minicourse m8: pre-reading and workbook

Minicourse M8: STUDY GUIDETo read prior to the minicourse on 5th December

2016 as “flipped classroom” pre-work

‘We need three kinds of people to transform healthcare; patients, professionals and pirates.

Be a rebel pirate!’ Lucien Engelen

Faculty:Helen Bevan @HelenBevan

Kathryn Perera @KathrynPereraHashtags #IHIFORUM #pirate

How to be a great change agent flipped classroom pre-work

ContentsIntroduction...........................................................................................................................................3

This study guide.................................................................................................................................3

What are YOUR goals as a healthcare change agent?.......................................................................3

Setting the scene: the challenge of change.......................................................................................4

Who are the most effective change agents in healthcare?................................................................6

Rebels versus troublemakers.................................................................................................................6

Rocking the boat and staying in it..........................................................................................................8

Being an effective healthcare change agent is about knowing, doing, living and being change that makes a difference................................................................................................................................9

Beginning to be the change: RCTs (Randomised Coffee Trials)............................................................10

What do we mean by resistance to change?.......................................................................................11

What is our mindset about resistance?...........................................................................................11

The power of resistance......................................................................................................................12

Diversity...........................................................................................................................................12

Understanding why people resist and what to do about it.................................................................13

Where am I in the change cycle and what will help me to progress to the next stage?..................13

The Stages of Change (or Transtheoretical Change) model.............................................................14

Growing movements for change ……………………………………………………………………………………….……… ……17

Statement of intent………………………………………………………………………………………………………………….………18

Mapping our communities……………………………………………………………………………………………………………….19

Effective framing.................................................................................................................................20

My story…………………………………………………………………………………………………………………………………………..22

On strategy and tactics…………………………………………………………………………………………………………………….23

Reflection and evaluation……………………………………………………………………………………………………….….……25

Reference list.......................................................................................................................................29

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This Study Guide was prepared by Pip Hardy and edited by Dr Helen Bevan and Kathryn Perera.

Session 1: Being a healthcare change agent: change starts with me

Introduction ‘Be the change you want to see in the world.’ MK Gandhi

Welcome to the M8 minicourse: “Rocking the boat and staying in it: how to be a great change agent”

It’s tough being a change agent in healthcare, particularly when other people don’t always get it or want to change. Yet big change happens in healthcare only because of heretics and rebels; passionate people who are willing to take responsibility for change. We are people who support the goals of our healthcare systems, but also want to change existing thinking and practice and improve care for patients and people who use services.

Being a radical change agent isn’t related to hierarchy or position and you don’t have to work in the official system to qualify as one. People who have previously taken part in our workshops include patients and family members, students, senior leaders, improvement facilitators and clinical and care staff.

This minicourse seeks to provide us with tools, ideas and connections with a community of change agents to help us thrive and survive as agents of positive change and improvement

This study guide‘Education is the kindling of a flame, not the filling of a vessel.’ Socrates

This study guide is intended to enhance and complement the minicourse and help deepen your thinking and reflection. It is not compulsory, but it may give you some ideas of things to think about, questions to ask and you may take some inspiration from some of the examples and quotations. If you would find it helpful, please feel free to use this guide as a place to keep track of your own thoughts and ideas so you will have a record of your work on the day of the minicourse.

Throughout the study guide there are shaded sections for you to reflect on your own experience or respond to key questions. Even if you don’t write anything down, do take a few minutes to think about your responses to the questions and prompts; again, these could form great discussion points on the day of the school.

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What are YOUR goals as a healthcare change agent?In order to make the most of the one day minicourse, you may find it helpful to give some thought to your own personal goals – what do you hope to achieve by engaging with a community of change agents? You may like to think of this as the beginning of the story you will tell about developing your skills, knowledge and confidence as an agent of change.

REFLECTION: THE STORY BEGINS

What do you hope to achieve from the minicourse?

Here are some of the things other people have suggested:

‘Create a network of rebels!’

‘Reawaken interest in studying and applying knowledge. Connect with other participants who may understand what it feels like to be an extreme left field thinker in an ultra traditional organisation.’

‘I'd like to learn how NOT to get myself into trouble - or my ideas and the people I represent to be ignored - because I don't rock the boat in an appropriate way!’

