Social Movements

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Applying the Lessons of Social Movements and
Social Networks to Improvement

• Helen Bevan
• _at_HelenBevan

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Which tradition of change?
Leading and mobilising social movements
Leading and managing organisational change
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Which tradition of change?

• Organisational behaviour
• Leadership and management studies
• Clinical/medical audit
• Improvement science
• Academic tradition(s) 100 years

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Which tradition of change?

• Community organising, campaigns and social
  movements
• Learning from popular, civic and faith-based
  mobilisation efforts.
• Academic tradition 100 years

Leading and mobilising social movements
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A social movement is

• a voluntary collective
• of individuals committed to promoting or
  resisting change through co-ordinated activity
• to produce a lasting and self generating effect
  and creating, as they do a sense of shared
  identity

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Which tradition of change?

• Community organising, campaigns and social
  movements
• Learning from popular, civic and faith-based
  mobilisation efforts
• Academic tradition 100 years

• Organisational behaviour
• Leadership and management studies
• Clinical/medical audit
• Improvement science
• Academic tradition(s) 100 years

Leading and managing organisational change
Leading and mobilising social movements
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Learning from social movement leaders
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SEISMIC SHIFTS
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SEISMIC SHIFTS
DIGITAL CONNECTION
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SEISMIC SHIFTS
Work complexity
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SEISMIC SHIFTS
DIGITAL CONNECTION
Work complexity
Hierarchical power
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SEISMIC SHIFTS
DIGITAL CONNECTION
Work complexity
Change from the edge
Hierarchical power
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• We are on a collision course between the new,
  organic, human-focussed forces of social media
  and the machine world of our organisations

Source Maddie Grant
Source of image sullybaseball.blogspot.com
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Leading change in a new era
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Leading change in a new era
Most healthcare transformation efforts are driven
from this side
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How do we create change at scale?
Narrative why?
Strategy what?
Shared understanding leads to Action
Source Marshall Ganz
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What is strategy?

• Strategy is the process of turning the resources
  you have into the power you need to win the
  change you want
• Source Marshall Ganz

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Resources to improve health and care
grow
diminish

• Economic resources
• diminish with use
• money
• materials
• technology

• Natural resources
• grow with use
• relationships
• commitment
• community

• Based on principles from Albert Hirschman,
  Against Parsimony

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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)

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The reality
What the leader cares about (and typically bases
at least 80 of his or her message to others on)
does not tap into roughly 80 of the workforces
primary motivators for putting extra energy into
the change programme Scott Keller and Carolyn
Aiken (2009) The Inconvenient Truth about Change
Management
Source of image swedenbourg-openlearning.org.uk
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Whats the financial incentive?
Whats the project plan?
Who is performance managing?
Source _at_RobertVarnam
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or
I have some Key Performance Indicators for you

• I have a dream

Source _at_RobertVarnam
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If we want people to take action, we have to
connect with their emotions through values
action
Source Marshall Ganz
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Effective framing what do we need to do?

1. Tell a story

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Effective framing what do we need to do?

1. Tell a story
2. Make it personal

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Effective framing what do we need to do?

1. Tell a story
2. Make it personal
3. Be authentic

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Effective framing what do we need to do?

1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of us

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Effective framing what do we need to do?

1. Tell a 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

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It starts with me!
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Talk to the person next to you

• Tell your story about why the change you are
  involved in now is so important to you
• Relate it to a personal experience
• You have two minutes each

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Call to Action
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Lets talk about dementia......
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short-term treatment (up to six weeks) of
persistent aggression in patients with moderate
to severe Alzheimers dementia, unresponsive to
non-pharmacological approaches and when there is
a risk of harm to self or others.
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The reality

• Estimated 180,000 people in England with dementia
  were getting antipsychotics
• Only 36,000 get any clinical benefit from the
  drugs
• Negatives far outweigh the positives
• Source Bannerjee report

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It doesnt have to be that way!
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Dementia Action AllianceOur goal

• By 31st March 2013,
• all people with dementia who are receiving
  antipsychotic drugs will have undergone a
  clinical review to ensure that if they are
  receiving these drugs they are doing so
  appropriately and that alternatives to their
  prescription have been considered and a shared
  decision has been agreed regarding their future
  care

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The challenge

• There is a lot of activity and energy for
  change.......
• Unless that energy is translated into appropriate
  prescribing and appropriate review of
  medications, it counts for nothing
• We want to provide a focus and direction that
  moves everyone in the same direction

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Our strategy

• To work in partnership with the Dementia Action
  Alliance and other networks and organisations
  that can make a contribution
• To engage everyone who can play a part in helping
  to achieve our goal
• To move beyond mobilising to organising to make
  this happen

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How did we go about it?

• Identify the specific actions that we are calling
  on the groups of people to take
• Get organised so that we can sign up lots of
  people
• Get lots of people taking action, building
  commitment and energy for change
• Measure progress, learn as we go and plan next
  steps

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Eight groups to call to action

• People with dementia and their carers
• Leaders of care homes
• Family physicians
• Psychiatrists
• Pharmacists
• Hospital doctors
• Commissioners of health and social care (payers)
• Clinical leaders of hospital systems

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CALLTO ACTION FOR PHARMACISTS What specific
action? What are the main themes for
action?
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Outcome

• Contributed to a 51 reduction in the prescribing
  of anti-psychotic drugs to people living with
  dementia across England

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• Leadership is the art of mobilising others to
  want to struggle for shared ambitions
• Jim Kouzes

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Implications for healthcare leaders

• A wider stage of action and additional players
• Attention to personal feelings and motivation
  and pride in articulating them
• Connection to wider experience, and open to
  others
• Celebrate historic contribution of leadership
  approaches, and adopt additional mobilising
  techniques
• Be true to self and honour the experience of
  others