and staying in it: How to be a great change agent www.changeday.nhs.uk/healthcareradicals Helen Bevan @HelenBevan Source of image: showstudio.com Leadership Assessment 10 credits • Reflective diary/ journal • Use a case study • the interpersonal challenges and achievements of leading others in relation to your quality improvement work based project. @HelenBevan Learning outcomes being assessed • Critical understanding of key theories, concepts, models and techniques underlying a range of strategies for leading others, with reference to own organisational context. • Critical understanding of political, ethical, legal and other challenges facing professionals as effective improvement practitioners. • Independently seek out knowledge relevant to developing strategies for improvement in own organisation. • Constructively question and analyse professional practices related to own organisational context. • Exercise own initiative in identifying problems and developing innovative and viable solutions. • Structure and communicate ideas effectively to both academic and organisation-based audiences. • Elicit, take account of, critically evaluate and respond to views of stakeholders and colleagues in own workplace. @HelenBevan @HelenBevan Source of image: Whatsthebigideascwartzy.blogspot.com Most large scale change doesn’t fully deliver its objectives 5% Gets anywhere near achieving the change and delivering the benefits 25% 70% Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey @HelenBevan Most large scale change doesn’t fully deliver its objectives 5% Delivers and sustains the change 25% 70% Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey @HelenBevan Most change efforts are built upon the shaky foundation of five flawed assumptions; that change can be managed, that human beings are objective, that there are ‘X’ steps to change, that we have a neutral starting point for change, and that change, itself, is the goal Peter Fuda http://www.peterfuda.com/wp-content/themes/peterfudabootstrap/content/Why-Change-Efforts-Fail.pdf @HelenBevan Source of image: Whatsthebigideascwartzy.blogspot.com Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on Increasing number of messages as information cascade through the organisation Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-faildon.aspx @HelenBevan Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on Increasing number of messages as information cascade through the organisation Buy in from front line staff is critical for improvements in quality and safety . Don’t overload them Buy in from front line staff is critical for improvements in quality and safety Source: adapted from Don’t overload them http://businessjournal.gallup.com/content/162707/change-initiatives-failhttp://healthaffairs.org/blog/2014/03/07/thedon.aspx dangers-of-quality-improvement-overload-insightsfrom-the-field/ @HelenBevan Leading change in a new era Dominant approach @HelenBevan Emerging direction @HelenBevan @HelenBevan John Kotter: “Accelerate!” • We won’t create big change through hierarchy on its own • We need hierarchy AND network • Many change agents, many acts of leadership • At least 50% buy-in Source of image:www.slideshare.net/m exicanwave/champions-trolls• Changing our mindset 10-years-of-the-cipd-online• From “have to” to “want to” @HelenBevan community The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro 1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy 2. If you want to create small scale change, work through a cohesive network If you want to create big change, create bridge networks between disconnected groups @HelenBevan Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/ @HelenBevan What happens to heretics/radicals/rebels/mavericks in organisations? @HelenBevan @HelenBevan Valuing radicals • “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection) • Big things only happen in organisations and systems because of heretics and radicals GALILEO DESCRIBES HIS DISCOVERIES TO THE CHURCH ESTABLISHMENT @helenbevan @HelenBevan The 90/30 conundrum of senior leaders say that to create more innovation, they need to activate the radicals/rebels in their organisations or systems @helenbevan @HelenBevan of senior leaders are very satisfied that radicals/rebels can provide this value in their organisations or systems Source: rebelsatwork.com We need to be boatrockers! • Rock the boat but manage to stay in it • Walk the fine line between difference and fit, inside and outside • Able to challenge the status quo when we see that there could be a better way • Conform AND rebel • Capable of working with others to create success NOT a Source: Debra Meyerson destructive troublemaker @helenbevan @HelenBevan There’s a big difference between a rebel and a troublemaker Rebel @helenbevan Source : Lois Kelly www.rebelsatwork.com Peter Fuda’s Transformational Change Agent framework Skills and methods for creating change Ability to make sense of, and reshape perceptions of ‘reality’ Personal characteristics and qualities @helenbevan @HelenBevan Peter Fuda’s Transformational Change Agent framework: my perspective “Doing” • Where most change agents in health and care put most of their effort and emphasis • What others typically judge us on • What we often perceive we need to do to add value • What most change and improvement courses focus on @helenbevan @HelenBevan Peter Fuda’s Transformational Change Agent framework: my perspective “Seeing ” and “Being” • We can only do effective “doing” if we build on strong foundations of “seeing and being” • Change begins with me • Hopeful futures, creative opportunities and potential • Multiple lenses for change • See myself in the context of my higher purpose @helenbevan @HelenBevan “Being” as a change agent Personal characteristics and qualities @helenbevan @HelenBevan "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 @helenbevan @HelenBevan ‘I do not think you can really deal with change without