Setting the scene: the challenge of changeAnyone who chooses to be a change agent, improvement or patient 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 change agent change, those with the power and/or a vested interest in keeping things as they are, colleagues and leaders who are sceptical, apathetic or scared of change. Often in our role as change agents, we feel isolated, vulnerable and misunderstood. Yet the future of healthcare rests with the non-conformists, the change agents, the heretics and mavericks in our midst. We are the people who are passionate about change, who question existing ideas and methods and open up new fields for action. 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 non-conforming minority.’

REFLECTION: PASSION AND CHANGE

What are you passionate about?

How do you ‘live’ your passion(s)?

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What have you already done to bring about change?

How did that work for you?

How can change agents work with different kinds of power?It is helpful to contrast what Timms and Heimans call “old power” and “new power”

Often in healthcare, the dominant form of power is “old power”; the people who can make things happen are the people with positional authority, who push commands through the system. Old power is like a currency, some people have a lot of money but most people don’t. Largely, old power is transactional; we hold people to account in a rational way for performance agreements and quality standards. By contrast, new power is like a current; it surges with energy when people come together with a shared purpose. It is relational; people engage in new power ways because they want to and it fits with their own priorities and values, not because they have to.

Healthcare change agents need to be able to operate in the sig-saggy space between old and new power. We need to be able to operate with the levers and opportunities of both. New power brings

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us lots of opportunities even when we don’t have a lot of positional authority to make things happen. In our minicourse for change agents, we will discuss how we can work with both kinds of power.

Who are the most effective change agents in healthcare?Research by Debra Meyerson suggests that the most effective change agents 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 agents 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 people are driven by their own convictions and values which makes them credible and authentic to others. Most importantly of all, they take action as individuals that ignite broader collective action that leads to big change. Change agents already exist in and around every health or care organisation, in many different roles and multiple levels. Often they are not at the most senior levels of the organisation yet the impact of their change activities are often just as significant as if they were.

REFLECTION

What makes you a change agent?

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Rebels versus troublemakersLois Kelly makes the distinction between ‘rebels’ and ‘troublemakers’. As change agents who challenge the status quo, we fit with her ‘rebel’ criteria (and we use the terms “rebel” and “change agent” interchangeably). 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 ‘rebels’. 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.

‘Troublemakers’ are often angry about how things are and don’t have much confidence 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 risks here for rebel change agents. Firstly, some organisational leaders view ANYONE who challenges the status quo as a troublemaker. Therefore, rebel change agents get unfairly labelled as troublemakers. Secondly, lots of change activists in healthcare start out as rebels but when their voices don’t get heard, they begin to question the status quo stridently and often in a manner which is self-defeating; and they cross the line from rebel to troublemaker.

As rebel change agents, 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 (there will be more on this topic later).

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REFLECTION: REBELS AND TROUBLEMAKERS

What is your experience of rebels and troublemakers?

How can you protect yourself against moving from rebel to troublemaker?

Rocking the boat and staying in itSuccessful boat rockers tend to:

1. Be driven by conviction and values

2. Have a strong sense of ‘self-efficacy’, that is, the belief that they are personally able to create the change

3. Be able to join forces with others to create action

4. Be able to achieve small wins which create a sense of hope, self-efficacy and confidence

5. Be more likely to view obstacles as challenges to overcome

The issue of self-efficacy is a particularly important one for healthcare change agents. By self-efficacy, we mean the belief that a person has that she or he is capable of delivering the specific change required. There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change and get good outcomes.

ACTIVITY: BUILDING SELF-EFFICACY

What are some of the ways that you can build self-efficacy into your practice as a healthcare change agent?

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Being an effective healthcare change agent is about knowing, doing, living and being change that makes a difference

As change agents it is important, but not enough, to continue to 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 the most effective healthcare change agents apart is the extent to which they seek to live and be improvement in the way they operate in the world and in their interactions and relationships with others.

It’s only when we live the things we believe in (that is, we can align our sense of deeper life mission or calling, our values and the activities that we undertake every day) that we can make our full contribution as healthcare change agents and generate the kind of signals that lead others to transformational change.

