This entry tells the extraordinary story of how a small group of trainee clinicians, young leaders and improvement facilitators from within the National Health Service (NHS) of England created a call to leadership action that resulted in 189,000 people taking action to improve the care and experience of the patients we serve.
NHS Change Day 2013 was the biggest day of collective action for improvement in the history of the NHS. It made a profound impact across the whole of England and was a force for good in the lives of tens of thousands of patients.
As one of the leaders who took part in NHS Change Day commented on the MIX website:
Change Day fundamentally changed the way I thought about engagement and connection. It was phenomenal to be a part of it and the power that was created by commitment rather than compliance. The even more inspiring element of this was that it was undertaken in [one of] the most hierarchal organisations in the world. The breaking down of barriers and liberating staff to make a difference was brilliant - and I know it made a difference to people's lives (both staff & patients)
Robert Ferris-Rogers, Director of Engagement, NHS Newark and Sherwood, Nottinghamshire, England
Change Day 2013 was an extraordinary moment in the history of the NHS. It taught us that EVERYONE is a potential leader of change, that large-scale improvement is possible and that the best way to do it is through connectivity, collective commitment, action and by keeping it simple. It was about making big change happen, not just thinking about it, analysing it or suggesting how to do it but just by doing something better together in an act of collective leadership.
The team is now busy planning NHS Change Day 2014, with a goal of 500,000 people pledging and undertaking acts of change that will make a positive and sustainable impact for patients. Discussions are taking place with healthcare activists in 16 other territories across the world who were inspired by NHS Change Day 2013 and want to help to grow Change Day 2014 into a global movement that will impact on the care of many millions of patients.
This story exemplifies three of the big challenges ("moonshots") of MIX:
- Redefine the work of leadership: The English National Health Service, as a large and complex system, has traditionally defined its leadership in terms of structures and positional authority. However, the scale of change that the NHS now requires is unlikely to be delivered within that leadership mindset: however hard we try to minimise bureaucracy, the very nature of hierarchies and standard management processes make them risk averse and difficult to change. "Leadership everywhere" in an NHS context is about people at every level of the system, with or without positional authority, wielding positive influence and taking responsibility for change. NHS Change Day is a catalyst for this kind of leadership transformation and creates conditions for service transformation
- Expand the scope of employee autonomy: Many front line staff in the NHS felt that they couldn't make even small changes without asking for permission from their line managers. They would not have defined themselves as leaders prior to Change Day. NHS Change Day has been such a positive force in a) showing grass roots teams and individuals that they ARE leaders and they have the power to make positive changes and b) demonstrating to managers just how much creativity, energy and passion for change their teams have, when the context is right. In fact, in itself, NHS Change Day was a powerful symbol of taking action for positive outcomes rather than waiting for permission; Change Day came about through a coalition of internal NHS improvement facilitators (who had enough clout to garner resources and support from the formal system to enable it to happen) and young leaders/trainee clinicians (who had the informal networks and credibility with the front line that enabled it to fly).
- Encourage the dissenters: Around 10% of the patients who use NHS services are harmed by the NHS. Healthcare systems around the world that monitor patient harm report similar or higher figures. We want every person who works for and with the NHS to be a dissenter, willing to challenge the status quo: systems, processes and cultures that lead to poor care. This isn't just about speaking up when bad things happen (which is very important) but about taking action in our own spheres of influence to make improvements for patients every day. NHS Change Day has built the foundations for a movement of "dissenters"; those who support the patient-focussed mission of the NHS and who are willing to go the extra mile, individually and collectively, to challenge existing arrangements and help create some "new truths" for the NHS.