a person asking real questions about who they are and how they belong in the world’ David Whyte, The Heart Aroused 1994 @helenbevan @HelenBevan Source of image: fistfuloftalent.com Five things we know about successful boat rockers CHANGE BEGINS WITH 1. Driven by conviction and values me 2. strong sense of “self-efficacy” belief that I am personally able to create the change 3. able to join forces with others to create action 4. able to achieve small wins which create a sense of hope, self-efficacy and confidence 5. More likely to view obstacles as challenges to overcome @helenbevan @HelenBevan Source: adapted from Debra E Meyerson Source: @NHSChangeDay @helenbevan @HelenBevan Source: @NHSChangeDay What is the issue here? “permission” ? (externally generated) or Self efficacy ? @helenbevan @HelenBevan (internally generated) Building self-efficacy: some tactics 1. Invest in your own change agent development • create the conditions where success is more likely to happen 2. Create change one small step at a time 3. Reframe your thinking: • failed attempts are learning opportunities • uncertainty becomes curiousity 4. Make change (and learning cycles from change) routine rather than an exceptional activity 5. Get social support 6. Learn from the best 7. Get people whose opinions you value to encourage you (mentor?) @helenbevan @HelenBevan “Being” as a change agent • Living my conviction and values • Strong sense of “self-efficacy” belief that I am personally able to create the change • Stepping outside my comfort zone • A “rebel” rather than a “troublemaker” • Learning not judging CHANGE BEGINS WITH #NHSChangeDay #SHCRchat @HelenBevan me “Seeing” as a change agent Ability to make sense of, and reshape perceptions of ‘reality’ @helenbevan @HelenBevan Seeing “Seeing, looking, monitoring, listening, perceiving and especially the indefinite concept of intuitive feeling ” Aubrey Jango @helenbevan @HelenBevan Task Have a table discussion: What are some of the different ways of “seeing” change? @helenbevan @HelenBevan What do we mean by resistance to change? @helenbevan @HelenBevan Resistance Any force that stops or slows movement Source of image: sport-fitness-advisor.com @helenbevan @HelenBevan Employee resistance is the most common reason executives cite for the failure of big organizational-change efforts Source of image: Businessconjunctions.com @helenbevan @HelenBevan Scott Keller and Colin Price (2011), Beyond Performance: How Great Organizations Build Ultimate Competitive Advantage Diagnostic and dialogic approaches to resistance to change @helenbevan @HelenBevan Resistance: a “diagnostic” approach • Change is something that happens “out there” in the organisation or system • Resistance is a force to overcome • Resistance prevents change • Change agents must diagnose, manage and/or overcome resistance • Resisters may be otherwise known as “laggards”, “blockers”, “in denial” @helenbevan @HelenBevan Resistance to change @helenbevan @HelenBevan Diagnostic: the role of the change agent “The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to implement successfully and may not succeed at all” David Stonehouse The change agent: the manager’s role in change British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445 @helenbevan @HelenBevan Resistance: a “dialogic” approach • People make their own reality • Change results from transformational conversations involving more and different people in change discussions altering how and which people engage with each other by stimulating different perspectives to shape how people think about things • Resistance is an inevitable consequence of a complex change process (based on diversity) • Resistance should be embraced and worked with @helenbevan @HelenBevan Dialogic: the role of the change agent 1. Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system, and by being welcoming 2. Create opportunities for everyone to express their views, spot opportunities and build on each other’s ideas 3. Create ways for people to reflect together to find meaning, understanding and shared purpose in the change Source: Peggy Holman @helenbevan @HelenBevan Diversity is critical to innovation and change “The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities. Do this before you start hiring consultants and rethinking your innovation process, there is no process that works without true diversity.” Idris Moore @helenbevan @HelenBevan Source of image: idsgn.org Health and care radicals should be champions of diversity for change “Leaders and organisations must let go of the idea that there is “one right way” and instead focus on creating a learning culture where people feel accepted, are comfortable contributing ideas, and actively seek to learn from each other” Diaz_Uda, Medina and Schill (2013) @helenbevan @HelenBevan Source of image:fineartamerica.com Discussion In the context of “rolling with resistance” • What are the implications of embracing diversity of thought, experience and background in our change efforts? • What skills and perspectives do health and care radicals need to work effectively with diverse teams for change? @helenbevan @HelenBevan Source of image:fineartamerica.com The effectiveness of change agents is not a matter of intention; it’s a matter of impact @helenbevan @HelenBevan • Helen’s intent was to give people quick solutions, help them do their work faster and get on to the next problem at hand • However, her impact was that people did not know how to solve their own problems so that Helen’s style was impeding their development Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee Source of image: thedigitalawards.com @helenbevan @HelenBevan Stop talking AT ME Start talking TO ME Source of image: prepbeijing.com @helenbevan @HelenBevan What should I do to manage intent and impact? • Build a trusting and supportive work environment • Listen with an open heart and open mind • Commit to the change 100% • Seek