ACTIVITY: MAKING A DIFFERENCE

What are the opportunities for you to build your perspectives and skills as an agent of change and improvement?

How can you move beyond skills and knowledge of change to live and be the change?

Who can help and support you as a change agent?

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What are the implications for the way you work?

Beginning to be the change: RCTs (Randomised Coffee Trials)

It’s hard to ‘do’ change on your own and one of the best ways of being the change you want to see is to work with others who share your intentions and values.

During the minicourse, we will be encouraging you to develop your networks and find other people with whom you can share ideas and explore opportunities. One great way of doing this is by an RCT, that is, a Randomised Coffee Trial. RCTs can help you connect with people over a cup of coffee (or tea). It is a particularly useful approach within organisations where people may have little time to get to know one another, exchange ideas and share stories but it is also a wonderful way for cross-pollination to occur across organisations.

Do take a few minutes to learn more about RCTs here: http://www.gurteen.com/gurteen/gurteen.nsf/id/randomised-coffee-trials

And here: http://www.nesta.org.uk/blog/institutionalising-serendipity-productive-coffee-breaks#

Questions for reflection

1 What are the opportunities for me to build my perspectives and skills as an agent of change?

2 How can I build self efficacy as a change agent?

3 How do I move beyond skills and knowledge of change to live and be change?

4 Who can help and support me as a change agent?

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http://www.nesta.org.uk/blog/institutionalising-serendipity-productive-coffee-breaks

http://www.gurteen.com/gurteen/gurteen.nsf/id/randomised-coffee-trials


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Session 3: Rolling with resistance

Introduction

‘Learning is in the relationships between people.’ McDermott 1999

ACTIVITY: THE STORY CONTINUES

How do you deal with resistance to your change ideas or actions?

Have you considered the ways in which you may able to use resistance to help you achieve your goals?

What do we mean by resistance to change?Resistance means any force that stops or slows movement.

Resistance is inevitable… learn to expect it, welcome it.

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What is your mindset about resistance?How we deal with ‘resistance to change’ depends on how we perceive the resistance. Is resistance something negative that will get in the way of the changes that we are seeking to implement, something that we need to overcome if we are to deliver the change? Or is it something to welcome that ensures a diversity of perspective and builds better change?

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The power of resistanceResistance is powerful. If unharnessed, it can be harmful, much like lightening. But, when the power of electricity is harnessed, it is immensely useful.

Find ways of harnessing the power of resistance to help you achieve your goals. Go with the energy rather than against it.

DiversityResearch studies show that teams of people with diverse backgrounds, experiences and views of the world will consistently outperform groups of more talented but homogenous individuals.

Diverse teams have better insights, they are more effective as problem solvers and they make fewer mistakes.

The ‘best people’ for our change projects are not necessarily the people who are most like us. As healthcare change agents, we want to embrace diversity and bring people into our change teams who think differently to us or who have had different experiences of life. This may include patients and families, community leaders, people from other industries and organisations. By deliberately seeking diversity we create the risk of greater resistance, challenge and disagreement within the group, even though the outcome is likely to be better.

Research conducted into interprofessional education (Anderson 2014) has found that, by bringing together people from different clinical professions to talk with and listen to patients, clinical outcomes are improved. Each profession looks for and sees something different and the sum of their perspectives provides a more holistic understanding of the issues facing the patient. This approach is a good example of the benefits of embracing diversity.

As change agents, we need to embrace and value the differences.

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ACTIVITY: DIVERSITY - VALUING THE DIFFERENCE

In the context of ‘rolling with resistance’…

What are the implications of embracing diversity of thought, experience and background in my change initiative?

What skills and perspectives do I need to develop to work effectively with diverse groups of people for change?

Understanding why people resist and what to do about itThere are a number of models and frameworks that can give us insight into why people are resisting change and suggest actions to take as a change agent to roll with resistance. Many healthcare change agents use the ‘Stages of Change’ or ‘Transtheoretical Model of Behaviour Change’ from Prochaska, DiClemente and Norcross to support their change effort. It is a model of health-related behaviour change that many clinicians are already familiar with through their clinical practice. It can be used for improving service quality and patient safety too

Where am I in the change cycle and what will help me to progress to the next stage?The basic model consists of five stages of change that individuals go through in changing their behaviours. By working out where on the cycle an individual is, we can plan some appropriate actions to help that person to embrace and contribute to the change. In healthcare, when people ‘resist’ change is it much more likely to be a result of their interpersonal interaction with the change process than their innate character traits. This means that people are more likely to be resisting because of a bad change process not because they are a difficult person. The Stages of Change model helps us to understand this and work out where the person is at.

