IHI National Forum on Quality and Safety

IHI National Forum on Quality and Safety

Minicourse M10: How to Be a Great Change Agent

Monday 9th December

Crystal Ballroom, Salon D

Helen Bevan, Robert Varnam, Andrew Hasler

Description of the minicourse:It’s tough being a change agent, particularly when other people don’t want to change. Yet big change happens in health care organizations only because of heretics; passionate people who are willing to take responsibility for change. Such individuals support organizational goals, but also want to change existing thinking and practice and improve care for patients. This minicourse provides a toolkit for surviving and thriving as a change agent.

After this session, participants will be able to:

• Identify and practice tactics for being an effective change agent

• Build a toolkit of powerful approaches to enable change

• Connect with and learn from other change agents

We will provide a CD to everyone who takes part in the minicourse, containing copies of all the presentations, films and a range of other materials that will bevery useful for healthcare change agents. As pre-reading for the minicourse, we set out some of the main principles below.

Rocking the boat and staying in it: how to succeed as an effective change agent in healthcare

Anyone who chooses to be a change agent or improvement leader in healthcare doesn’t choose an easy life. There are so many forces opposing the changes we want to see; a system that rewards people for “keeping the trains running” rather than for radical change,those with power or a vested interest in keeping the status quo, colleagues and leaders who are sceptical, apathetic or scared of change. Many people who lead healthcare improvement report that they have feel isolated, vulnerable and misunderstood.Yet big change only happens in healthcare organisations because of heretics and radicals; the courageous, passionate people who are willing to take responsibility for change, who support their organisation in its mission but also challenge the status quo. If you are, or aspire to be, a healthcare radical, come and spend the day with likeminded individuals who come together in solidarity to change the face of healthcare.

As Martin Luther King described it: ‘‘The saving of our world . . . will come, not through the complacent adjustment of the conforming majority, but through the creative maladjustment of a nonconforming minority’’. The hope of healthcare rests with the non-conformists, the radicals, the heretics and mavericks in our midst.

Who are themost effective change agents in healthcare organisations? Research byDebra Meyerson shows that the people who are most effective at leading change are those who have learnt to oppose and conform at the same time. Or, as she puts it, “they are able to rock the boat and yet stay in it”. These are change leaders who stand up to challenge the status quo when they see there could be a better way. They develop the ability to walk the fine line between difference and fit, inside and outside. These leaders are driven by their own convictions and values which makes them credible and authentic to others in their organisations. Most importantly of all, they take action as individuals that ignite broader collective action that leads to big change. These leaders already exist in every healthcare organisation, in many different roles and multiple levels. They aren’t typically the Chief Executives or senior clinical leaders yet the impact of their change activities are often just as significant. Being an effective change agent has very little to dowith status in the hierarchy or positional power.

Lois Kellyhas developed some fantastic resources for “rebels at work” and we recommend a trip round her website to all healthcare change agents. Helpfully, she makes the distinction between a “radical” and a “troublemaker” and we have adapted her table below. As radicals, we continuously seek innovative new ways of delivering care. We are committed to the patient-centred mission and values of our organisations. We are driven by our passion for better care for patients. We are optimistic about the future, the potential for change and see many possibilities for doing things in different ways. We generate energy for change which attracts others to unite with us for a common cause

“Troublemakers” also challenge the status quo but in a way that is very different to “radicals”. Troublemakers complain about the current state of affairs but their focus tends to be around their own personal position rather than achieving the goals of the organisation.

Rebel / Troublemaker
create / complain
mission-focused / me-focused
passion / anger
optimist / pessimist
energy-generating / energy-sapping
attract / alienate
possibilities / problems
together / alone

Source: Adapted from Lois Kelly

They are angry about how things are and don’t have much confident that things will get better in the future. They alienate other people because if others link with them, troublemakers will sap their energy. This just confirms what troublemakers probably know already– they don’t belong.

There are a couple of points we want to make about radicals and troublemakers. Firstly, many organisational leaders view ANYONE who challenges the status quo as a troublemaker;therefore, radicals get unfairly labelled as troublemakers.Secondly, many change leaders in healthcare start out as radicals but their voice doesn’t get heard, they begin to stridently question the status quo in a manner which is radical and self-defeating and they cross the line from rebel to troublemaker. As radicals, we have a responsibility to look out for this and try to prevent it happening by building relationships and forming alliances with others who challenge the status quo.