common purpose and common interests • Take time to build relationships • Be open with my intent • Take responsibility for my own actions @helenbevan @HelenBevan @helenbevan @HelenBevan If your horse dies, get off it Cherokee proverb @helenbevan @HelenBevan Source of image: fenwickgallery.co.uk Task Have a discussion with others at your table: • How can I manage my intent and impact? @helenbevan @HelenBevan @helenbevan @HelenBevan “Stages of change” Transtheoretical model of behaviour change @helenbevan @HelenBevan Prochaska, DiClemente & Norcross (1992) The model is mostly used around health-related behaviours • • • • • • • • • • smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake domestic violence HIV prevention use of sunscreens to prevent skin cancer medication compliance mammography screening @helenbevan @HelenBevan The model is mostly used around health-related behaviours • • • • • • • • • • smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake It works for organisational and domestic violence HIV prevention service change too! use of sunscreens to prevent skin cancer medication compliance mammography screening @helenbevan @HelenBevan “Stages of change” Smoking @helenbevan @HelenBevan I am not aware my smoking is a problem – I have no intention to quit Prochaska, DiClemente & Norcross (1992) “Stages of change” Smoking 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 @helenbevan @HelenBevan Prochaska, DiClemente & Norcross (1992) “Stages of change” Smoking 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. @helenbevan @HelenBevan Prochaska, DiClemente & Norcross (1992) “Stages of change” Smoking 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 have stopped smoking! @helenbevan @HelenBevan I am making plans & changing things I do in preparation. Prochaska, DiClemente & Norcross (1992) “Stages of change” Smoking I am continuing to not smoke. I sometimes miss it – but I am still not smoking I have stopped smoking! @helenbevan @HelenBevan 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. Prochaska, DiClemente & Norcross (1992) “Stages of change” Smoking I am continuing to not smoke. I sometimes miss it – but I am still not smoking I have stopped smoking! @helenbevan @HelenBevan 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. Prochaska, DiClemente & Norcross (1992) “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992) @helenbevan @HelenBevan Some questions • Which stage do most change activities in health and care focus on? • Which stage are most people actually at? @helenbevan @HelenBevan 90% of the tools available for health and care 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 @helenbevan @HelenBevan 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 @helenbevan #SHCRchat #NHSChangeDay 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 management” for not enforcing change @helenbevan @HelenBevan The single biggest problem in communication is the illusion that it has taken place George Bernard Shaw @helenbevan @HelenBevan 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 @helenbevan @HelenBevan • I am not thinking about changing my behaviours, actions or work processes • The problem or issue is outside my frame of awareness or my perceived need @helenbevan @HelenBevan • The focus should be on creating awareness for me of the need to change • Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation Reflection Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model: • What stage of change are some of the key people that you need to influence for your change initiative at? • What actions can you take to help them move to the next stage? @helenbevan @HelenBevan “Seeing” as a change agent • • • • The big picture Multiple perspectives The positive intentions of others Possibility of bad change processes rather than resistors, blockers and laggards • Hopeful futures, creative opportunities and potential • Multiple paradigms for change (eg, diagnostic and dialogic) • See myself in the context of my higher purpose @helenbevan @HelenBevan A 3-word concept @helenbevan @HelenBevan [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 @helenbevan #IQTGOLD @HelenBevan #NHSChangeDay Avoiding “de facto” purpose • What leaders pay attention to matters to staff, and consequently staff pay attention to that too • Shared purpose can easily be displaced by a “de facto” purpose: hitting a target reducing costs reducing length of stay eliminating waste completing activities within a timescale complying with an inspection regime • If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector @helenbevan @HelenBevan @helenbevan @HelenBevan @SimonJGuilfoyle Police Inspector and systems thinker @helenbevan @HelenBevan @SimonJGuilfoyle Police Inspector and systems thinker Police @helenbevan @HelenBevan @SimonJGuilfoyle Police Inspector and systems thinker Education @helenbevan @HelenBevan @SimonJGuilfoyle Police Inspector and systems thinker Healthcare @SimonJGuilfoyle Police Inspector and systems thinker @helenbevan @HelenBevan “Doing” as a change agent • Create the conditions where everyone can contribute and do their best • Join forces with others to create action • Achieve small wins which create a sense of hope, self-efficacy and confidence • Appeal to both the head (logic/planning/data) and the heart (shared values/purpose, framing, relationships) • Make change (and learning cycles from change) routine rather than an exceptional activity • Use models, theories and frameworks effectively #NHSChangeDay #SHCRchat @HelenBevan A call to action • Create shared purpose for improving the quality of care • Work out how to rock the boat and stay in it • Build your own self-efficacy @helenbevan @HelenBevan Coming soon……… @helenbevan @HelenBevan Outwitted He drew a circle that shut me out Heretic, rebel, a thing to flout. But Love and I had the wit to win: We drew a circle that took him in. Edward Markham @helenbevan @HelenBevan