school for change agents - module 1 transcript

NHS IQ Webinar (UKNHSI1602A)

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HELEN BEVAN: It's time to go. Welcome, everyone, to the 2017 term of the School for Change Agents, and this is the first of our five modules, Change Begins With Me. I welcome all of you who are taking part in today's module live and those of you who are watching it afterwards, whether you are watching it on your own or with a bigger group of people. You know, what's amazing about this school is that we are a truly global community of change agents. The team that run the school, we are part of the Horizons team in NHS England, and we make the school available for the health and care community in England. But, you know, opening it out to a much wider group of people gives us a greater level of connectivity and a richness which we gain so much from, so it is absolutely fantastic to welcome so many of you from so many different places. The thing that all of us have in common is that we are people who are trying to create social good through change. This is the fourth year that we have run the School for Change Agents, and this year we have got well over 2,000 people who have enrolled, which brings our total over the four years to about 10,000 people from a very, very wide range of places. What I would first of all like to do is to introduce our team today. My name is Helen Bevan, and I am the chief transformation officer in the Horizons team, and I will be doing most of the talking. I am also joined by Pip Hardy. Can you hear me? What we are doing this year for the first time is we are creating some separate learning groups at the end of each of the virtual lectures, and Pip has the important job of enabling that. How do you feel about that? PIP HARDY: I am really pleased to be able to do it. It is a bit of a change to the role I have had for the last couple of years, but I am looking forward to the different format and helping people to implement their learning quite quickly. HELEN BEVAN: Thank you. In terms of the chat room, hopefully loads of you will be contributing to the chat room because it is such an important part of our school. Ollie and Kate will be looking after the chat room. I will talk to Kate a moment. Give us a sense already from the chat box of the range of people joining us today. KATE POUND: Hello. It is really exciting to be joining this today, and, wow, there are people from all over the world.



I'm really impressed with the international feel we have today. We have people from across the UK, joining from local hospitals, and beyond. There is a real sense of excitement and anticipation for this first week. HELEN BEVAN: Great, and we will find out more shortly. Looking after Twitter, we have our colleagues, Leigh and Louis. Leigh, what has been happening on Twitter? LEIGH KENDALL: Hello, everyone. I am looking after Twitter on the School for Change Agents account. There has been so much activity over the last few days, and it has been building up the excitement. It has been fantastic. People are looking forward to getting started. If you are on Twitter, please tweet us and let us know how you're finding it. Please share pictures from stations and use the hashtag #S4CA. HELEN BEVAN: And last but not least, our two colleagues providing all of the important technical support, Jo and Paul. Would you like to say hello? JOANNA HEMMING: Hello, everybody, really looking forward to this exciting session. Paul is running technical support right now! HELEN BEVAN: He is doing what he is meant to be doing, working behind the scenes! What we are going to do next is find out where everybody is. We are going to use annotation to do this. Jo, can we let loose the annotation tools? In the top right hand corner of your screen, underneath where it says "Quick start" there are various tools. There are arrows and shapes, and there are also some pens. Just say hello. You know, make a mark. Just get a sense... You can do that. That's it! OK, great. It's looking very... I don't know what to say. Probably Pollock-like. Hold back with your artistry now! If you could take the annotation away, and we can go on to the next slide. What we want to do is see where you are on Earth. We want you to use the first tool, the pointer. If we could go on to slide number five. That's great. Use the pointer to show us where you are on the globe.



The pointer is the first tool. Jo, could you give everybody rights back? Let's see where we are. Fantastic. Nigel is in New Zealand. Hello, I knew you were with us! Fantastic. What we are basically seeing as we have a lot of Brits. We have a number of people from mainland Europe. Lots of people in Australia will be joining, but they are mostly asleep at the moment, and they will be joining later. Fantastic to see so many people from North America, both from the US and Canada, particularly. For those of you who are in the UK, would you like to get your arrow out again and show us where in the UK you are? Again, great. Fantastic mix. From north to south, and also in Scotland, and also colleagues in Northern Ireland, which is fantastic as well. Here we are from all over the place. Jo, if you could take the annotation away now, that would be fantastic. What a great range of people and a great geography. Let's talk about joining in. It really helps with the school if we can have a really active chat box. When you are listening to the session today, if you have things to add and sources you know about and links, if you want to get some debates and discussions going at the same time, please, please feel free to do that. As Leigh said, we want you to tweet and use the hashtag #S4CA, and the school handle is @Sch4Change. we have a very active Facebook group. You have to request to join it, but it is not difficult to get into. It is not very elite. Please join in. We will pull together the chat and the tweets, and we will create a document which we will put on the website. It will be a representation of how people taking part in the school are feeling and what they are thinking. Just a little bit before we get going just to say that the whole idea of the School for Change Agents is about building capability. Often, when we think about people being change agents in organisations, we think about the functions, the things we do to make change happen.



