1. @helenbevan Rocking the boat and staying in it: respiratory leader as organisational radical Helen Bevan Delivery team NHS Improving Quality @helenbevan @NHSIQ

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4. @helenbevan How does it feel to be a heretic/radical/rebel/maverick in our organisation?

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6. @helenbevan What happens to heretics/radicals/rebels/mavericks in organisations?

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8. @helenbevan 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

9. @helenbevan Troublemaker Radical Complain Create Me-focused Mission-focused Anger Passion Pessimist Optimist Energy-sapping Energy-generating Alienate Attract Problems Possibilities Alone Together Source : Lois Kelly www.foghound.com Sometimes people see us radicals as troublemakers

10. @helenbevan 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?

11. @helenbevan First they ignore you, then they laugh at you, then they fight you, then you win Gandhi

12. @helenbevan Valuing radicals New truths begin as heresies (Huxley, defending Darwins theory of natural selection) big things only happen in organisations because of heretics and radicals

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14. @helenbevan Source: Foghound

15. @helenbevan Four tactics for organisational radicals 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Don't be a martyr

16. @helenbevan Four tactics for organisational radicals 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Don't be a martyr

17. @helenbevan 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

18. @helenbevan "Theres only one corner of the universe you can be certain of improving, and thats your own self." Aldous Huxley

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20. @helenbevan 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 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

22. @helenbevan Source: Foghound

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24. @helenbevan 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 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 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 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 dont belong

28. @helenbevan 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 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

30. @helenbevan Four tactics for organisational radicals 1. Start with myself 2. Build alliances 3. Work out what might help others to change 4. Don't be a martyr

31. @helenbevan The easiest way to thrive as an outlier ...is to avoid being one Seth Goodin

32. @helenbevan if you want to go fast, go alone. If you want to go far, go together African proverb quoted by Al Gore

33. @helenbevan 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)

34. @helenbevan What do we need to do? 1. Tell a story

35. @helenbevan What do we need to do? 1. Tell a story 2. Make it personal

36. @helenbevan What do we need to do? 1. Tell a story 2. Make it personal 3. Be authentic

37. @helenbevan 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)

38. @helenbevan 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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43. @helenbevan Four tactics for organisational 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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45. @helenbevan Stages of change Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)

46. @helenbevan 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

47. @helenbevan 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 It works for organisational and service change too!

48. @helenbevan Stages of change Smoking Prochaska, DiClemente & Norcross (1992) I am not aware my smoking is a problem I have no intention to quit

49. @helenbevan 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

50. @helenbevan 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.

51. @helenbevan 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!

52. @helenbevan 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

53. @helenbevan 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

54. @helenbevan Stages of change Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)

55. @helenbevan 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 Its hard to engage people in change Its 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

56. @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

57. @helenbevan One key issue is that many doctors already feel that they are delivering patient centred care unfortunately that is not what patients report. Dr Nigel Mathers, Vice Chair, Royal College of General Practice

58. @helenbevan 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 Overestimate the motivation of those who say theyre ready to change and underestimate the motivation of those who indicate no interest in change (Lundberg)

59. @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) Dont argue against it Encourage elaboration of resistance What makes it so hard? What would help? Build shared purpose

60. @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

61. @helenbevan Discussion What might you do to: enhance your own role as a respiratory maverick, radical or heretic? Support other mavericks, radicals or rebels in your organisation or system?

62. @helenbevan ....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

63. @helenbevan 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 little clot of ailments and grievances, complaining that the world will not devote itself to making you happy George Bernard Shaw