Is #wenurses THE NHS social movement?

I’m late to the party - #wenurses  has been around for a while; but then. I’m not a nurse. I discovered #wenurses by accident and lurked in the background of a few of their weekly tweetups.  What a joy.  Usually my Twitter feed “nhs” search column has an ever-increasing stream of negativity and attacks on the NHS.  #wenurses is different.

#wenurses is a way for nurses of all disciplines and interests to connect using social media. They can get training in using Twitter, have blogs, resources and are active with tweetups, workshops and blogs.

#wenurses tweetups are Thursday evenings at 8pm. The first tweetup of 2013 was a delight in the endless positive comments about the successes of 2012 and filled with ideas on what to do in 2013. I loved the way someone suggested it would be good to get a CEO to join them. Someone replied mentioning the twitter names of those who may be good to ask. By the end of the tweetup a number of those CEO’s were joining in the chat. That is digital democracy at it’s best.

These are nurses who don’t talk about what’s wrong, or complain about the reforms. They are asking questions about how they can be better at what they do, how they can get help in understanding changes, such as commissioning.  

Is it a social movement? I think it is because:

• There is no organisational or policy imperative that they come together and do something
• There is a simple website around which they can organise themselves on social media; it#s #wenurses website and isn't a subset of another organisation. The branding and identity is clear.
• There are no apparent rules, other than a very good statement of appropriate behaviour for nurses using social media
• It’s self-organising around topics
• It’s driven by the passion of individuals
• The purpose is clear; to use social media to connect the community of NHS nurses, to share knowledge and to provide support.

The friends and family test comes into use in the NHS in a few weeks. This is where patients will be asked if they would like a member of their family or a close friend cared for on this ward, in this hospital, by this doctor etc.  When I’m a patient, I’m going to be looking out for the small #wenurse badge. If I see a #wenurse mug on the desk then I’ll know already that this is a good placed to be.

Book Review: New Age of Innovation; Prahalad & Krishnan

If you're interested in large scale change and innovation then you'll find this book fascinating. On the one hand it felt like there was nothing startlingly new to me yet on the other it was neatly put together in a readable way that made sense.

A key premise is the current trend of personalisation and how value is based on the unique experience we all want. The authors refer to this as N=1. Current technology drives this, social networking, web 2.0 etc. How can we co-create value with our users and consumers? What are the challenges with managing who owns the knowledge? All good questions. They also suggest we need to make the most of collaborative networks, electronic and face-to-face, be flexible and ensure scalability. I liked the section on scalability and in my mind there is more in here than what they covered. This is a key element and is also linked to their second premise.

The 2nd key premise is the one that resources need to be global and they use another little formaula: R=G. Here they suggest the issue is that access to resources is more importnat than providing products; namely it is the solutions that matter rather than the kit or pieces. I think I agree with this. Again, scalability comes up.

They mention social movements and how they figure in the process as well as organisational transformation. There was nothing much new in the organisational process other than the context of the infomrational technology infrastructure - well, that is rather new and for some people rather perplexing.

If you've not yet engaged with Web 2.0 and new technology then this is definitely worth a read.

Book Review: Groundswell by Charlene Li & Josh Bernoff

The authors define a groundswell as “…a social trend in which people use technologies to get the things they need from each other, rather than from traditional institutions”. mmm that sounds like an important thing to know about if you think you're a traditional institution, or if you think you're breaking new ground, or if you're a consumer wondering why you're starting to feel left out the loop.

What I liked about the book was the examples and case studies. Usually I skip these, however, I foudn these ones riveting reading. Who needs thriller novels when the business world presents us with such chaotic and roller coaster events. Fabulous.

I also found the way the book was constructed and organised to be very helpful, especially when faced with a disconcerting topic. Far from being disorganised, the underlying structure helped get the message through.

Read this book and it will move you on from thinking about "all we need to do is have the odd blog and a fancy web 2.0 website" and get you into strategising about your social media presence. I have always been convinced that social media is not just for the youngesters and this book has all the examples and conceptuals models to help you create some of your own thinking for your business to prove it is for everyone.