The English National Health Service (NHS) is the biggest health system in the world, serving the needs of a population of 54 million people. It’s also the 5th biggest employer in the world with 1.7 million employees - only the US Department of Defense, the Chinese Red Army, McDonald’s and Walmart have more people. Every day, a million patients use the services of the NHS. It’s a massive, complex system, operating at the interface between birth, life and death. Whilst the NHS performs well compared to many other healthcare systems, it sometimes lets people down badly and it’s REALLY hard to change it
The British National Health Service was founded just after the end of World War Two, as a bold move to build social solidarity for health and create a better future for a nation that had suffered such hardship and loss in the preceding years. As a result, for the last 65 years, the NHS has provided free healthcare to the people of Britain, regardless of ability to pay, funded by direct tax. We, the British people, have a special relationship with our NHS. In a recent national survey, people said they cherish the NHS more than the Royal Family or the armed forces. The politician Nigel Lawson famously described the NHS as "the closest thing the English have to a national religion".
However, like many healthcare systems across the world, the NHS faces unprecedented challenges; pressures of economic constraint, demographic change and rising patient and public expectations. Basically, expenditure is rising at a rate that is higher than the economy can provide and this financial trajectory makes the current NHS system unsustainable. Unless the system of delivery is transformed, there is a real threat to the timeless and passionately-held principles of free healthcare upon with our NHS was founded and which remain at its heart to this day.
To meet this challenge, we have to change our mindset about two key issues:
1. Leadership for change As the leadership task of healthcare becomes increasingly complex and grows in scale, we need many more leaders than ever before. The pool of leadership talent that we need to create the future won’t just include the “usual suspects” with formal roles within the NHS hierarchy. We have to move beyond positional authority and create leaders everywhere. This means we must think widely and diversely about who our leaders are; they include front line staff, clinicians in primary care, community leaders, people who use services who want to help shape the future and our partners in local government. We have to redefine what being a leader actually means; Daniel Pink describes leadership as being about autonomy, mastery and purpose. We have to create ways for each of our "leaders everywhere" to feel confident to take initiative and responsibility, to continously improve themselves and the services they deliver and to feel like they are a key and valued player in our higher purpose of outstanding care for everyone, at the point that they need it, regardless of ability to pay.
2. Resources for change. Usually when we think about resources for change we think about economic resources (budgets, technology, project managers etc). These resources are limited and finite; when we have used them up there are no more. However, we needed to consider the “natural” resources that exist: the sense of shared purpose around the NHS and the values and principles of common good that it stands for which energise the goodwill and commitment of NHS staff, patients and citizens. The great thing about these resources is that the more we use them, the more they grow.
NHS Change Day 2013 is an exemplar case study of how to liberate “leaders everywhere”. The story begins in mid 2012 when a group of trainee doctors and healthcare improvement leaders stepped up to unleash these resources and be at the forefront of change by launching the very first “NHS Change Day”, to take place on 13th March 2013. We were seeking to harness the creativity, innovation and energy of people who work for and with the NHS in a single day of collective action. The shared purpose of Change Day was to organise a grass roots movement of people to pledge to take a specific action to improve the outcomes and experience of care for patients on a sustainable basis. The initial goal was to mobilise 65,000 people - 1,000 for each year since the NHS was established. This would make it the single largest simultaneous improvement event in the history of the NHS and, therefore, one of the largest of any organisation in the world.
This story describes the journey taken by this leadership team and shares some examples of the difference made through the first NHS Change Day. We not only reached our 65,000 aim, but smashed it, receiving a staggering 189,000 online pledges of action and subsequent actions for change. Our analysis post NHS Change Day suggests that as many people again took action but didn’t register their pledges on the online pledge wall. The true total is probably nearer a third of a million people.
Today, we believe that we are at a point in NHS history when there is a greater need than ever for those who value the NHS to contribute to making it fit for the future. NHS Change Day and the movement of change leaders it has sparked shows we can rise to that challenge.
Right from the moment we started talking about NHS Change Day, the most common piece of feedback we got was “why hasn’t anyone thought of doing this before?” It was people taking action on a collective basis that led to the creation of the NHS 65 years ago. Since that time, people who have cared passionately for the ideals of the NHS have played their part in changes to take the service and its values forward.