The whole idea of this school and the principle behind it is around capability, so rather than focusing on the things that we do, it's about our ability to do things. There is really good evidence behind this thinking about capability and also the kinds of capabilities we are going to be suggesting to you within the School for Change Agents. One of the models that we like a lot is this one. It comes from Peter Fuda, who comes from Sydney, Australia, and he is one of our favourite thinkers and thought leaders around transformational change. One of the things he produced was a framework of transformational change agents, and 15 qualities that make somebody who is a transformational, active, successful change agent, the 15 things that are different about them. Peter talks about doing, seeing and being change. The world that many of us live in, which is the world of health and care, a lot of the focus is on the top here, it's about doing. Doing change, you know, and skills and methods is really important. But the reality is that, everyone, to be a really effective change agent, we also need to focus on seeing and being change. When we talk about seeing change, seeing possibilities and opportunities, looking at things in different ways and from diverse perspectives. Being change – I like this definition that Peter gives. We are a role model first and preaching at other people second, so we can't ask other people to change unless we change ourselves. The curriculum of the five weeks of the School for Change Agents, we have developed it over four or five years, and we have also had it formally evaluated by the Chartered Institute for Personnel and Development. What was interesting was the team from the CIPD showed that, actually, taking part in this school experience created a positive effect on every dimension of impact that the research team looked at, both at an individual level and the impact it made in terms of those change agents in their organisations. The dimensions of this included, first of all, people's knowledge of change and how that was built. Secondly, the extent to which their sense of purpose and motivation to improve what they were doing grew. Their ability to challenge the status quo and the way things are. And, particularly importantly, their ability to challenge and rock the boat but stay in it. I think most importantly of all is connecting with others to build support for change because



essentially that is what School for Change Agents is about. What we will do every single week between now and 16 March is we will cover different key capabilities that enable change agents to do their job in helping to deliver change for social good. Today, we are starting on being a change agent – Change Begins With Me. Next week, I will hand over to my colleague, Kathryn Perera, who will take us through a fantastic session about From Me To We. How can we build communities? How can we learn from the great social movements? It is back to me for 2 March, where the topic is around resistance and resilience. Then on 9 March we have a very practical session around how do we actually make change happen? Lots of tools and approaches and mindsets. For our final session – and it will go very quickly between now and then – we are calling it Moving Beyond The Edge, and you will see shortly why we want to talk about the edge. How do we take the learning from the school and how do we move on? Each week, as Pip says, we are doing things in a different way to previous years. Every week, we will start with a virtual talk for one hour, and then for everyone who wants to be part of it, we will put you into a 30-minute virtual learning group. We will randomly allocate you with a group of other change agents who have also been taking part and a facilitator so you have half-an-hour of follow-up and discussion and practical application. Thinking about that, we just wanted to get a sense of what is your starting point? You have enrolled in the school, you are somebody who is a change agent, but we want to get a sense of how you see yourself. We are going to put a poll up on the right-hand side, and it will ask you to rate yourself between 1-10. If you rate yourself one, it means you have very, very little experience or skill or confidence as a change agent. For those of you who give yourself a 10, "I am highly experienced, highly skilled and highly confident at change." Can I hand over at this point to Jo? Do you have the poll ready? JOANNA HEMMING: Yes, I will just get it started.



