twitter/helenbevan @helenbevan

1. http://twitter.com/helenbevan@helenbevan Building contagious commitment to change: what healthcare improvement and reform can learn from social movements Helen Bevan

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

3. 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

4. Average spending on health per person Source: Commonwealth Fund 2010

5. What Britain loves

6. 72% How Britons rank their “national treasures” 71% 68% Source: Demos/Sunday Times, 27th November 2011 55% 51% 47%

7. 72% How Britons rank their “national treasures” 71% 68% Source: Demos/Sunday Times, 27th November 2011 55% 51% 47%

8. 72% How Britons rank their “national treasures” 71% 68% Source: Demos/Sunday Times, 27th November 2011 55% 51% 47%

9. 72% How Britons rank their “national treasures” 71% 68% Source: Demos/Sunday Times, 27th November 2011 55% 51% 47%

10. 72% How Britons rank their “national treasures” 71% 68% Source: Demos/Sunday Times, 27th November 2011 55% 51% 47%

11. 72% How Britons rank their “national treasures” 71% 68% Source: Demos/Sunday Times, 27th November 2011 55% 51% 47%

12. 72% How Britons rank their “national treasures” 71% 68% Source: Demos/Sunday Times, 27th November 2011 55% 51% 47%

13. 72% How Britons rank their “national treasures” 71% 68% Source: Demos/Sunday Times, 27th November 2011 55% 51% 47%

14. 72% How Britons rank their “national treasures” 71% 68% Source: Demos/Sunday Times, 27th November 2011 55% 51% 47%

15. 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

16. The NHS belongs to the peopleIt 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

17. 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

18. “Revolution begins with transformation of consciousness” Paul Bate

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

20. Which tradition of change? Management of change organizing and mobilizing

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

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

23. 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

24. Source: Bernard Crump/Helen Bevan

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

26. From the old world to the new world Source: Helen Bevan

27. “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

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

29. 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

30. 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)

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

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

33. “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

34. Do not be dismayed in these terrible times....... 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

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

36. Learning from movement leaders: what do we need to do? • Tell our story • Make it personal

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

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

39. Learning from movement leaders: what do we need to do? • Tell our story • Make it personal • Be authentic • Create a sense of “us” (and be clear who the “us” is) • Build in a call for urgent action

40. 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)

41. 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

42. “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