Building contagious commitment to change: what healthcare improvement and reform can learn from social movements Helen Bevan

Our agenda 1.Why these principles are important to healthcare: some British context 2.Comparing traditions of change 3.How movement leaders changed the world 4.Learning from movement leaders: what we need to do

The English NHS: facts and figures Provides comprehensive healthcare to 54 million people Funded by direct tax It’s free Virtually EVERYONE uses it There is lots of patient choice

Average spending on health per person Source: Commonwealth Fund 2010

What Britain loves

How Britons rank their “national treasures” Source: Demos/Sunday Times, 27 th November % 72% 68% 55% 51% 47 % Shakespeare

How Britons rank their “national treasures” Source: Demos/Sunday Times, 27 th November % 72% 68% 55% 51% 47% Shakespeare The British Armed forces

How Britons rank their “national treasures” Source: Demos/Sunday Times, 27 th November % 72% 68% 55% 51% 47% Shakespeare The British Armed forces The Union Jack flag

How Britons rank their “national treasures” Source: Demos/Sunday Times, 27 th November % 72% 68% 55% 51% 47% Shakespeare The British Armed forces The Union Jack flag The National Health Service

How Britons rank their “national treasures” Source: Demos/Sunday Times, 27 th November % 72% 68% 55% 51% 47% Shakespeare The British Armed forces The Union Jack flag The National Health Service The Royal Family

How Britons rank their “national treasures” Source: Demos/Sunday Times, 27 th November % 72% 68% 55% 51% 47% Shakespeare The British Armed forces The Union Jack flag The National Health Service The Royal Family The BBC (British Broadcasting Corporation)

How Britons rank their “national treasures” Source: Demos/Sunday Times, 27 th November % 72% 68% 55% 51% 47% Shakespeare The British Armed forces The Union Jack flag The National Health Service The Royal Family The BBC (British Broadcasting Corporation) The Beatles

How Britons rank their “national treasures” Source: Demos/Sunday Times, 27 th November % 72% 68% 55% 51% 47% Shakespeare The British Armed forces The Union Jack flag The National Health Service The Royal Family The BBC (British Broadcasting Corporation) The Beatles The British legal system

How Britons rank their “national treasures” Source: Demos/Sunday Times, 27 th November % 72% 68% 55% 51% 47% Shakespeare The British Armed forces The Union Jack flag The National Health Service The Royal Family The BBC (British Broadcasting Corporation) The Beatles The British legal system Parliament

If there was one thing that the British people took from the [World War II] experience, it was a health service free at the point of use And no government of any stripe has dared to try to take it away from us since..... Andrew Marr History of Modern Britain

The NHS belongs to the people It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most

The NHS is facing its biggest challenge ever Impact of economic recession Rising demand and expectation 4% compound reduction, four years running Securing the future of the NHS system Delivering higher value through quality improvement

“Revolution begins with transformation of consciousness” Paul Bate

We possess power “Our problem is to hitch it up for action on the broadest, daring and most gigantic scale”

Which tradition of change? Management of change organizing and mobilizing

Organisational behaviour Leadership and management studies Clinical/medical audit Improvement “science” Academic tradition(s) – 100 years Which tradition of change? Management of change

Community organizing, campaigns and social movements Learning from popular, civic and faith-based mobilisation efforts Academic tradition– 100 years Which tradition of change? organizing and mobilizing

Which tradition of change? Organisational behaviour Leadership and management studies Clinical/medical audit Improvement “science” Academic tradition(s) – 100 years Community organizing, campaigns and social movements Learning from popular, civic and faith-based mobilisation efforts Academic tradition – 100 years Management of change organizing and mobilizing

Source: Bernard Crump/Helen Bevan Anatomy of changePhysiology of change Defined as The shape and structure of the system; detailed analysis; how the system fits together The vitality and life-giving forces that enable the system and its people to develop, grow and change. Focus Processes and structures to deliver health & healthcare Energy/fuel for change What leaders do measurement and evidence improving clinical systems reducing waste and variation redesigning pathways creating a higher purpose and deeper meaning building commitment to change connecting with values creating hope and optimism about the future calling to action

“You can’t impose anything on anyone and expect them to be committed to it” Edgar Schein, Professor Emeritus MIT Sloan School

Source: Helen Bevan From Compliance States a minimum performance standard that everyone must achieve Uses hierarchy, systems and standard procedures for co- ordination and control Threat of penalties/ sanctions/ shame creates momentum for delivery From the old world to the new world To Commitment States a collective goal that everyone can aspire to Based on shared goals, values and sense of purpose for co-ordination and control Commitment to a common purpose creates energy for delivery

“ Large scale change is fuelled by the passion that comes from the fundamental belief that there is something very different and better that is worth striving for” Leading Large Scale Change (2011) NHS Institute for Innovation and Improvement

Source: Marshall Ganz Shared understanding leads to Action How did the great transformational leaders change the world? Strategy What? Narrative Why?

Leaders ask their staff to be ready for change, but do not engage enough in sensemaking Sensemaking is not done via marketing...or slogans but by emotional connection with employees Ron Weil

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)

If we want people to take action, we have to connect with their emotions through values action values emotion Source: Marshall Ganz

But not all emotions are equal inertia urgency anger apathy solidarity isolation you can make a difference Self-doubt hope fear Overcome Action motivatorsAction inhibitors Source: Marshall Ganz

“A cynic, after all, is a passionate person who does not want to be disappointed again” Zander R and Zander B (2000) The art of possibility. Harvard Business School Press. As quoted by Steve Onyett

Leaders are “signal generators” “As a leader, think of yourself as a “signal generator” whose words and actions are constantly being scrutinised and interpreted by others” Our words and actions as leaders are massively amplified “Signal generators reduce uncertainty and ambiguity about what is important and how to act” Charles O’Reilly, Leaders in Difficult Times, 2009 Do not be dismayed in these terrible times

Learning from movement leaders: what do we need to do? 1.Tell our story

2.Make it personal Learning from movement leaders: what do we need to do?

1.Tell our story 2.Make it personal 3.Be authentic Learning from movement leaders: what do we need to do?

1.Tell our story 2.Make it personal 3.Be authentic 4.Create a sense of “us” (and be clear who the “us” is) Learning from movement leaders: what do we need to do?

1.Tell our 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 Learning from movement leaders: what do we need to do?

What the framing literature tells us “‘a new idea must be at the least couched in the language of past ideas; often, it must be, at first, diluted with vestiges of the past” Saul Alinsky Rules for Radicals (1971)

What the framing literature tells us “‘a new idea must be at the least couched in the language of past ideas; often, it must be, at first, diluted with vestiges of the past” Saul Alinsky Rules for Radicals (1971) In other words: People are much more likely to embrace change if it is framed as something that builds positively on what they are familiar with than as something that seems far away and unachievable

“When you have gone so far that you can’t manage one more step, then you have gone just half the distance that you are capable of” Proverb of the Inuit people of the Arctic Circle