HELEN BEVAN: What is your starting point as a change agent enrolled in this school? Somewhere between one, with no experience, and 10, with lots of experience. Put a tick or a blob against one of those options, and we will allow this to run for one minute. The timer is not going down. HELEN BEVAN: It isn't going down now, but I will count it down. It is saying... Let's do another five. Can we see the poll results now? It just takes a little while. How is it doing there? There we go. Fantastic. Thank you, Jo. I hope everyone can see. I think it's quite an interesting curve there. What it is showing us is the mean of that is about six. We have a few people who see themselves as experienced and a very big range of people. We might run this again in module five and see if it is any different. Thanks for that. Let's carry on. One thing that we are very keen on with the School for Change Agents is that it isn't just something nice to do that sits on the side but it helps in terms of certification and continuing professional development. For nurses and midwives and allied health professionals in the UK, you can use this school experience as part of your reflective experience as part of your CPD. We will explain how to do that in our newsletter. We have also applied for CPD credits for the school from the royal colleges for colleagues who are doctors. We will explain that. For everyone, basically, if you watch all five of the talks, either live or in recordings, and you demonstrate that you have applied some of the techniques and the learning then you can apply to become a certificated change agent. Basically, we will show you later in the school how to do that. Providing you can show that evidence, then we will award you a badge of a certificated change agent. So lots of opportunity to get recognition for your contribution in the school. Really keen to get going with the content of module one. As we said, in each of the five modules, we will be focusing on what we believe are the key capabilities for change agents in the world that we live in. In this module, the capability that we will be looking at is something we are going to start with called ripple intelligence. That's about us being able as a change agent to stand back and see what the trends and themes are in the world. And act on those quickly. Secondly, a big theme for a change agents in the modern world is operating at the edge. We will be working with what I think is a really important principle of old power and new power. We will be looking at how to be a rebel rather than a troublemaker. We will be focusing on self-efficacy and what we mean by that is a belief that I can personally create change. Jo, can you mute everybody for me? Hello, we can hear Spanish.



HELEN BEVAN: OK, I'll try and talk above the Spanish. Finally, our final case is about starting from a place of love. Great. Just a couple of things to say about this. We are operating with the fundamental rule of conventional conferences which means the sum of the expertise of the people in the audience is far greater than the expertise of the people doing the talking on the screen. I think you know we can see that already by the level of change expertise that we have got in this audience from that poll. The very final thing to say is that the principle of the school, in fact the learning method, the learning theory is called connectivism and that is a learning theory for a new age. It basically says that for people to learn effectively, one of the best ways of doing that is to connect people with each other. In a sense, if we can make connections with people with different views on different experiences and backgrounds, then that creates one of the best learning opportunities of all. Already, we are seeing that by what we are seeing in the chat room and on Twitter. When we think back to when we started the school four years ago, a big part of it was because our team undertook a learning review. What it basically said was that when it came to feeling able, people feeling able to make change happen in the NHS and the wider health and care system, there was such a sense of permission culture. People feeling, "I can't even make a small change in my service or in my area because I don't have permission." We have choices here because we can try and change the permission culture but that may take a long time. What if we can actually work with change agents and help people to feel that maybe they don't need permission? That's what this is about. This slide, I think it's my personal picture. I've been a helping change care agent in the system for years. When I look back, this is an art installation by an artist called Adam Katz and he took 13,000 orange toy soldiers and he put them on a window and it said "all of my good ideas are battles". I can't think of many things in my career as a change agent when someone has said, "that's a great idea for change. Here's thousands of pounds and two people full-time to make that happen." The reality isn't like that. Our reality as change agents is that we are challenging the vested interests, the existing order, how things are. When we choose to be a change agent, we choose to want to do things differently for social good. We don't necessarily choose an easy life. I like this quote from Thomas Huxley who was an evolutionary biologist at the time of Darwin. He said "new truths begin as heresies". I think that is true for us as change agents. Every new truth begins as a heresy. I think that we are at a time of change now where there's a lot of new truths that people maybe don't want to hear.



That brings me to our first capability that I want to look at today. It's this idea of ripple intelligence. This means, as change agents, we should be working with ripple intelligence. This is about connecting up with lots of people in other places, learning and seeing trends, understanding risks and opportunities and connecting dots. So that we are making connections with things like the ripples of a pond. I want to take you through five of the very big themes that we are seeing here in the wider world of change. In my role, I get to link with lots of people in other sectors, other health and care systems who are petitioners, thinkers and futurists. Whatever sector we look at, whatever system, people are talking about the same themes that are making a difference. Let's go through them quickly. The first that we see is that across the globe, change is becoming more disruptive. It's becoming bigger scale. There will always be a place in the world for incremental improvement, but on its own, it isn't enough. Very often, I talk to people who work in the healthcare sector who say, "we are burned out by change." We need to stop for a bit. The reality is when you look at our world through the trajectory of change, is just get harder and harder. We need to be thinking about how we go about change in different and additional ways. The second team that we see is what I'm calling the acceleration of connectedness. The reality, the revolution of digital connectivity means that everyone of us can connect up with people all over the world. We can learn from each other. We can challenge each other. Just the fact that there are so many hundreds of us sat here today in very different places, connecting at a massive scale. Here, we have the modern conference table. Everyone is looking at their screens. It means that sometimes, efforts are made to try and control this and it's probably the worst thing to do. What we know is that our employees have got 10 times more connections because of digital connectivity, social media and corporate social accounts. What it means is that when we work in organisations that have got controlling social media policies, it absolutely misses the point. We have to empower our staff to be the voice for organisations because they have far more audience and they have far more credibility than we have in terms of our corporate approaches. The third thing that we see happening again all over the world is that hierarchical power is diminishing. Note that I said diminishing not diminished. In this world of disruptive change and digital connectedness, it's inevitable. The kind of hierarchical structures that many organisations were designed around were designed for a different age and era where they worked very, very well. In an era where things were very stable and there was only small change, it made sense to organise everything and people and job functions into neat little units. In this really fast moving world, it just doesn't work in the same way.