President John F Kennedy once quipped that “victory has 100 fathers and defeat is an orphan”. In the case of NHS Change Day, it is a victory for a burgeoning social movement for change owned not by hundreds but by tens of thousands of leaders across the NHS and beyond.We cannot name all of them individually here, but each and every one of them can be found on our Pledge Wall. This story is submitted with our heartfelt appreciation to all of them for taking part. Anyone can join them by getting in touch with us and joining our change movement via our social media channels.
NHS Change Day should be seen in the context of a decade long strategy within the NHS, led by Helen Bevan, to apply social movement principles to improving healthcare. An initial publication, "Towards a Million Change Agents" written by Paul Bate, Helen Bevan and Glenn Robert in 2004 has had more than 3 million downloads and influened a generation of leaders of healthcare improvement. This approach was a response to some of the existing change initiatives in the NHS at the time, typically using Lean, Six Sigma and other industrial approaches to process change.Many of these projects were delivering promising results but mostly on a small scale.
We needed additional thinking about how to call people to action for change across a whole system. What could we learn from the leaders of the great social movements, people who typically had few resources for change (in an economic sense) and no hierarchical or positional power, yet were able to deliver change on a massive scale? We continued to test and build these approaches over a period of time.
In 2009, inspired by the use of community organising principles in the Obama for America election campaign, we wrote to Marshall Ganz at the Kennedy School of Government who was the intellectual architect of the grassroots approach that the Obama campaign adopted, asking him to help us to transform the NHS. As a result, a number of NHS improvement leaders were trained in the skills of community organising and Public Narrative which were then cascaded to “healthcare radicals” throughout the NHS system. One of the outcomes of this work was a nationwide “call to action” to reduce the unwarranted prescribing of antipsychotic drugs to people with dementia (basically more than 100,000 vulnerable, mostly elderly, people in England were being given powerful brain-changing drugs inappropriately. These drugs should only have been given to people with schizophrenia and psychosis). We were able to mobilise a huge community of leaders to help put right an intolerable situation; this included doctors and nurses, advocacy groups, families and “dementia-friendly” communities, senior leaders of major drug store chains and owners of private care homes. This call to action contributed to a 51% reduction in the prescription of antipsychotic drugs to people with dementia across England. You can read about it in this learning evaluation by a team from the University of Manchester.
By 2012, we started to notice how many young leaders and trainee clinicians were getting involved in social movement/community organising activities for healthcare improvement. Generation Y was coming of age in healthcare! Five years earlier, it had often felt impossible to engage young NHS leaders in improvement activities as they were so focused on completing their training and/or kickstarting their careers. Now a growing cadre of young leaders was active on social media, stepping up to engage in change and were passionate about making a difference for patients. There was a growing sense amongst more mature (established) members of the NHS improvement community that these young leaders were the key to transformational change. When we look at the history of revolution and radical change, there are typically young leaders at the vanguard. In 1948, it was a new young generation of doctors who had come through the war that were instrumental in overthrowing the established order and securing the set-up of the NHS.
So NHS Change Day started with a conversation on Twitter between some trainee doctors (usually perceived as powerless and at the bottom of the NHS hierarchy) and some NHS improvement leaders in the summer of 2012. By “improvement leaders” we mean people who have a full time job in the NHS supporting and facilitating change. We began exchanging ideas and a vision about how we could bring together staff across the NHS and its supporters to produce positive change and improvement.
We took our initial inspiration from Earth Hour, a worldwide event organised by the World Wide Fund for Nature (WWF), held at the end of March annually, which encourages households and businesses to turn off their non-essential lights for one hour to raise awareness about the need for action on climate change. The event first took place in 2007, when 2.2 million residents of Sydney participated by turning off all non-essential lights. Following Sydney's lead, many other cities around the world adopted the event in 2008. By 2012, it was taking place in more than 7000 cities and towns across 152 countries and territories.
