1. LEADERSHIP & FRAMING FOR STAKEHOLDER ENGAGEMENT Quality Academy – Cohort 6 April 8, 2013

2. Building advanced improvement capability for BC Another view : Quality of … Level One: doing (processes ) Level Two: thinking/ decision making Level Three: information that influences thinking Level Four: information that influences behavior Level Five: relationships (information flow) Level Six: perceptions and feelings (culture) Level Seven: individuals mind-sets (personal beliefs and values) “Engine” of quality D. Balestracci. Data Sanity. 2009 “Fuel” of quality Quality of …

3. Overcoming the Challenges … They get designed using the same mindset, belief and rules as have been used before ….

4. “Mindset Shift” From …. “current mindset” ‒Hierarchy – I don’t question those above me ‒Professional silos ‒Complications (e.g., infections) are part of our business ‒Partners must comply with what we tell them to do To … “future mindset” ‒No infection is acceptable ‒I can speak up when I have concerns ‒Patients are equal partners ‒We work in teams

5. Building advanced improvement capability for BC “Mindset Shift” (Exercise: 15 min) From …. “current mindset”To … “future mindset”

6. Creating a Sense of “Us” – Building Momentum for Change Strong ties vs weak ties (social network theory) When we spread change through strong ties … –Interact with “people like us” with the same experiences, beliefs and values –Change is peer to peer (e.g., nurse to nurse, GP to GP) –Influence is spread through people who are strongly connected to each others, who like and generally respect each other –It works because people are far more likely to be influenced to adopt new behaviors or ways of working from those they are most strongly tied Source: Helen Bevan, 2011

7. Strong Ties – Group Exercise Advantages of Strong TiesDisadvantages of Strong Ties

8. What About “Weak Ties”? When we seek to spread change through weak ties: –We build bridges between groups and individuals who are previously different and separate –We create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action –We mobilize all the resources in our system Source: Helen Bevan, 2011

9. We need BOTH strong and weak ties … Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers In situations with uncertainty, we gravitate to our strong tie relationships –Yet evidence shows that weak ties are much more important than strong ties when it comes to searching out resources More breakthroughs in innovation occur when we tap into weak ties The greatest opportunity we likely have for large scale improvement and change is through weak ties When framing your story – consider BOTH strong and weak ties Source: Helen Bevan, 2011

10. © NHS Institute for Innovation and Improvement, 2009 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 Based on organisational accountability (“if I don't deliver this, I fail to meet my performance objectives”)........To Commitment States a collective improvement 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 Based on relational commitment (“If I don’t deliver this, I let the group or community and its purpose down”) The new era requires a shift in thinking Source: Helen Bevan

11. The Value of Commitments We commit to specific actions that are measurable –not vague promises –not just outcomes Make commitments as simple as possible (“one specific action”) We want to hold people to account to the things that they commit to When we do it effectively, commitment is much more effective than compliance A definite “no” is always better than a wishy-washy “yes” or “maybe” Source: NHS Institute for Innovation and Improvement, 2011

12. Building Commitment and Connection Key PlayersNo Commitment Let It HappenHelp It HappenMake It Happen Unit ClerksXO AdministrationXO QIXO etcXO etcXO XO Three Strategies: 1.Mobilizing narratives 2.Authentic Voices (e.g., Patients for Patient Safety Canada) 3.Hot-housing (e.g., energizing meetings and events out of usual environment) Source: NHS Institute for Innovation and Improvement, 2011

13. Exercise: (10 min) Building Commitment and Connection Key PlayersNo Commitment Let It HappenHelp It HappenMake It Happen 1.List the key stakeholders that you need to engage in your work. 2.Mark an “X” to reflect current status 3.Mark an “O” to reflect where you need them to be Source: NHS Institute for Innovation and Improvement, 2011

14. © NHS Institute for Innovation and Improvement, 2011 Act – assignment three: commitment chart Commitments we make (actions not outcomes) GETS Commitments we ask others to make WhoWhat By when Executive name: _____________________________ Executive signature: ___________________________ Trust name:

15. 5 Key Steps for Building a Movement Frame to connect with hearts and minds Energise and mobilise for action Organise to drive change forward Make change a personal mission Hold the gains and sustain momentum

16. Picture frames – what is in it, you see; what is outside you do not Provide shape and structure for organizing ideas and arguments “Hooks” for pulling people in (frame in one way and I pull you in; frame in another, and it goes over your head) “Springboards for mobilizing support” Relies on authenticity and a connection with an individual’s reality Must be credible! –Resonate with mainstream beliefs and experiences –In terms of claims they make –Delivered by credible people Frame to Connect with Hearts & Minds

17. Framing … telling the story Three components of a great narrative (story): 1.Diagnostic: ‒What is the program/issue that we are addressing? ‒What is the extent of the problem? ‒What is the source/sources? 2.Prognostic: ‒What could the future look like? ‒What is our plan of attack and our strategy for carrying out the plan? 3.Motivational: ‒Why is this urgent? ‒What is our call for action that connects with the emotions and values of the audience (compelling sense of a different future tied to values) Source: Helen Bevan, 2011

18. Approaches for Effective Framing Hooking People In –Need to build mass; therefore appeal to a range of stakeholders –Think about the different people you need in order to achieve goals  Consider based upon readiness to act … “believers, sympathizers, ambivalents, antagonists, etc…” –Frame differently for each target group Connect with Hearts and Minds –Emotional heart tug –Intrinsic motivation and values –Imagine if …  mental health is understood by all  No one loses their dignity  hospital admissions are rare Source: Power of One, Power of Many, NHS

19. Bridging and Linking Diverse Groups –Outward looking and inclusive –Movements that are exclusive and inward looking become sects and elites Use a Range of Strategies –Words, stories, anecdotes –Visual images –Humor and irony –Performance and spectacle Source: Power of One, Power of Many, NHS

20. Key Approaches to Framing Clearly articulate your cause: –not too broad, not too narrow –worthy and worthwhile –ambitious and lofty, yet achievable –make more friends than enemies Connect with emotions Connect with minds, logical/rational thinking Bridge and link diverse groups Employ a range of strategies to share message Source: Helen Bevan, 2011

21. An Effective Frame … Increases the readiness to act Is credible: –involve empirically credible claims –is delivered by a credible individual Is salient: –compatible with life experience of the audience –resonates with values and sentiments Is compelling and optimistic Aligns with the desired direction Has the right scope Remains fresh

24. Project Aim: Priority Key individuals or groups to engage in this process or system Framings of the topic I feel will engage them to action What am I asking them to commit to? Framing Exercise: 15 minutes 1.On your own, begin to complete table; 2.Share your top 2 with your group and provide feedback