In the minicourse, we will look at four sets of tactics for change agents to survive and thrive as radicals in healthcare:

1. Start by improving myself
2. Build alliances for change
3. Work out what might help others to change
4. Don’t be a martyr

As improvement leaders, it is tempting to look at the world around us and identify things that need improving. If we are to deliver safe, high quality care to every patient and to make the most of our precious healthcare resources, we need to continuously improve processes and systems of care. Yes, this is really important, but as healthcare radicals we have to start at an earlier point in the foodchain of improvement. To quote Aldous Huxley: “There’s only one corner of the universe you can be certain of improving, and that’s your own self." So before we are tempted to launch into a massive effort to influence other people to change the way they think or do things, we have to start by reflecting on and changing ourselves. I have to understand myself, because the person who will be the hardest for me to lead through change is me.As leaders of the mincourse, we areinspired by the work of David Whytewho is a corporate poet. He understands this completely when he says: “I do not think you can really deal with change without a person asking real questions about who they are and how they belong in the world.’ (The Heart Aroused 1994)

Many of the organisations we work for (and with) have got ambitions for large scale change. As change agents, we sometimes feel thatwe should take a back seat whilst our organisations and leaders take the lead in setting up the improvement programme, so we can contribute to the organisation’s overall change mission and we can play our own part.

However, sometimes we just can’t just wait whilst someone else starts the change as a) it might be a long wait and b) patients might be harmed or get bad experiences in the waiting period. We are not saying that we should rush off and start making changes on our own, regardless of what is being planned in the wider system. However, as healthcare radicals, we do need to be creating our own goals for change right now, strategising about how and where we can best make our contribution to the bigger purpose, reaching out and building alliances with others and demonstrating willingness to move the change agenda forward, despite the challenges and scepticism that might face us. When we have the courage to act proactively like this, we find that most organisations will value these behaviours, even where the organisation doesn’t currently have a strong improvement or learning culture.The reality is that each of us who leads and/or facilitates change is a signal generator.Our words and deeds are constantly scrutinised and interpreted by the people around us in our teams, organisations and in the wider system. The amplification effect of what we do and say is far greater than we imagine. The most powerful way to inspire others to change is to be the vanguard for that change. If we want other people to take a risk and change the way they think or organise for improvement and/or patient safety, we have to take the lead. We like the way that Tanveer Naseerdescribes it:

You have to be the first one up and off the high dive you’re asking others to leap from. Ask yourself: where am I playing it too safe and what is that safety costing me? Then leap from your platform of safety into the cold water of change.

This situation creates a specific call to action to healthcare radicals. We, the signal generators at the vanguard of change, must embrace the spirit of the student.This means taking responsibility for our own learning and being open to continuous learning; embracing new ideas and approaches and being willing to challenge and change our existing belief systems. We have to be the best, most active, most humble learners.

In addition, our learning must move beyond knowledge and skills. For healthcare radicals it is important, but not enough, to continuously build our knowledge of improvement methods and approaches. It’s also important, but not enough, to take responsibility for our own development as skilled leaders or facilitators of change. What sets healthcare radicals apart is the extent to which we purposefully seek to live and be improvement, in the way we operate in the world and in our interactions and relationships with others. Wethink that the diagramme below from Rianna Mooresums this up very well. It’s only when we live the things we believe in (that is, when we can align our sense of deeper life mission or calling, our values and the activities that we undertake every day) that we can truly energise ourteams and organisations by working from our true selves and make our full contribution as healthcare radicals.

Being a great change agent is about knowing, doing, living and being improvement

History tells us that organisational or system transformation is always preceded by personal transformation. So if, as organisational radicals, we want to play our role in transforming the care our organisations provide, we have to focus deeply on our own perspective and the ways we interact with and influence others. The more people we can influence in a positive way and the more that we (as organisational radicals) can unleash that powerful reservoir of energy for change, the more our influence and impact will grow.

Corporate Rebels United is a global movement of “corporate rebels” across multiple industries and sectors. Many healthcare radicals are part of this. This is the manifesto of Corporate Rebels United which perfectly captures the mission of radicals in healthcare to deliver the new truth of healthcare transformation:

We are architects and scouts into the future, and we want to guide our organisations in navigating a safe path from now to then:

Relentlessly

Challenging the status quo

Changing the rules

Saying the unsaid

Spreading the innovation virus

Seeding tribal energy

With no fear

With a cause to do good

Leading by being from our true selves

Going after the un-named quality

Relentlessly

Some conclusions

1. There are many radical change agents out there in the healthcare system across the globe; passionate people who support the patient-centred goals of their healthcare organisations, who are willing to take responsibility for change but who question and challenge the current ways of going about change
2. “Radical” status isn’t related to hierarchy or position and we don’t have to work in the healthcare system to qualify as a healthcare radical. The movement of healthcare radicals includes many radical patient leaders and radical Chief Executives and Chief Finance Officers
3. We have to find ways to unite and mobilise this radical community; this is a latent and potentially powerful reservoir of energy for change
4. We must help healthcare leaders to understand the difference betweenradicals and troublemakers and exploit the talents of the radical element within the healthcare improvement community for the greater good

Helen Bevan, Robert Varnam, Andrew Hasler

November 2013

Please join us in Crystal Ballroom, Salon D on 9th December for Minicourse M10: a day of inspiration, co-learning and building a movement for healthcare transformation

The Twitter hashtags for this minicourse are #IHI25Forumand#ChangeAgentsWe will produce and share two records of the day via Storify and Pinterest