Our initial questions were about what we could do in the NHS that might be our equivalent of turning the lights off. Some of the fundamental questions we considered were:
· What is our objective?
· What shall we use as our goal?
· Should we identify a specific action that we want everyone to take (as in Earth Hour) or should we leave it to people to take an action that is meaningful to them?
· Should we give people themes to pledge about?
· How will we measure the outcomes and impact?
· Who owns Change Day - how do we keep it grassroots?
· How will the change be sustained beyond a single day?
A major difference between Earth Hour and NHS Change Day is that Earth Hour is an umbrella movement that brings many organisations and activists together in a common cause. NHS Change Day was going to be a movement largely INSIDE a hierarchical system. We needed to get the balance right between igniting frontline action AND using the leverage of the hierarchy to make positive change happen without destroying the grassroots power of Change Day.
It was very important that we framed the call to action and its underpinning narrative as about commitment, not compliance. The workforce of the NHS had been used to a decade of top down, performance driven goals, set by national government, based on minimum standards with targets such as maximum waiting times for patients and compliance with treatment pathways. There were heavy penalties for NHS organisations if government targets were not achieved. Even though there was a good intention to the targets regime, it became “have to do” not “want to do” and the strategy created a lot of resentment, particularly amongst the clinical leadership community, many of whom felt that priorities got skewed. Hitting a target treatment time was sometimes inappropriately viewed as more important than giving priority to the most seriously ill person. As soon as a numerical goal got mentioned or an action was specified, people in the NHS assumed it was a compliance target has that was what they expected and were used to.
For NHS Change Day, we wouldn’t be able to build “leaders everywhere” through compliance; NHS Change day had to be underpinned by a massive commitment-driven approach, based on shared purpose. Initially we thought of asking everyone taking part to develop an improvement project inspired by some of the best practice approaches to change that already existed. Some of us thought a target of 500 projects might be reasonable. Others thought we could be more ambitious. At a strategy meeting, the goal of achieving 65,000 online pledges was agreed – 1,000 for every year of the NHS. After brainstorming various ways in which this social movement could be brought about, we developed the concept of a single day of action.
A core leadership team was established for NHS Change Day. It was self-selected, made up of the people who were most active plus some people with critical technical and organisational expertise who were recruited to help. The role of the core leadership team was to organise and mobilise people and to put in place a range of channels, activities and platforms – particularly harnessing social media – to enable existing communities of like-minded individuals amongst the NHS and its supporters to come together for common purpose. The central mechanism to allow them to do so was a web solution allowing people to create a pledge, join existing pledges, comment on any pledges and include the number of people pledging with them.
The members of the core team were:
· Damian Roland – Trainee paediatric doctor
· Stuart Sutton – Family physician
· Pollyanna Jones – NHS Graduate Management Trainee
· Jo Allen – Administrator
· Helen Bevan, Rachel Douglas-Clark Michaela Firth, Stuart Hill, Jackie Lynton, Alan Nobbs,– improvement leaders
· Kat Trimble - PR and Communications
· Jacqui Fowler - Social Media and knowledge management
· Joe McCrea - Social Media strategy and channels
The improvement leaders on the team were people who were trained in community organising methods and already had experience in leading calls to action. Only two people worked on Change Day full time and then only for three months. Most people on the core team were volunteers and did other jobs as well
Even thought we had bold ambitions for the whole NHS system, we didn’t seek permission from the senior leadership of the NHS to run Change Day. Rather, the core team got organised and just decided collectively to do it. We then worked out how we were going to make it happen. As Marshall Ganz would say, we were “strategically resourceful” We used what resources we could find and work with. For instance, we needed a web platform to host our online “Pledge Wall” for people to post their pledges for action. We identified an existing website that we could adapt. It wasn’t ideal because there was a complex registration system for pledgers to be able to get on the system. It meant that people often had to be very determined if they wanted to pledge and that a large number of pledges weren’t posted. However, it worked well enough and we have learnt a great deal about how we need to do things differently for Change Day 2014. We were also able to frame NHS Change Day as a helpful way of delivering existing improvement priorities and attracted some more resources that way. Overall, it was much more important to build the spirit of volunteerism than to seek a lot of formal resources for the initiative. As Gary Hamel puts it, in the new world, “resources get attracted, not allocated”.