The problem with hierarchy is that it tends to be very slow and risk averse. To quote Clay Shirkey, what we are seeing is this radical shift that is happening in communication paradigms. Just being able to communicate through a hierarchical structure is increasingly inadequate. We have got to be working in ways that are about many to many networking indications. One of my favourite themes is the growth of the maker movement. We are seeing this all over the world, a renaissance of do it yourself, have-a-go creativity, make things. Again, fuelled by digital connections. We are seeing this impact massively in terms of the health and care world. Here is something I was involved in a little while ago – the Healthy and Fit Hackathon, which was run by Hammersmith and Fulham council and Public Health England, and this was looking at really significant challenges within this borough around childhood obesity. As well as doing what we would normally do, bringing in experts to advise what we should do, we brought in a different kind of expert, bringing in a huge number of local young people and families, fast food owners, coders, designers, public health leaders, and actually put these people into diverse groups to make things. The evidence from this is really clear. If you bring a diverse group together like this, they will consistently make better decisions than small groups of experts. Lots of opportunities, I think, in the new world to make things. The second example here is Night Scout. How this came about was there was a parent who had a child with type I diabetes, and this father felt very anxious about sending his child to school without continuous glucose monitoring. He literally invented his own continuous glucose monitor. Because this is a world where people are connecting, lots of other people all over the world are picking up this idea and making their own continuous glucose monitors. Often, healthcare professionals are saying, "It's outrageous, people can't make their own glucose monitors." They can, and they are. On the right-hand side, this is called the Night Scout Project. This maker movement is happening all over the place. Just to give you an example close to me in Coventry, we have something here which is called Coventry Mind The Gap, which is a platform for change. A platform and a space where people can come together, where people can think and create, about how we have bridged the gap between the services that are available and people having happy and healthy lives. Yes, there is good support for it from statutory services, but it's about the people themselves getting creative and making things.



The final theme I wanted to talk about is change is moving to the edge. Again, what we are seeing across the world when we look at what is happening in manufacturing and big pharma and so on, research and development and innovation functions that used to be based in the middle of organisations and systems are moving out to the edge. It is obvious why this is happening in this world of disruptive change and fast moving change and connectedness. If we want to keep up with what is going on and the pace of change, we can't be right in the middle of our organisations. We have to be on the outside, one foot in the organisation, one foot outside. That is what we are. Joining the School for Change Agents, we are on the edge, with one foot inside our organisation, wanting to be the change leaders that can help to take the goals of our organisations forward, and at the same time one foot outside in the bigger system, linking up with thousands of other change agents. Just to show you an excellent organisation that has got this. The Cabinet Office has shifted its policy innovation department to the outside. The Cabinet Office is the heart of British government and decision-making. What they have done, if you look, by putting the policy innovation lab and function on the edge, it means they can connect with many, many other people. Being on the edge gives space to experiment and do things differently. This is probably my favourite quote about being on the edge, from Ayelet Baron. She says leading from the edge and choosing to position ourselves on the edge as change agents brings us into contact with a far wider range of relationships, and this in turn increases our potential for diversity. It is that diversity word again. We heard it before when we talked about the maker movement. Diversity, in terms of thought, different experiences and background. The reason why we want to be on the edge and seek diversity is because it gives us more disruptive thinking, faster change and better outcomes. Just to give notice to my Twitter and chat colleagues that I will call you in in a moment, I just want to look at one more slide before we have a look at the chat and Twitter. This is, I think, a framework, a model and an approach that is very helpful for us as change leaders, change agents in a changing world. What we are talking about here is the relationship between old power and new power. This is from a book which will be published this year from Jeremy Heimans and Henry Timms, and I think this model is going to become globally very, very significant, but you saw it here first



