helen bevan - building contagious commitment for change: a dynamic, inter…
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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.TRANSCRIPT
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@helenbevan #Quality2013 #Qradicals
#Quality2013 #Qradicals
Calling all change agents
Helen Bevan
@HelenBevan #QS13
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@helenbevan #Quality2013 #Qradicals
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@helenbevan #Quality2013 #Qradicals
#QS13
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@helenbevan #Quality2013 #Qradicals
#QS13
What happens to heretics/radicals/rebels/mavericks
in organisations?
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@helenbevan #Quality2013 #Qradicals
#QS13
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@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
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@helenbevan #Quality2013 #Qradicals
“Bad” Rebels/Radicals “Good” Rebels/Radicals
Break rules Change rules
Complain Create
Assertions Questions
Me-focused Mission-focused
Anger Passion
Pessimist Optimist
Energy-sapping Energy-generating
Alienate Attract
Problems Possibilities
Vocalize problems Socialize opportunities
Worry that......... Wonder if...........
Point fingers Pinpoint causes
Doubt Believe
Social loner Social
Source : Lois Kelly www.foghound.com
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@helenbevan #Quality2013 #Qradicals
#QS13
First they ignore you, then they laugh at you, then they fight you, then you win
Gandhi
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@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
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@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
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@helenbevan #Quality2013 #Qradicals
#QS13
Greatest value that radicals provide to organisations
Source: Foghorn survey http://www.slideshare.net/Foghound/corporate-rebel-ebook#btnNext
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@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
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@helenbevan #Quality2013 #Qradicals
#QS13 Source: Foghound
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@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
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@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
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@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
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@helenbevan #Quality2013 #Qradicals
#Quality2013 #Qradicals
"There’s only one corner of the universe you can be certain of
improving, and that’s your own self." Aldous Huxley
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@helenbevan #Quality2013 #Qradicals
#QS13
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@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
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@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
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@helenbevan #Quality2013 #Qradicals
#QS13 Source: Foghound
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@helenbevan #Quality2013 #Qradicals
#QS13
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@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
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@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
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@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
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@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
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@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?
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@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
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@helenbevan #Quality2013 #Qradicals
#QS13
Tactics for change agents
1. Start with myself
2. Work out what might help others to change
3. Build alliances
4. Don't be a martyr
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@helenbevan #Quality2013 #Qradicals
#QS13
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@helenbevan #Quality2013 #Qradicals
#QS13
“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
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#QS13
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
I am not aware my smoking is a
problem – I have no intention to quit
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@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
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@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.
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@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!
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@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
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@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
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@helenbevan #Quality2013 #Qradicals
#QS13
“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
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@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
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@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
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@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)
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#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
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Case study: Call to action for shared decision making for people with end stage
kidney disease
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The Case For Change
50, 000 people living with end stage renal failure in England
61% of people on dialysis regretted their decision
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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’
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#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.
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#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
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@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
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@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
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@helenbevan #Quality2013 #Qradicals
#QS13
Tactics for change agents
1. Start with myself
2. Work out what might help others to change
3. Build alliances
4. Don't be a martyr
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#QS13
The easiest way to thrive as an outlier
...is to avoid being one
Seth Goodin
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“if you want to go fast, go alone. If you want to go far, go together”
African proverb quoted by Al Gore
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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)
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If we want people to take action, we have to connect with their emotions through values
action
values
emotion
Source: Marshall Ganz
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What do we need to do? 1. Tell a story
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What do we need to do? 1. Tell a story
2. Make it personal
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What do we need to do? 1. Tell a story
2. Make it personal
3. Be authentic
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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)
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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
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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”?
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Are you ready to do what hasn’t been done before?
Corporate Rebels United http://www.corporaterebelsunited.com
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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
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