The whole ethos of NHS Change Day was no one needs to ask permission to make positive changes for patients. We didn’t anticipate it in advance but “not asking permission” became a really big theme as a lot of frontline colleagues were at first reticent to take the initiative in their pledges without getting the consent of their line managers. This is a cartoon we produced:
As a core team we used our existing relationships and influences to win people to our cause. Once Change Day started to take off, we got fantastic, active support from system leaders. NHS Change Day was endorsed by, amongst others the Chief Executive of the NHS, David Nicholson, the Secretary of State for Health, Jeremy Hunt and the Mayor of London, Boris Johnson. Once senior leaders started acting as signal generators to the NHS leadership community, many others started to pledge personally and to encourage their workforce to pledge
The foundations of Change Day were built around a grassroots shared purpose - creating a mass movement of “leaders everywhere” working in and with the NHS and demonstrating the difference they could make by one simple act each for sustainable improvement. The only condition for participation was a willingness to publicly make a pledge and to register on the site before doing so.
This is the campaign chart that sets out the key timelines for NHS Change Day and our initial "mountain top goal" of 65,000 pledges
After the launch of NHS Change Day in January 2013, the numbers of pledges started slowly rising. With five weeks to go, the overall online pledge total stood at 5,000. Although the core team knew that a host of organisations and individuals were standing ready to make pledges before or on the day itself, and therefore the 65,000 target was probably achievable, nothing could have prepared us for what subsequently happened.
In the final month before 13th March, NHS Change Day - and the social movement we sought to build and inspire – just ignited.
Feedback and requests for support began to pour in from organisations and individuals, wanting to make their own pledge or support others to do so. Social media channels began to build significant traction and traffic. The online pledge total began to build spectacularly. On 14th February, the total was at 5,000. By 21st February it had grown to 43,000 and by 1st March it stood at 80,169 – breaking through the 65,000 target with two weeks still to go to the event.
The 100,000 pledge mark was broken at lunchtime on Monday 11th March. By the morning of Change Day itself, there were 130,000 pledges registered on the website– double the target.
Liz Saunders from the influential healthcare policy think tank, the Kings Fund blogged and tweeted on the evening before NHS Change Day:
“If ever you're losing faith that there is the energy to make a difference in the NHS…there are more than 130,000 pledges on there, people actively choosing to make a difference to the services they provide and to patient care. It's uplifting.”
Change Day pledges poured into the online site throughout the day, from across the country. The focus of NHS Change Day was England, but people also caught the spirit of Change Day in Ireland and we received 13,000 pledges from there. By the end of Change Day itself, a staggering 182,000 pledges had been received. Over 50,000 had come in on the day. A further 1,000 were added the day afterwards and a further 7,000 before the end of March 2013 – hitting a final total of 189,000 pledges.
The success of Change Day led well-known NHS commentator (and change sceptic), Roy Lilley, to declare
“Sometimes an event comes along that simply and fundamentally changes things. They call it a "gamechanger". The dictionary definition is "a newly introduced element or factor that changes an existing situation or activity in a significant way". Well, I think we have a new Gamechanger. It's called NHS Change Day - it happened this week and it came from the NHS grassroots.”
Originally, NHS Change Day was aimed at “people who work for and with the NHS” and the core team was made up of people who work in the NHS. However, the networks of people who engaged in Change Day went far beyond the boundaries of the NHS.