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The Stages of Change (or Transtheoretical Change) model

Prochaska, Di Clemente and Norcross offer us framework that we can use to work out which stage of change a particular individual is at and plan actions to help the person get to the next stage. We unpack the model on the next couple of pages.

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Stage Where am I in the change cycle? What will help me move to the next stage of change?

What’s a good outcome from efforts at this stage?

PREC

ON

TEM

PLAT

ION

I am not thinking about changing my behaviours, actions or work processes. The problem or issue is outside my frame of awareness or my perceived need. Therefore, there is no problem because I am not awareness of the situation as it might affect me. Obviously, I have no intention to change at this stage and my defences may be raised if you push me to change. I often get labelled as ‘resistant’, ‘blocker’ or ‘in denial.’

The focus should be on creating awareness for me of the need to change.

Use strategies to raise my awareness and lower my doubt

Increase my perception of risks and problems with current ways of working

Emphasise the consequences and costs associated with maintaining the existing system

Emphasise the benefits that I and others will get from the change.

Use basic skills such as reflective listening and open-ended questions

Function as my collaborator not my educator

Remember, the goal is not to make me (as a pre-contemplator) change immediately, but to help me move to contemplation.

I begin to recognise that there might be a problem that I need to do something about.

CON

TEM

PLAT

ION

I am aware a problem exists and I am seriously considering action, but I have not yet made a commitment to an action. I have some level of awareness of the problem. I might not want to admit it but I also have a large degree of fear of the unknown and of the amount of effort I may need to make for the change. If you force me to change at this stage, there is a risk that my defences will remain in place. This means that I might be compliant with the change but not committed to it. As a result, the change may not be sustained.

The focus should shift to increasing the perceived benefits of the change and reducing the expected or perceived negative consequences of changing for me. You will want to create a ‘tipping point’ where the expected benefits outweigh the expected costs of the change. To get me to this point it may be necessary for you to help further clarify both the benefits (which may be unknown) and costs (which may be unrecognised). You need to try to step into my shoes, considering the pros and cons of change from my perspective.

I have made a tentative commitment to changing the way I currently do things but it is fragile.

PREP

ERAT

ION

I have made a decision to take future action, but I am not yet prepared to actually take the action now. I need to do some more thinking about the individual steps that I need to take prior to attempting the new behaviour or new way of working. There is a strong likelihood that my peers will still be at the pre-contemplation and contemplation stages (80% of others in many research samples). As a result, I may be discouraged or question my decision to take action.

Help me to build my skills, knowledge and confidence in the new way of working:

• build an action plan for change• include others in the plan• examine barriers to change and help me

work through potential solutions (what will the first week be like?)

• encourage me to take part in formal training sessions and workshops

• give me interesting articles to read that show evidence

• agree how the change will be evaluated

I’m making clear statements about the change and I have an action plan in place.

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ACTI

ON

I am aware a problem exists and have actively modified my behaviour, work process and/or environment in order to overcome the problem. I’ve actually made the changes and I’m working in a new way. However, some of my old habits and tendencies toward the old behaviour are still in place and it is quite likely that I will revert to the old way of working. The good news is that my commitment is clear and I am making a big effort to change.

Reinforce the changes I have made by coaching and mentoring me:

Recognise and acknowledge the success of the change even if the success is only the attempt with results not yet evident

Reaffirm your own commitment to the change and engage in active problem solving with me and my colleagues

I’m working in the new way. The risk of relapse is diminishing as my new behaviours/ways of operating replace the old ones.