in the School for Change Agents! Let's talk first of all about old power. It's like a currency. It is held by a few people, position of authority. Few people have got it, most people haven't, and it gets pushed down in organisations. People are commanded. You have to do that. It is the quality goal. It is a standard operating procedure. It is the contract. Old power tends to be closed. If I am a leader of a healthcare system working with leaders from my local community, I can't command them to do anything. Old power only goes to the base of my organisation. Lastly, we would say that old power is transactional. It's about holding people to account, about processes and mechanisms and systems. Let's contrast that with new power, which is like a current. We surge with energy when people come together with a common cause. When we were starting the school today, just reading some of the chat before we started, I got a real sense of the current, the energy of new power, and it is made by many people coming together with a common cause. We pull it into our organisation, and it is shared. The more people who engage, the more power we have. It is open. People who share our purpose and goals can be part of it. Largely, we would say new power is relational. It is about relationships. One of the big differences between new power and old power is that people engage in new power because they want to, not because they have to. If I engage, I put myself out, then I believe that action is going to be taken, and things will be followed up. If I make an effort to engage in some change, and the things I am promised will happen do not happen, I will not engage again. Relationships and particularly trust are very, very important. When we think about the capabilities that we need, I think, as change agents for social good, we have to be able to operate in this really difficult zigzaging place in the middle, which can be very, very hard. You see, I don't think that old power is going to die in any health and care organisation that I know soon, but if we want big, radical transformational change to happen, we have to work with



new power as well. What I can see happening is a new level of new power appearing on top which will create opportunities, but we have to be able to work with both. I am going to stop for a moment and breathe. Kate and Ollie, can I ask for a quick summary of what we are seeing in the chat box? KATE POUND: Shall I go first? First of all, it's great to see people reconnecting from previous years and seeing some old faces and names in the chat room. From my perspective, I would say that there is a lot of discussion around the culture, and there is a question about the relationship between performance and permission culture and how they can collide. Do they intertwine with each other? There was a discussion about the ripple effect and throwing in a boulder. That was really great. Let's go big. There was a question about how do we harness the energy in everyday life? HELEN BEVAN: That's great. It would be great to save these up because it would make some fantastic conversations in the virtual learning groups afterwards. KATE POUND: Yes, I agree, and people were saying that this is something for discussion later. Fantastic, keep putting them in. HELEN BEVAN: Ollie, anything to add? Hello, Ollie? Can we hear Ollie? Hello. What I'm going to do is move over to Leigh and Louis. What are we seeing on Twitter? LEIGH KENDALL: Twitter is so busy, keeping me on my toes, which is fantastic to see, so much activity and excitement and chat. One thing coming over very strongly is people understanding their potential as change agents, their inherent ability to make a difference. And the paradigms shift in power and communication, and how those networks can work. People have been talking about how they value their own Twitter communities and how that shared purpose can make a difference. Brilliant to see that activity on Twitter. Keep it going. We are loving to see everyone's comments and interactions.



HELEN BEVAN: Thank you, everybody, for your comments and contributions. Let's keep them coming. This is a piece of research that has influenced me a lot over the last two or three years. Hello to everybody joining us from Canada because this is Canadian research. This is called the network secrets of great change agents, published in the Harvard business review, July and August 2013. What Julie Battilana and Tiziana Casciaro, these two Canadian researchers, did was they went into a very big organisational system, and they followed 68 different change projects round this system. They wanted to understand what makes a great change agent. What are the characteristics or the position or the status of people who are really good at making change happen in organisations? If we were face-to-face and not doing it like this, I would say to you, "Does anyone know the name of the very big organisational system that these two Canadian researchers went round?" Someone from the audience would shout, "the English National Health Service". They would be right. The researchers found in the NHS that being an effective change agent was actually very little to do with old power. Where I am in the hierarchy in positional terms is much less important than where I am in the informal system. Actually, someone who is here in the middle of the informal system has got far more power and potential to be a change agent than somebody who is in a senior role in the hierarchy. I see this all the time because people say to me, "I can't make change happen in my organisation because I'm just a student nurse," or "I am just a patient liaison person," or "I am just a staff nurse." We see this time and again from different research. This comes from Leandro Herrero, who says people who are highly connected have twice as much power to influence change as people with hierarchical power. All of us, however we are in the system, have got huge potential to make a difference. I think that very often some of the leaders who I love to work the best with are very senior leaders who understand how to work in new power and old power ways. I think those are some of the leaders who really enable the conditions for great change to happen. I think that where we are in the world now and particularly in the world of healthcare, we need to