The specific innovations that built our successful movement of “leaders everywhere” were:
· Having an initiative run by young leaders and clinical trainees who view the world in a different way to the established paradigm of change management and (for the more mature members of the core team) having the courage and humility to appreciate that their new approaches might be better
· Viewing the entire workforce of 1.7 million people as potential leaders of change, rather than just those with positional power
· Adapting principles from social movement leaders and community organisers and applying them in an organisational setting
· Using social media to build a change movement at scale
· Making the best of both networks and hierarchies, working through informal networks and communities of interest and creating a genuine grassroots movement at the same time as enabling leaders with positional authority to role model “change leadership” in a new way
· Building and testing insights into the future of large scale change in public service. Examples include our emerging understanding of the potential of “social capitalism” (as opposed to “venture” capitalism) and a change matrix which helps leaders understand where the best opportunities for culture change might lie in their organisations, based on the nature of pledges received for Change Day
· Building the skills and confidence of thousands of thousands of front line staff to lead change without authority and permission
These were major challenges/risks that the core team identified and the solutions/mitigating actions we put in place:
There had never been a grassroots improvement movement inside the NHS before. The NHS is a system where most of the changes come from policy changes by government, top down restructuring, compliance with assurance regimes and financial incentive systems. Many people did not believe it was possible to build a movement inside a hierarchy
· Work with the hierarchy AND build informal networks for change; understand and respect the power of the hierarchy to both be a powerful lever for change and a barrier of change but don’t let it dictate what happens
· Encourage leaders with positional authority to make pledges for NHS Change Day that role model shared purpose and distributed leadership; show that there are other ways to lead change
· Demonstrate how pledges that are commitment based are just as effective at enabling change and achieving organisational goals as the established levers for change
Many frontline NHS staff don’t see how they can lead change without getting permission/being told what to do by those above them in the hierarchy
· Build “strong tie” support networks so that people in similar roles making similar pledges for change can build alliances and support each other
· Promote the actions of “role model” line managers who create distributed leadership
· Build the movement of confident, capable, frontline leaders who have the skills and courage to lead change
· Let the emerging generation of young leaders show a different way
If the grassroots workforce are going to be “leaders everywhere”, their leaders and managers have to change their leadership mindsets and actions as well
· Help line managers understand the difference between a “good rebel” and a “troublemaker”
· Encourage and support positional leaders to pledge actions that will build the environment for “leaders everywhere”
· Build a narrative for change that promotes new ways of thinking about and leading change
NHS Change Day was a specific day of action. We didn’t want it to be a one off day but a catalyst to enable our “leaders everywhere” to lead change all year round
· Promote pledges that are not just actions on one day but are about on-going change
· Build momentum, energy and outcome measures for Change Day that are not just about pledging on the day but the actions and consequences afterwards
· Make Change Day communication a year round process
How do we ignite the fire of NHS Change Day at scale and enable it to go viral?
· See section on social media strategy below
The role of social media
Social media played a crucial role in the success of NHS Change Day. It was a core part of our strategy of running our change intiative from the viewpoint of young leaders and traineee clinicians. Survey research carried out since suggests that one in three Change Day participants first heard about NHS Change Day through social media (primarily Twitter) closely followed by the personal contacts of the core team itself . Combined, these two channels were responsible for almost two thirds of people (59%) first finding out about Change Day.