MAI

NTE

NAN

CE

I have made a sustained change. My new ways of working have become firmly established and the threat of relapse is become less intense. It’s no longer necessary for me to consciously think about and plan the new way of working as it has become more automatic. I (and my patients and colleagues) are realising the benefits of the change and my confidence that it was the right thing to do is growing. However, in times of stress there is still a risk that I might revert to the old ways of doing things

Understand that even though I am well established in the ‘maintenance’ phase, I still need ongoing support and encouragement. Be there for me if I relapse. If this happens, help me to:

• Reaffirm the original reasons for the change

• Explore the factors that precipitated the crisis

• Get back on track

Hopefully, I successfully exit the final stage of change cycle and move into a new cycle for a new change. If I relapse, I will re-enter the contemplation or preparation stage.

Adapted from DiClemente, 1991; Prochaska and Norcross, 1994 and Wirth 2004 by Robert Ferris-Rogers and Helen Bevan

REFLECTION: STAGES OF CHANGE

At what stage of change are some of the key people that you need to influence for your change initiative?

What actions can you take to help them move to the next stage?

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Session 3: Growing movements for change

Introduction

“People who have ideas and drive are on every street, in every project, every workplace and school, waiting in the wings, ready to be discovered. Someone has to reach them and recognise them. Someone has to ask them to step out, not to be consumers or props or spectators but to be players in the unfolding drama if public life. And that someone is what we call a leader or organiser.”

Michael Gecan, Going Public

As human beings, we are inherently social animals. We form pairs, families, communities, societies and cultures. As the previous section reminded us, we are all interconnected. It is when the connections are broken that change agents may become trouble makers. Without those connections it is unlikely that we can bring about significant social change and improvement.

So how can we harness the power of our shared humanity to help us accomplish positive change?

In adapting to change in the 21st century, the most progressive organisations are shifting away from hierarchical models of leadership that seek to shape the workforce to the goals and ethos of the organisation and towards the recognition of the need for shared purpose, shared values and a sense of community. So what can we learn from those leaders who had few economic resources and little power in a formal sense, yet were able to change the course of history? These people are the leaders of the great social movements, for example, the women’s suffrage movement, the Civil Rights movement, the Anti-Apartheid movement, the climate campaigners of the 1970s and leaders of the Arab Spring.

In this section, you will learn about:

Growing movements for change in health and social care

Developing community relationships for common purpose

Using stories (‘Public Narrative’) to motivate others

The value of campaign strategy and tactics in leading change

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ACTIVITY: SOCIAL MOVEMENTS

What learning and inspiration can we take from social movement leaders to help us in our roles as agents of change in healthcare?

Statement of Intent

Who am I seeking to organise?

Are you seeking to organise a particular group in your community? Are you working within an organisation, such as a hospital, local medical center or similar? Do you want to organise a particular group of people across a region or area? Are you seeking to better use people inside your own organisation to exploit their networks and resources? Do the people in question want you to organise them (yet)?

Where am I organising?

If you are one person or a small team, you may need geographical limits to ensure you are focusing your resources. What is the physical location of your work? What does that community look like? Who lives there? If you are organising a more dispersed community, for example members of a particular clinical profession across a region, what do you know about them?

What am I organising for?

What change do you want? What issue or problem are you organising around? What would success look like in a campaign? Are there short-term and long-term goals which you have in mind? Do you have a practical solution which you are seeking? Is there support for this specific change?

Developing answers to these questions will help you to shape a statement of intent, which you can refer back to as your work develops to check that you’re on track.

I AM ORGANISING (who?) _________________ TO (do what?) ______________________ THROUGH

(how will you do it?) ______________.

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Mapping our communities“As an organiser I start where the world is, as it is, not as I would like it to be. That we accept the world as it is does not in any sense weaken our desire to change it into what we believe it should be — it is necessary to begin where the world is if we are going to change it to what we think it should be.”

Saul Alinsky, Rules for Change agents

“Organisers identify, recruit and develop leadership; build community around leadership; and build power out of community.”

Marshall Ganz, Kennedy School of Government

Increasingly, there is an emphasis in healthcare on the need to work in and with communities, so it is a good idea to be aware of the communities of which you are a part. Most of us belong to a number of communities: some may be virtual, such as Facebook and LinkedIn groups, while others will be actual, real time, perhaps even face-to-face groups. It is worthwhile to consider how each of these communities contributes to your efforts to bring about change – and whether they are the right communities for you.

