rocking the boat and staying in it - helen bevan

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Rocking the boat and staying in it:

respiratory leader as organisa3onal radical

Helen Bevan Delivery team NHS Improving Quality @helenbevan @NHSIQ

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How does it feel to be a here0c/radical/rebel/maverick in our

organisa0on?

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What happens to here0cs/radicals/rebels/mavericks in organisa0ons?

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Are you a boat rocker? •  One who challenges the status quo when they see that there could be a be@er way

•  Energise their organisa0on by working from their true self

•  Capable of working with others to create success NOT a destruc0ve 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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Troublemaker Radical Complain Create Me-‐focused Mission-‐focused

Anger Passion Pessimist Op0mist

Energy-‐sapping Energy-‐genera0ng Alienate A@ract Problems Possibili0es Alone Together

Source : Lois Kelly www.foghound.com

Some3mes people see us radicals as troublemakers

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Task

•  Talk to others at your table about your experiences around “rebels” and “troublemakers”

•  Which have you been and why? •  What moves people from being “good” to “bad”?

•  How do we protect against this?

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First they ignore you, then they laugh at you, then they fight you, then you win

Gandhi

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Valuing radicals

•  “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selec0on)

•  big things only happen in organisa0ons because of here0cs and radicals

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@helenbevan Source: Foghound

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Four tac3cs for organisa3onal radicals

1.  Start with myself 2.  Build alliances 3. Work out what might help others to

change 4.  Don't be a martyr

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“There is nothing more difficult to carry out, nor more doub9ul of success, nor more dangerous to handle, than to ini;ate 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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"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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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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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

@helenbevan Source: Foghound

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our commitment, in order to survive 2.  leave the organisa0on

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§  we cannot find a way to be true to our values and commitments and s0ll survive

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3.  stridently challenge the status quo in a manner which is increasingly radical and self-‐defea0ng

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3.  stridently challenge the status quo in a manner which is increasingly radical and self-‐defea0ng §  this just confirms what we already know – that

we don’t belong

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1.  convic0ons and values – driven 2.  strong sense of “self-‐efficacy”

§  belief that I am personally able to create change §  belief in others

3.  ac0on orientated §  ignite collec0ve ac0on §  mobilising others, inspiring change

4.  able to join forces with others §  work as a collec0ve body for commonly valued changes

5.  able to achieve small wins which create a sense of hope, self-‐efficacy and confidence

6.  op0mis0c in the face of challenge §  see opportuni0es §  take account of obstacles

What do we know about successful boat rockers?

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Three assump3ons for organisa3onal radicals

1.  Assume that everyone has a noble inten0on 2.  Mo0va0on and behaviour in a change

process are due to interpersonal interac;on (not just innate character trait)

3.  My role as a change agent is about alignment, not judgement

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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, ar3culate and put across their message in a powerful and compelling way in order to win people to their cause and call them to ac3on Snow D A and Benford R D (1992)

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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 authen0c

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What do we need to do? 1.  Tell a story 2.  Make it personal 3.  Be authen0c 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 authen0c 4.  Create a sense of “us” (and be clear who the “us”

is) 5.  Build in a call for urgent ac0on

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“Stages of change” Transtheore0cal model of behaviour change

Prochaska, DiClemente & Norcross (1992)

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The model is mostly used around health-‐related behaviours

•  smoking cessa0on •  exercise adop0on •  alcohol and drug use •  weight control •  fruit and vegetable intake •  domes0c violence •  HIV preven0on •  use of sunscreens to prevent skin cancer •  medica0on compliance •  mammography screening

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The model is mostly used around health-‐related behaviours

•  smoking cessa0on •  exercise adop0on •  alcohol and drug use •  weight control •  fruit and vegetable intake •  domes0c violence •  HIV preven0on •  use of sunscreens to prevent skin cancer •  medica0on compliance •  mammography screening

It works for organisa3onal and service change too!

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“Stages of change” Smoking


I am not aware my smoking is a

problem – I have no inten0on to quit

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I know my smoking is a problem – I

want to stop but no plans yet

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I am making plans & changing things

I do in prepara0on.

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I do in prepara0on.

I have stopped smoking!

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I do in prepara0on.

I have stopped smoking!

I am con0nuing to not smoke.

I some0mes miss it – but I am s0ll not

smoking

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“Stages of change” Transtheore0cal model of behaviour change


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90% of the tools available for healthcare change agents are designed for the “ac3on” stage

The reality of our change situa3on •  Our tools are oken not effec0ve 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, irra0onal •  We feel powerless in our ability to lead or facilitate the change

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Example -‐ Surgical Checklist

•  Designed for Stage 4 – ACTION!

•  Mandated it through targets

•  Despite compelling case for change – people resisted it – no values connec0on

•  People did the task and missed the point

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“One key issue is that many doctors already feel that they are delivering pa;ent centred care – unfortunately that is not what pa;ents report.” Dr Nigel Mathers, Vice Chair, Royal College of General Prac0ce

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So what do we TEND to do? •  Lower our ambi0ons for improvement •  Focus our energies on those who are already in the “ac0on” stage

•  Put nega0ve labels on those who are not yet at the ac0on stage such as “blocker” or “resister” or “laggard”

•  Blame the leadership for not enforcing change •  Overes0mate the mo0va0on of those who say they’re ready to change and underes0mate the mo0va0on of those who indicate no interest in change (Lundberg)

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So what SHOULD we do

•  Listen and understand •  appreciate the star0ng point •  elaborate interests

•  Build meaning and convic0on in the change •  Roll with resistance (Singh)

•  Don’t argue against it •  Encourage elabora0on of resistance

•  What makes it so hard? •  What would help?

•  Build shared purpose

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OutwiPed

He drew a circle that shut me out -‐ Here0c, rebel, a thing to flout. But Love and I had the wit to win: We drew a circle that took him in.

Edward Markham

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Discussion

What might you do to: •  enhance your own role as a respiratory maverick, radical or here0c?

•  Support other mavericks, radicals or rebels in your organisa0on or system?

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....the last era of management was about how much performance we could extract from people .....the next is all about how much humanity we can inspire Dov Seidman

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We have a choice

“This is the true joy of life, the being used up for a purpose recognised by yourself as a mighty one,

being a force of nature instead of a feverish, selfish li@le clot of ailments and grievances, complaining that the world will not devote itself to making you

happy”

George Bernard Shaw

rocking the boat and staying in it - helen bevan

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