LEADERSHIP & FRAMING FOR STAKEHOLDER ENGAGEMENT

Quality Academy – Cohort 6 April 8, 2013

Building advanced improvement capability for BC

Another view:

Quality of …

“Engine” of quality

D. Balestracci. Data Sanity. 2009

“Fuel” of quality

Quality of …

Overcoming the Challenges … They get designed using the same mindset, belief and rules as have been used before ….

“Mindset Shift”

From …. “current mindset”

‒ Hierarchy – I don’t question those above me

‒ Professional silos ‒ Complications (e.g., infections) are

part of our business ‒ Partners must comply with what

we tell them to do

To … “future mindset”‒ No infection is acceptable‒ I can speak up when I have

concerns ‒ Patients are equal partners‒ We work in teams

Building advanced improvement capability for BC

“Mindset Shift” (Exercise: 15 min)

From …. “current mindset” To … “future mindset”

Creating a Sense of “Us” – Building Momentum for Change

• Strong ties vs weak ties (social network theory)

• When we spread change through strong ties … – Interact with “people like us” with the same experiences, beliefs and

values– Change is peer to peer (e.g., nurse to nurse, GP to GP) – Influence is spread through people who are strongly connected to

each others, who like and generally respect each other – It works because people are far more likely to be influenced to

adopt new behaviors or ways of working from those they are most strongly tied

Source: Helen Bevan, 2011

Strong Ties – Group Exercise

Advantages of Strong Ties Disadvantages of Strong Ties

What About “Weak Ties”?

• When we seek to spread change through weak ties:– We build bridges between groups and individuals who are

previously different and separate– We create relationships based not on pre-existing similarities

but on common purpose and commitments that people make to each other to take action

– We mobilize all the resources in our system

Source: Helen Bevan, 2011

We need BOTH strong and weak ties …

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

• In situations with uncertainty, we gravitate to our strong tie relationships

– Yet evidence shows that weak ties are much more important than strong ties when it comes to searching out resources

• More breakthroughs in innovation occur when we tap into weak ties

• The greatest opportunity we likely have for large scale improvement and change is through weak ties

• When framing your story – consider BOTH strong and weak ties

Source: Helen Bevan, 2011

© NHS Institute for Innovation and Improvement, 2009

From............

Compliance

States a minimum performance standard that everyone must achieve

Uses hierarchy, systems and standard procedures for co-ordination and control

Threat of penalties/sanctions/shame creates momentum for delivery

Based on organisational accountability (“if I don't deliver this, I fail to meet my performance objectives”)

........To

Commitment

States a collective improvement goal that everyone can aspire to

Based on shared goals, values and sense of purpose for co-ordination and control

Commitment to a common purpose creates energy for delivery

Based on relational commitment (“If I don’t deliver this, I let the group or community and its purpose down”)

The new era requires a shift in thinking

Source: Helen Bevan

The Value of Commitments

• We commit to specific actions that are measurable – not vague promises– not just outcomes

• Make commitments as simple as possible (“one specific action”)

• We want to hold people to account to the things that they commit to

• When we do it effectively, commitment is much more effective than compliance

• A definite “no” is always better than a wishy-washy “yes” or “maybe”

Source: NHS Institute for Innovation and Improvement, 2011

Building Commitment and Connection

Key Players No Commitment

Let It Happen Help It Happen Make It Happen

Unit Clerks X O

Administration X O

QI X O

etc XO

etc X O

etc XO

Three Strategies:1.Mobilizing narratives2.Authentic Voices (e.g., Patients for Patient Safety Canada)3.Hot-housing (e.g., energizing meetings and events out of usual environment)

Source: NHS Institute for Innovation and Improvement, 2011

Exercise: (10 min)Building Commitment and ConnectionKey Players No

CommitmentLet It Happen Help It Happen Make It

Happen

1. List the key stakeholders that you need to engage in your work.2. Mark an “X” to reflect current status3. Mark an “O” to reflect where you need them to be

Source: NHS Institute for Innovation and Improvement, 2011

© NHS Institute for Innovation and Improvement, 2011

Act – assignment three: commitment chart Commitments we make (actions not outcomes)

GETSCommitments we ask others to make

Who What By when

Executive name: _____________________________

Executive signature: ___________________________

Trust name:

5 Key Steps for Building a Movement

• Picture frames – what is in it, you see; what is outside you do not • Provide shape and structure for organizing ideas and arguments• “Hooks” for pulling people in (frame in one way and I pull you in;

frame in another, and it goes over your head)• “Springboards for mobilizing support” • Relies on authenticity and a connection with an individual’s reality • Must be credible!

– Resonate with mainstream beliefs and experiences– In terms of claims they make– Delivered by credible people

Frame to Connect with Hearts & Minds

Framing … telling the story Three components of a great narrative (story):

1.Diagnostic:‒ What is the program/issue that we are addressing? ‒ What is the extent of the problem? ‒ What is the source/sources?

2.Prognostic:‒ What could the future look like? ‒ What is our plan of attack and our strategy for carrying out the plan?

3.Motivational: ‒ Why is this urgent? ‒ What is our call for action that connects with the emotions and values of the audience (compelling sense of a different

future tied to values)

Source: Helen Bevan, 2011

Approaches for Effective Framing

Hooking People In – Need to build mass; therefore appeal to a range of stakeholders– Think about the different people you need in order to achieve goals

Consider based upon readiness to act … “believers, sympathizers, ambivalents, antagonists, etc…”

– Frame differently for each target group

Connect with Hearts and Minds– Emotional heart tug – Intrinsic motivation and values – Imagine if …

mental health is understood by allNo one loses their dignityhospital admissions are rare Source: Power of One, Power of Many, NHS

Bridging and Linking Diverse Groups– Outward looking and inclusive– Movements that are exclusive and inward looking

become sects and elites

Use a Range of Strategies– Words, stories, anecdotes– Visual images– Humor and irony– Performance and spectacle

Source: Power of One, Power of Many, NHS

Key Approaches to Framing

• Clearly articulate your cause:– not too broad, not too narrow– worthy and worthwhile– ambitious and lofty, yet achievable– make more friends than enemies

• Connect with emotions• Connect with minds, logical/rational thinking• Bridge and link diverse groups• Employ a range of strategies to share message

Source: Helen Bevan, 2011

An Effective Frame …• Increases the readiness to act

• Is credible:– involve empirically credible claims– is delivered by a credible individual

• Is salient:– compatible with life experience of the audience– resonates with values and sentiments

• Is compelling and optimistic

• Aligns with the desired direction

• Has the right scope

• Remains fresh

Framing Exercise: 15 minutes1.On your own, begin to complete table;

2.Share your top 2 with your group and provide feedback