Make a list below of the institutions, leaders and other people whom you think have, or could have, significant influence on your cause (positive and negative). You might choose to divide this list into local, regional and national actors, depending on the complexity of the work you are undertaking.

Consider the actors on your list in terms of their “ability to act” (power). To what extent could they influence the success or failure of your cause (positively or negatively)? What would be the impact of their support?

Now consider the actors on your list in terms of how you understand their position to your cause currently. Do you think they are on-board with what you’re trying to do? Neutral? Opposed?

Through this simple exercise, you are starting to map your understanding of how able you are to make the change you seek within your community.

Take the exercise one step further. Of those whom you think have significant influence on your potential success, and who are currently opposed or neutral, whom do you think you could most readily convert to support? What steps might help you to achieve this?

FramingFraming is the process by which leaders and agents of change construct, articulate and convey their message in a powerful and compelling way in order to win people to their cause and call them to

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action. Effective framing is a critical first stage to creating the conditions that lead to mobilisation and large-scale change.

ACTIVITY: FRAMING

How can you frame your messages about change in a way that will win others to your cause and call them to action?

“Storytelling is the mode of description best suited to transformation in new situations of action.”

Schön, 1988

“All real life is meeting not meetings”

Michael Gecan, Going Public

Most of us, if we are passionate about something, want to share our passion with others in the hope of drawing them into the future we want to create for our patients, service users, colleagues and communities. This requires more than just vision or passion. We need to give something of ourselves, to connect with others and let them know that we are authentic in our attempts to bring about change. A story that offers some insight into us as individuals will have a more powerful effect than a story that is based on statistics or targets. A vision of improving care that is based on an experience of care that was either wonderful or terrible is more likely to engage people than a vision that is based on the number of people affected by a particular condition.

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The best stories also reveal the storyteller’s ability to meet and overcome challenges by making the most appropriate choice or choices to achieve the desired outcome.

‘No matter what form the dragon may take, it is of this mysterious passage past him, or into his jaws, that stories of any depth will always be concerned to tell….’

O’Connor 1969

Framing your storyIf you want people to join you in your change attempts, you will need to engage them. Stories provide the basis to do this:

1. Make it personal and authentic (‘story of self’)

2. Create a sense of shared purpose (‘story of us’)

3. Build in a call for urgent action (‘story of now’)

ACTIVITY: CHALLENGES AND CHOICES

Give some thought to your story. How will you attract the attention of the people you want to call to action? What personal experience will enable them to connect their experiences with yours? How will you make your story authentic?

Imagine that you have to write the story that will convey your mission for change in four sentences.

In the first sentence, make a connection with your audience.

In the second sentence, give us the context of your story.

In the third sentence, tell us about the challenge or crisis in your story.

In the final sentence, provide closure to your story – tell us the outcome of your choices.

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Of course, telling a story in four sentences is a tall order, especially if you are trying to be specific and provide vivid detail. It is a good way of establishing the skeleton of your story though, and you can always go back later to fill in the details. It is also worth bearing in mind that the average attention span of 21st century humans is about two minutes, so if you can keep your story short and to the point, you will win the admiration and respect of your community!

My StoryA “story of self” communicates the values that called you to lead in this way, at this time.

People tend to overthink writing their own public story, or worry that it has to be very dramatic or tragic. In fact, some of the simplest stories can be the most effective. Getting your story right can take a while, so don’t worry if you struggle at first – most people do. Take 5 minutes now to look back at the notes you wrote prior to coming this weekend, adding anything you might have thought of during this session. You can use this stick-person to help you - write down anything that is important to who you are- people, values, ideas, moments, experiences, places, anything. You can use this to build on later.

What change do you want to see in the world?

Why?

Our storyA “story of us” communicates shared values that anchor your community, values that may be at risk, and may also be sources of hope.

What urgent challenge might you call on us to face?

What vision could we achieve if we act?

Story of nowA “story of now” is urgent, an urgency based on threat, or, equally, on opportunity: it is meant to inspired others to drop other things and pay attention; it is rooted in the values you celebrate in your story of self and us, but poses a challenge to those values. It contrasts a vision of the world as it will be if we fail to act with the world as it could be if we do act, and calls on us to act.

