1. @helenbevan The art and science of nursing and midwifery: How to rock the boat and stay in it Helen Bevan Delivery team NHS Improving Quality @helenbevan @NHSIQ

2. @helenbevan The art and science of midwifery As nurses and midwives we have two jobs: 1.To deliver safe effective care

3. @helenbevan The art and science of midwifery As nurses and midwives we have two jobs: 1.To deliver safe effective care 2.To continuously improve our services

4. @helenbevan

5. What happens to heretics/radicals/rebels/mavericks in organisations?

6. @helenbevan

7. Are you a boat rocker? One who challenges the status quo when they see that there could be a better way 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 Source: adapted from Debra E Meyerson

8. @helenbevan #IQTGOLD Source : Lois Kelly www.foghound.comwww.foghound.com Sometimes leaders see radicals as troublemakers

9. @helenbevan Task Talk to others around you about your experiences around “rebels” and “troublemakers” Which have you been and why? What moves people from being “good” to “bad”? How do we protect against this?

10. @helenbevan First they ignore you, then they laugh at you, then they fight you, then you win Gandhi

11. @helenbevan 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

12. @helenbevan Source: Foghound

13. @helenbevan Four tactics for change agents 1.Start with myself 2.Build alliances 3.Work out what might help others to change 4.Don't be a martyr

14. @helenbevan "There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley

15. @helenbevan

16. 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 Source: adapted from Debra E Meyerson

17. @helenbevan 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 Source: adapted from Debra E Meyerson

18. @helenbevan Source: Foghound

19. @helenbevan

20. 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 Source: adapted from Debra E Meyerson

21. @helenbevan 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 Source: adapted from Debra E Meyerson

22. @helenbevan 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 Source: adapted from Debra E Meyerson

23. @helenbevan 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 Source: adapted from Debra E Meyerson

24. @helenbevan 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? Source: adapted from Debra E Meyerson

25. @helenbevan Four tactics for change agents 1.Start with myself 2.Build alliances 3.Work out what might help others to change 4.Don't be a martyr

26. @helenbevan “if you want to go fast, go alone. If you want to go far, go together” African proverb quoted by Al Gore

27. @helenbevan

28. Four tactics for change agents 1.Start with myself 2.Build alliances 3.Work out what might help others to change 4.Don't be a martyr

29. @helenbevan

30. “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)

31. @helenbevan The model is mostly used around health-related behaviours smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake domestic violence HIV prevention use of sunscreens to prevent skin cancer medication compliance mammography screening

32. @helenbevan The model is mostly used around health-related behaviours smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake domestic violence HIV prevention use of sunscreens to prevent skin cancer medication compliance mammography screening It works for organisational and service change too!

33. @helenbevan “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992) I am not aware my smoking is a problem – I have no intention to quit

34. @helenbevan “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

35. @helenbevan “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.

36. @helenbevan “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!

37. @helenbevan “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

38. @helenbevan “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

39. @helenbevan “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)

40. @helenbevan 90% of our change efforts are aimed at the “action” stage 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 make the change happen

41. @helenbevan #IQTGOLD 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

42. @helenbevan “One key issue is that many doctors already feel that they are delivering patient centred care – unfortunately that is not what patients report.” Dr Nigel Mathers, Vice Chair, Royal College of General Practice

43. @helenbevan So what do we TEND to do? Lower our ambitions for improvement Put negative labels on those who are not yet at the action stage such as “blocker” or “resister” or “laggard” Blame “the management” for not enforcing change

44. @helenbevan So what SHOULD we do Listen and understand appreciate others’ starting point for change Build meaning and conviction in the change Roll with resistance (Singh) Don’t argue against it Understand why people are resisting the change What makes it so hard? What would help? Build shared purpose

45. @helenbevan....the last era of management was about how much performance we could extract from people.....the next is all about how much humanity we can inspire Dov Seidman