management

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

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

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

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

Volunteers – leaders everywhere
98% of activity via volunteers

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

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

Fun day for children Support group
with a stomas

NHS CEO personal National
pledge campaign

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

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

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

Local anaesthetic for
arterial blood gas
sampling
Clinician shows painful
procedure for patient
experience

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

Smile Feedback Wednesday
Ellie Milner

125
With the patronage and support of Her Royal Highness
Princess Muna Al-Hussein who was the first to pledge

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

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

• We must activate the mavericks, radicals, rebels and heretics
• From the top of the hierarchy:
 You CAN support and enable a social movement
 You CAN join forces to achieve shared purpose
 You CAN utilise movement principles
BUT you CANNOT lead or drive it
• It’s not enough to mobilise, we have to organise
• There is a massive untapped reservoir of energy and talent
out there and the potential is outstanding
What have we learnt?

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

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

More information
For more information visit
changeday.nhs.uk
@jackielynton

Health and care radicals

The school is based on two kinds of learning
Transactional learning Transformational learning
A “toolkit” of ideas &
approaches
Learning through
motivation, practice &
feedback
Seeks to transfer useful
knowledge
Seeks to transform beliefs
& underlying assumptions
Learning event,
presentations & materials
Experiential, interactive &
action-based
Generates understanding of
“what to do”
Generates increased
capacity in “how to do it”
Source: Based on John Wenger https://medium.com/corporate-learning/3deb1bb2e865

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

The extent of our reach
Nearly 5,000 enrolees in 2014 & 2015
2015: #SHCR: 20,786,339 impressions across 14,288 tweets
@School4Radicals: reached 35,044 unique twitter accounts;
1,686 followers; 24,551 views of school materials, including
attendees on live webinars
Nearly 7,000 subscribers, 13,000 unique users
@theedgenhs: 65,438 impressions; reached 50,413 accounts;
1,726 followers / The Edge: 6,652 subscribers;
Since 5 November 2014: 22,328 visits to The Edge website,
with 64,611 page views from 13,011 separate users
Since launch of 2015 campaign on 1 December 2014:
@nhschangeday: 708,100 impressions, 12.2k followers
#nhschangeday: 30,053,800 impressions across 11,396 tweets
#100daysofchange: 1,629,672 impressions across 539 tweets
Facebook reach of 9,995, 10 separate campaigns launched
29,068 visits to website, with 70,593 page views from 19,777 separate users
Since 1 December 2014:
#thoughtdiversity: 10,839,571 impressions across 3,749 tweets

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

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

36.3m twitter impressions (across all main accounts)
Reached 143k individual accounts
36k twitter followers across all main accounts
24.5k views of #SHCR materials, including students on live webinars
64.6kviews from 13kunique users of The Edge
480k impressions and 2,451clicks for Challenge Top-Down Change
Horizons group: numbers for February 2015

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

Thank you for listening
@jackielynton
Jackie.lynton@nhsiq.nhs.uk

California presentation march 2015 final 2 - jackie lytnon

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