Why does it matter to us now?

What “action” might you call upon us to join you in taking?

The ability to articulate our stories (of ourselves, our shared purpose and our call to action) is central to our ability to organise and lead change. Public leadership requires the use of both the “head” and the “heart” to mobilise others to act effectively on behalf of shared values. It engages people in

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interpreting why they should change the world – their motivation – and how they can act to change it – their strategy.

Public narrative is the “why” – the art of translating values into action through stories. These stories provide the basis for meaningful conversations we have with people in our communities to identify, recruit and develop leadership, build community around that leadership, and create change through that organised community. Meaningful conversations based on stories, often shared one-to-one with others, are the bread and butter of organising for change.

Think of a story you have heard which has inspired or meant something to you. Why was the story effective?

On strategy and tacticsIn order to create change in the world we have to engage in action. But in order for that action to mean something it needs to be guided by a clear, compelling strategy that lays out a believable path to change. That doesn’t mean the path will be easy or certain, but it has to make sense to you and your team.

Strategy enables you to turn what you have into what you need to get what you want; how to turn the resources you have into the power you need to achieve a specific, measurable goal. Tactics are the means by which you achieve your strategic goals. You constantly test your strategy by trying new tactics, evaluating them and improving over time, while staying completely committed to your ultimate goal. Goal first : then strategy.

Tactics are the on the ground implementation of your strategy, when you can turn your resources into actions. It’s important not to think of strategy as big and tactics as small: they are equally important. Strategy without tactics is just some good ideas, and tactics without strategy is a waste of resources: you will lose power as you go - instead of building it - and burnout.

Below are some questions which may prompt your thinking as you develop a strategy to grow a movement for change. They are designed to help you develop concrete, realisable goals around which you can organise with other people in your community.

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ACTIVITY: Strategy and tactics

What is the problem that is bothering us that we want to change?

Can we break that problem down into issues?

Can we think of a creative and realistic solution to those issues?

Is the change both worthwhile and winnable?

Who has the ability to deliver the change we want to see?

What action is needed for us to engage that person? What do we think would motivate them to engage with us and to make the change we want to see?

How powerful are we (do we have the ability to act)?

Can we grow a team that is prepared to commit time, resources and take action to run this campaign? Who else do we need to make it happen?

Reflection and evaluation

“You did what you knew how to do and when you knew better you did better.”

Maya Angelou

No matter how talented you are, no matter how committed you are, no matter how much time you spend winning over people in your hospital, your workplace or your community: you will face resistance. Leading change is not easy. Often the problems come not from expected opponents but from those who “should” be friends and allies. You will face those in your own group who organise to maintain a status quo rather than to challenge it.

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Evaluating the actions we take to lead change with others is essential to being effective. If you are forever walking alone then you need to reassess what you are doing. Self-reflection and evaluation are not the same as self-doubt. Used as a central part of strategy, they help us to build the resilience needed for sustained action in the face of resistance.

Unless you are repeatedly asking yourself what you have, what you need and what you want you are not being strategic. Developing leadership means ensuring your team members are learning from each campaign action. Evaluation is essential to strategy but it is also dependent on strategic thinking in the first place: without a clear objective for your work it is difficult to evaluate whether we were successful in achieving it.

Be relentless in your pursuit of change through short-term victories and defeats. Be prepared for meetings when no-one turns up before you build the support you need to win change. Be prepared to be out-manoeuvred and out-thought by powerful interests, at least at the outset. “Fight, fail, fight again” has been the path every leader of change has had to tread.

Building evaluation into our organising is so easy that it is difficult to understand why we don’t do it more often. In campaigns it can be as easy as asking people at the end of a meeting or action to wait around for 5 minutes and assess how things went. This can be done standing up and with a simple list of questions.

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ACTIVITY Reflection and evaluation

How do we each feel?

What happened?

What was our plan of action?

Did we follow it? (why not?)

What was the reaction?

Did we achieve our goal today?

Were there any surprises?

What did we learn?

What will we do differently next time?

Did we need more information?

What are our next steps?

Reference list Here are some of the references that we will refer to in the minicourse and in the study guide and/or which we have used to help shape the content. Click on the reference to get the link.

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