be thinking about rebels. And being rebels. What do we mean by a rebel? Typically, somebody who is the principal champion of a change initiative, a cause or an action i.e. a change agent. The thing we know about rebels is that they don't wait for permission. We talked about the permission culture. They don't need to be led. They are not hurtling round organisations causing havoc. Rebels are able to make great things happen in health and care and other systems because they name things that other people don't see yet. They point to new possibilities and horizons. I think my favourite quote is without rebels, the storyline never changes. In our world of health and care, the storyline has got to change. It's great saying, all go off and start rebelling. What happens to people and organisations who are heretics and radicals and mavericks? Do they have a nice life? The reality is very often you put your head above the parapet, with the best motivation in the world, we try and make things different and this is what happens. One of the key things for us as rebels is we need to be boat rockers. We need to develop the skills as change agents to rock the boat and stay in it. That's about walking the fine line between being different and fitting in, being inside and outside at the same time. We talk about the edge. Absolutely classic. Being able to rock the boat and managing to stay in it. It is about challenging the status quo and having the bravery and skill is when we see that there could be a better way. If we look at the evidence around effect of boat rockers like Debra Meyerson, what her research shows is that when you look at people who have managed to stay in organisational systems as boat rockers and succeed year after year, what they have done is develop the ability to both conform and rebel at the same time. When we say conform, if we're going to be change agents, we need to be the very best at getting reports in on-time, turning up for meetings, never talking badly about other people in the organisation. We need to be the best corporate citizens because by conforming in that way, that gives us the space to rebel. What we are talking about is again people who are capable of working with other people to create success, not destructive troublemakers. This is a model that we use a lot. What is the difference between a rebel and a troublemaker? I think some aspects of this are not great. We have to look beyond the label to what is underneath. Let's get the essence of this. They generate energy in the people around them. We attract people and resources. They see potential possibility and hope. As we said, they are capable of working together with other people to make a difference. That is different from being a troublemaker. The troublemaker is somebody who often will complain a lot. There is nothing wrong with complaining and being angry. What you often see with troublemakers is that it is very me focused. The injustice of my situation, how badly I'm being treated. Often, people who are troublemakers, they have tried to make change happen in the past but have not had a voice. They have gone past believing that it's ever going to happen. They are very pessimistic and



hard work. They sap the energy of other people and alienate them. When the rebel comes along with some great idea for some brilliant way of improving citizen experience, the troublemaker can see 1,000 reasons why it won't work. Very often, they are left alone. In our world, a change agency, very often when you are a rebel in an organisation, other people think that you are a troublemaker. The other thing I would say is that very often, people start off being rebels. When I look at the healthcare world, I know so many healthcare professionals, doctors and nurses who come in to help with a sense of mission. They find themselves in an environment that is toxic or dysfunctional and go down that slippery slope to being a troublemaker. Often, we are a mix of both. All I would say about this is think about it. It is something you might want to talk about in your learning group. One last thing about rebels and troublemakers, when you look down this list here. Look at the rebel column. There is one of those descriptions that is the most important one when it comes to staying a rebel and not becoming a troublemaker. Some of you have already started to write it. In the chat box, which of those terms which describes a rebel you think is most important to keep someone a rebel and not becoming a troublemaker? I'm not seeing the right one. I've seen it a couple times. Let me show you. It is together. All those other factors are really important. One of the things is that if we choose to be a rebel, if we choose to be a change agent that are challenging ways and things that happen at the moment, however clever or creative or tough we are, we cannot do this on our own. We can never make big change happen on our own. We have to connect with other people. We always say this. The number one rule for being a rebel at work is you cannot be a rebel on your own. That's why the session, the module that Kathryn is taking us through is all about how do we connect with other people. It is such a critical part of being an effective change agent. You might want to talk about this in your learning groups. Next thing I want to talk about is the whole idea that change begins with me. Earlier, we talked about Thomas Huxley, the evolutionary biologist from Victorian times. This is Aldous Huxley a century later. He says there is only one corner of the universe you can be sure of improving and that is your own self. It is so true. When you are a change agent, you can look out there and see all the things that are wrong. You can see all the reasons why people and patients and citizens get such a bad experience. It's very easy to say, everything else out there has to change. Often we can change things. We can only change ourselves. That takes us back to what Peter Fuda was saying when he said what are the characteristics of a transformational change agent, doing, seeing and being change. Otto Scharmer is saying the same things. The success of actions as changemakers does not depend on what we do or how