Social media was one of the few areas where we commissioned expert external help, rather than relied on volunteers. Joe McCrea, our social media lead designed and led our social media strategy which enabled NHS Change Day to go viral at minimal cost:
· We very quickly established a full suite of social media channels, capable of broadcasting and capturing video, audio and written materials;
· We created an easy ‘How to go viral for NHS Change Day’ video and got it to the NHS via traditional communications means, existing website and via our new channels;
· We ensure that all our outputs very quickly and explicitly encouraged participants to fulfill the core function of Change Day – i.e. visit our and make a pledge;
· Initially, we used our existing material captured through traditional means but then added further high-end material at little additional cost by assuming an unofficial role as a central broadcast channel for equally well produced material from the front-line (e.g. a promotional video for Change Day by Leicester University Hospitals);
· We began to complement this high-production material – again at marginal cost - with one to two minute anecdotes, interviews and snippets captured on iPhone and capable of being turned around from capture to broadcast, via a MacBook and iMovie, in less than an hour – (e.g. a visit by Jackie Lynton from our core team to Queen’s Hospital, Romford);
· We contacted communications and digital teams in other organisations whom we knew would be supporting Change Day, asking them to let us have their own material as it became available – so our own channels could be constantly growing and changing;
· The word began to spread amongst local NHS organisations and pledgees that their own produced material was available on the national site, and our social media communities began to grow as parents and colleagues began to come to our channels and comment on or ‘like’ specific items;
· We relentlessly and instantly cross-fertilised the full suite of our social media channels as new material appeared on one or the other (e.g. tweeting, Facebooking and podcasting audio and video material as it went onto YouTube);
· We spread confidence and a sense of momentum across the NHS by using our Twitter channel as a ‘breaking news’ service – with updates on the growing number of pledges and latest examples of pledges from the frontline;
· We took part in Tweetchats led by established publications in the healthcare world– as well as webinars hosted by ourselves – in the final week before the event itself.
In everything we did, we balanced anarchic and humorous examples of grassroots ideas and pledges from staff throughout the NHS – for example, a 90-second ‘Change Day’ jingle written and performed by staff from Harrogate Hospital, which has become by far the most popular item on our YouTube channel, with over 1,200 views – with a serious message around leadership and change from senior leaders and decision-makers.
Moving forward into 2014, NHS Change Day’s use of social media is being strengthened and deepened through a ‘mobile first’ approach, underpinned by social media and industrial-strength infrastructure:
· to support leaders everywhere in the healthcare system by using social movement thinking in the NHS as an approach of delivering large scale change;
· to measure the social value of NHS Change Day as a bottom up approach for engaging grassroots leaders for levering change at the frontline;
· to inspire leaders everywhere and make it easier for them to participate in NHS Change Day and its associated social movement, make a difference and deliver value;
· to deliver a transformed knowledge sharing and engagement capacity captured through meaningful data and driving actionable knowledge, experience and insight
Sometimes the most profound benefit is the most glaringly obvious. In the case of NHS Change Day, the most profound benefit we demonstrated was that "it can be done". As one of our pledgers - a student nurse - put it when asked what her advice would be to others looking to make improvements to patient care and promote change...."just do it".
Some might have thought - indeed some did think - it a crazy idea to try to get thousands upon thousands of frontline staff across the NHS to commit simultaneously and publicly to change and improvement for no reward other than recognition and support.
The pledge involving the most people was to show that “we can all get through distress & suicidal thoughts - there is hope/help via http://www.connectingwithpeople.org/ucancope’ This was submitted by Alys Cole-King of Connecting with People, in partnership with the Royal College of Psychiatrists and many supporters.
- I pledge to make my work colleagues feel supported and valued. To remind them of the great jobs they are doing everyday
- I pledge to take part in Tea 4 two - sitting with a patient on a regular basis who doesn’t have visitors and enjoy a cup of tea and a chat,or
- As a nurse I pledge to say thank you to the healthcare assistant I work with; asking her what more I can do to support her in her work .
- I will 're-humanise' my practice of medicine by always using patients' names when talking about them as a constant reminder of individuality ; and
- I pledge to taste a variety of paediatric medications I prescribe to my patients .
- Other pledges involved more substantial action. For example: A pledge by staff at Queen’s Hospital, Romford, to create a Wellbeing Centre ; or
- University Hospitals, Leicester pledging to introduce a more accountable electronic record-keeping system in their dermatology department .
The nine BIG leadership lessons for “leaders everywhere” from NHS Change Day 2013:
NHS Change Day 2013: the postscript
Since 13th March 2013, many organisations within the NHS have continued to use the principles behind Change Day; the idea of ‘doing something better together’ and the power of giving permission to develop your own change leadership programmes and strategies. Led from the grassroots, this means that sustainable changes are happening on a more frequent basis. For example, Leeds Community Healthcare launched an innovation e-forum on NHS Change Day which has become a platform to allow grassroots members of staff to suggest innovations which they will then be empowered to act upon.
