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@helenbevan #Quality2013 #Qradicals #Quality2013 #Qradicals Calling all change agents Helen Bevan @HelenBevan #QS13
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Helen Bevan - Building Contagious Commitment for Change: A dynamic, inter…

Oct 21, 2014

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Health & Medicine

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.


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Page 1: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#Quality2013 #Qradicals

Calling all change agents

Helen Bevan

@HelenBevan #QS13

Page 2: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

Page 3: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

Page 4: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…
Page 5: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

What happens to heretics/radicals/rebels/mavericks

in organisations?

Page 6: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

Page 7: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 8: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 9: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

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

Gandhi

Page 10: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 11: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 12: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

Greatest value that radicals provide to organisations

Source: Foghorn survey http://www.slideshare.net/Foghound/corporate-rebel-ebook#btnNext

Page 13: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 14: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13 Source: Foghound

Page 15: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 16: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 17: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 18: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 19: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

Page 20: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 21: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 22: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13 Source: Foghound

Page 23: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

Page 24: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 25: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 26: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 27: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 28: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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?

Page 29: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 30: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 31: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

Page 32: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

Page 33: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 34: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 35: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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.

Page 36: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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!

Page 37: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 38: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 39: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

Page 40: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 41: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 42: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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)

Page 43: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#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

Page 44: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#Quality2013 #Qradicals

Case study: Call to action for shared decision making for people with end stage

kidney disease

Page 45: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

The Case For Change

50, 000 people living with end stage renal failure in England

61% of people on dialysis regretted their decision

Page 46: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

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’

Page 47: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#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.

Page 48: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#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

Page 49: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 50: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 51: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@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

Page 52: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

The easiest way to thrive as an outlier

...is to avoid being one

Seth Goodin

Page 53: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

“if you want to go fast, go alone. If you want to go far, go together”

African proverb quoted by Al Gore

Page 54: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

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)

Page 55: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

If we want people to take action, we have to connect with their emotions through values

action

values

emotion

Source: Marshall Ganz

Page 56: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

What do we need to do? 1. Tell a story

Page 57: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

What do we need to do? 1. Tell a story

2. Make it personal

Page 58: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

What do we need to do? 1. Tell a story

2. Make it personal

3. Be authentic

Page 59: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

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)

Page 60: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

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

Page 61: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

Page 62: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

Page 63: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

Page 64: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

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”?

Page 65: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

Are you ready to do what hasn’t been done before?

Corporate Rebels United http://www.corporaterebelsunited.com

Page 66: Helen Bevan - Building Contagious Commitment for Change:  A dynamic, inter…

@helenbevan #Quality2013 #Qradicals

#QS13

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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@helenbevan #Quality2013 #Qradicals

#QS13