we do it but on the in a place from which we operate. Being a change agent is an absolutely critical part of this. What do we know about successful boat rockers? Four things are really important to take account of today. The first one is being able to join forces with other people to create action. It goes back to what we were saying about rebels together. Being an effective change agent is connecting with other people. Secondly, we should never underestimate the power of small wins. And our ability to do things. We might only make a difference to one or two patients but just the fact that we are showing that we are making a difference, it means that we move from talking about it to a position of hope and confidence. There is a difference around people as successful boat rockers in the way they are able to view obstacles as challenges they can overcome. Finally, a concept that is very important to change agents is this idea of self-efficacy. Self-efficacy means that I believe that I personally am able to create the change. Just a few things. The person who is the real guru when it comes to self-efficacy as this guy here in the top right hand Albert Bandura. He said that self-efficacy is the ability to act is tied to the belief that it is possible to do so. If I believe I can make something happen, I can. Henry Ford said, "If you think you can or think you can't, you are right." To summarise the evidence, there is a positive significant relationship between the self-efficacy beliefs of a change agent and his or her ability to facilitate change and get good outcomes. Let's go back to this diagram before when we talked about this permission culture. For those of us who work in the NHS or use the NHS, this sense of permission culture which stops people from doing things. Let's think what is going on here. Is it a permission issue? I am part of a bigger system or culture that stops me doing things or is it a self-efficacy issue. Me and how confident and skilled I feel. I would say it is probably a combination of both. The good news about self-efficacy is that we can build it. The evidence tells us that. If we are waiting to change the permission culture of our organisations, we might be waiting for a very long time. If we focus on building self-efficacy, our own self-efficacy as change agents, we can make things happened. One of the key ideas is about building self-efficacy. I know we are running out of time so I will show you one more slide. The way the tactics we can choose to build their own self-efficacy and those of us around us. When you put them together, they are so many common issues.



Number one, create change one small step at a time. Being able to go out there and demonstrate. Secondly, we want to reframe our thinking. If we want to renovate, not everything is going to work. Instead of thinking, that was a failure, this is terrible. Let us celebrate it. Some of those of us who are leaders get into a situation where we think I cannot be certain. I must have all the answers are people will think I am weak. Number three, make change routine rather than an exceptional activity. Many of the people I know who are taking part today are people who are in organisations that have made a massive commitment to quality improvement. Those are the kind of organisations where everybody is a quality improver. Number four, get social support. The number one rule of being a healthcare change agent rebel, you cannot go rebel on your own. Number five which I think is a bit of an opportunity from today, learn from the best. In terms of some of the people that you can learn from or you can connect with, who are the very best people in the world? I'm going to take a breath. We are coming to the end of the session. All these slides are available now. They have been treated out and they are available on slide share. If Lee and some other colleagues, if you can put the slide share into the chat room to make sure that everyone gets them. That is the end of the formal teaching for this week. One of the things we are running as part of the school is a randomised coffee trial, and basically what it means is we want to link you up – if you would like to – at random with somebody else, somewhere in the world to have a cup of coffee and talk about being a change agent. What we will do is we will show you how to do this. Basically, it will be in our newsletter, and we will randomly allocate you to talk to somebody else. Look out for that one. And just to say, I hope you have enjoyed today and that you will join us again for the next three weeks – four weeks! So, now we will move on to our new enhanced feature of the School for Change Agents. Those of you who have your own group – because I know some of you have your own groups arranged straight away after this – others are watching the recording of this so you will have a conversation, and that is fantastic. But if you would like to join a virtual learning group for the next 30 minutes, stick with us now on



the WebEx. If you are having your own face-to-face learning group, or you are doing it at a different time, or you just want to listen to the lecture, that's fantastic. Nobody will think you are rude if you leave us now. Everybody who would like to be in a virtual learning group and have a fantastic conversation now, please stay with us.


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school for change agents - module 1 transcript

Healthcare