Mobilising for change: where do we start?

Leaders must wake people out of inertia. They must get people excited about something theyve never seen before, something that does not yet exist. Rosabeth Moss Kanter, Leadership for Change: Enduring Skills for Change Masters

We are at an extraordinary inflection point in the story of the NHS. Whilst the NHS is being protected from cuts in its core budget, the triple challenge of changing demography, new technology and rising public expectations means that the NHS still faces probably the greatest financial challenge in its history. Many NHS leaders are experiencing significant changes in roles, in working relationships and in how their organisations operate. An extraordinary leadership response is required at this time. Achieving the results we need depends on the extent to which our leadership community, our clinical workforce and the people we serve answer an urgent call to action; a call to preserve and enhance what people value most about the NHS and to deliver safer, better quality care that makes better use of NHS resources. In essence, this is about mobilising thousands of people to build commitment to change at scale and organising to build leadership capacity so that the actions that people commit to are achieved. Do we have the skill and knowledge to do this? There are many inspiring stories from the last ten years of how NHS leaders have demonstrated skill and commitment in tackling difficult issues and creating imaginative new responses to long-standing problems. However, the current scenario requires change that is faster and broader than anything we have experienced before. We must garner and build on all the

change leadership capacity and experience that we have at present. At the same time, we probably require additional skills and perspectives that are in line with new thinking. Most of the methods, strategies and tools we use for change in the NHS come from a powerful body of healthcare improvement knowledge. NHS organisations are currently utilising a range of approaches, including service transformation, organisational development and process and system redesign. This knowledge has been derived from experience in other industries and adapted for healthcare. It has been built over the last 100 years. There is an additional body of knowledge about how to create change at scale, which has been built over a similar timescale. This knowledge is rooted in the tradition of community organising, campaigns and social movements, learning from popular, civic and/or faith-based mobilisation efforts. It is only in recent years that organisational leaders (such as those in the NHS) have started to recognise that the philosophy and methods of community organising has significant potential to help formal organisations and systems to achieve their goals. It isnt an alternative to existing healthcare improvement knowledge but it enhances our ability to make change happen and challenges some of the ways that we, as NHS leaders, have gone about change up to now. The community organising perspective teaches us that in order to mobilise, we need to motivate. Each person who we want to engage has to be able to make a personal and deep connection with the message, enough to inspire that person to take decisive action. The key to motivation is understanding that values inspire action through emotion. Emotions inform us of what we value in ourselves, in others, and in the world, and enable us to express the motivational content of our values to others.

Critically, because we experience values emotionally, they are what actually move us to take determined action, not only to the idea that we ought to take action. To translate this bluntly, people in the NHS are far more likely to take action on quality and cost improvement if we frame it as a commitment and connection to the core mission of the NHS. Essentially our efforts need to be about securing the future of the kind of NHS that we want for our patients and we would want to work in. It is not a soft option to focus the message in this way, rather than a rational message about quality and cost improvement per se. It does not shy away from the difficult challenges necessary to deliver higher quality, safer care at lower cost. In fact, by connecting to our deeper purpose and collaborating around our collective mission, we increase the chances of unleashing the energy and creativity of our workforce and making more profound, wide ranging changes more quickly and more sustainably. Contrary to much change thinking in the NHS, it is impossible to mobilise at scale by appealing to peoples self interests, whats in it for me? We can only create and sustain large scale change through a foundation of core values that are shared by leaders and followers alike. Evidence from the contrasting worlds of organisational development and social movements coalesce around the view that shared values are a pre-requisite for the commitment, courage and sense of common purpose required for large scale change in the circumstances in which we currently find ourselves. One of the most effective ways that leaders of social movements and campaigns translate values into decisive action is through storytelling and narrative. It is a skill that we should all invest in in an era of quality and cost improvement. Essentially, by developing skills in narrative we build our ability as leaders to draw from our own experiences and values to inspire others to join us in action. Stories communicate our values through emotions. This is because it is what we feel our hopes, the

things we care passionately about, our commitments not simply what we know that is most likely to inspire us with the bravery to act in the face of uncertainty. These are examples of the kinds of questions you might seek to answer through your own stories and narratives (with help from Charles Denham): As a senior leader, are you able to draw to from your own story to inspire everyone in your community or organisation? Have you created a powerful narrative to unify everyone in the organisation and give them a collective identity and sense of direction? Does your own story inspire people to step up to action to tackle the big challenges? As Board members, have you used your own stories to explain why you are serving, to articulate a collective focus on patient safety, quality and experience as the key strategy for driving down costs? Have you communicated a collective story of urgency to everyone in your organisation? As clinical commissioners, can you use your own stories to inspire others in your local health community to take action? Can you make a compelling request of others to join your quest for quality improvement and patient choice through a moving message? Can you translate your calling as a clinician into inspiring leadership action that shapes the future of the NHS? As a finance leader, can you use your own story to demonstrate a powerful coalition, driven by values, between clinical leaders and finance leaders that inspires future collective action? Does your story demonstrate how to generate value from your collective values? One of our greatest leadership priorities looking forward is to build a quality and productivity strategy that is based on commitment to change (connected to emotion through values) rather than compliance with change. In a world where traditional management levers like hierarchy and structure are diminishing, within an

environment that is increasingly complex and uncertain, understanding how the leaders of the great social movements met the challenge of commitment-building is essential learning for NHS leaders who want to create purpose for their workforce and deliver big changes fast.

Helen Bevan For more information and a reference list for this article, contact

mobilising@institute.nhs.uk