NHS Change Day has allowed the development of self-organising groups where natural leaders are being given the chance to emerge and shine. In the "benefits and metrics" section of this entry, we told how Louise Towse and fellow students at York University used Change Day to run a “virtual ward” and experience the NHS from the patient’s point of view. Beyond the impact this had for the way they will care for patients in the future, this allowed a cadre of future leaders, beyond hierarchy, to grow within the healthcare system. Realising the power they could have when they worked together, the students are now running their own campaign; ‘Every Nurse Matters’ works to promote the positive impact nurses can have and like Change Day, to redistribute the power of nurses to enable them to make long term impacts in the healthcare system, right from the start of their nursing carers.
Moving on to 2014, the Change Day movement will continue. We are aiming for 500,000 people to stand together and deliver quality improvements for Change Day 2014. This is being led not only by the founders of Change Day 2013, but by individuals inspired by Change Day wanting to step up to an NHS-wide leadership role. The core team has not developed a formal hierarchy, allowing anyone who wants to join in its development to be part of the leadership. This is backed up by a “train the trainer” approach, empowering a further generation of aspiring leaders to work together to deliver system-wide change. It is another example of how NHS Change Day is continuing to fundamentally redistribute power beyond the collective action of one day.
For Change Day 2014, there will be further development of simple web based tools, to allow people to join up their pledges and learn and collaborate more effectively. We are in discussion with healthcare activists from 16 other territories across the globe about the potential for Change Day to go global from 2014. We have also been receiving coaching advice from the very generous and collaborative leaders of Earth Hour, now in its eight year as a global force for change. It’s clear that we need to build a ten year strategy for Change Day
Going forward, we hope that the basic tools of Change Day (freedom to act without permission, building solidarity for change, collective knowledge) will motivate and inspire hundreds of thousands “leaders everywhere” to take small steps that together can ensure that our health services can continue to improve patient care on a very big scale.
Special thanks to:
- NHS Change Model Team and NHS Improving Quality
- Ashley Brooks - Patient Champion
- Nicola Mann & Team - Straker Films
- James Haddow - Surgeon
- Miles Ayling – Director of Innovation and Service Improvement – NHS England
- Carol McAlister, Jackie Adams, Sarah Bernley and Andrew Nicholls – Support Tea
- Jeni Cadman. Liz McKiernan. Steve Hibberd – IT and web support
- Steve Fairman - Director of Improvement - NHS England
- Members of our Expert Oversight Group
- the people from the NHS and from around the world who made comments about our entry on the MIX website and enabled us to improve the way we have told our story
We have really appreciated being a finalist in the "Leaders Everywhere Challenge". It has made us reflect deeply as a team and seek counsel from others. As a result, NHS Change Day 2014 will be much improved.
Thought leaders who have inspired us:
Saul Alinsky whose “Rules for Radicals” is a powerful manual of leadership tactics that can be contextualised to organisational settings
Paul Bate and Glenn Robert for helping to translate social movement theory into approaches to large scale change in the English National Health Service
Peter Fuda for helping us understand the difference between fear based urgency (burning platform) and burning ambition
Marshall Ganz who made social movement principles really practical for us and taught us skills for large scale change
Gary Hamel because so many soundbites in “What Matters Now” are profound words of wisdom for NHS Change Day. We think you wrote it for us.
Lois Kelly who helped us understand that that being a rebel is a good thing and quite different to being a troublemaker
Nilofer Merchant for teaching us about the social era, community, collaboration and onlyness and for being an inspiring role model
Deborah Meyerson who showed us how to walk the thin line between conformity and rebellion, inside and outside, difference and fit; how to rock the boat AND stay in it