The book has, as you would expect, a great website. http://www.forrester.com/Groundswell/index.html It is good to see them practising what they preach. They have a blog and there is also a social media profiling tool you can download and use.

I'm not one for giving 5 stars to a book, but this one deserves it. I might just read it a second time.

Book Review: Tribes: we need you to lead us; by Seth Godin

All of Seth Godin's books are amongst my favourites - sometimes you just resonate with an author. I like the way he speaks his mind and is unafraid to test out new thoughts and ideas.

He explains a tribe is nothing ore than a group of people connected to an idea, a leader and one another. His point is that with the web as it is developing we have more ways to find people of similar ilk and to join the "tribe". However, not all of these groups are fruitful and they need leaders and facilitation in order for them to be productive and constructive. This leadership angle is important.

Seth Godin's thoughts as I connected to them in this book is that being a leader of a tribe is tough and demanding. Often tribal leaders are accused of being outside the norm - a bit of a heretic. He believes that the leaders who are perceived as such and who stick to their views will win out in the end.

What does the author suggest we do to grow these tribal social movements?
1. Publish a manifesto; state who you are and what you are about
2. Others need to find and connect to you - make this as easy as possible
3. Keep the financial stuff in the background
4. Publicly track your movement's momentum and growth
mmm easy on paper though I wonder just how easy it is to do these things.


As good as his books, I also recommend Seth's Blog http://sethgodin.typepad.com/ and you can find out more about him and his books at http://www.sethgodin.com

Paper: Framework for analysing collective action events on Twitter

This freely available paper (PDF) is one for the nerdy person like me who wants a bit of theory and a framework to figure out what goes on when Twitter is used for collective action.

It's a shortish, easy to read and I think valuable addition to our thinking and understanding of the use oif Twitter for large scale change.

How to use Twitter to effect Social Change (Video)

"It takes many streams to create a river" - great quote from this video. I found this 3 minute video covers all the basics of Twitter good practice, especially for those who are hoping to influence social change through their use of the technology.  It was a bit quick and I had to rerun it to make sure I had all the info.

7 Twitter Resources for Healthcare Professionals, NHS

If you're just getting started on Twitter, here are some resources you may be interested in:

1. 140 uses for twitter by healthcare - a blog post and one of my favourites. A bit old but still up there with challenges for you
2. Using Twitter in the classroom or organisation - nice framework
3. Canadian booklet on Twitter for Healthcare Professionals; short, sweet and to the point. Recommended.
4. How using twitter can help increase staff transparency and trust - one of my blog posts from a while back
5. Twitter for Doctors - by a doctor, with his experience
6. Pull vs Push; a twitter case study - this is my personal 90 day project from when I first started using Twitter. The lessons then are relevant to anyone starting up now.
7. Using Twitter as a social movements strategy; one of my blog posts from March 2009. Some actions to consider.

Video: Christakis on Social Networks, Spread

Nicholas Christakis is my hero - his research is moving us on from the staid, static and way out of date work of Rogers (Diffusion of Innovations). I recommend spending 18 minutes to watch the video below if you're part of or planning any large scale change, social movement (not that I believe they can be planned), spread of project results.

The shift to norms being spread and not behaviours is significant. What are you doing in your own project work to build on this?

New Paper: What is the experience of national quality campaigns?

I liked the conclusion in this paper - "..may depend on.." as it summarised my experience of national quality campaigns - the results depend on a multitude of factors - and I would add depends on the perspective/s of the stakeholders involved.

 Health Serv Res. 2010 Dec;45(6 Pt 1):1651-69.

What is the experience of national quality campaigns? Views from the field.

Bradley EH, Nembhard IM, Yuan CT, Stern AF, Curtis JP, Nallamothu BK, Brush JE Jr, Krumholz HM.

OBJECTIVE: To identify key characteristics of a national quality campaign that participants viewed as effective, to understand mechanisms by which the campaign influenced hospital practices, and to elucidate contextual factors that modified the perceived influence of the campaign on hospital improvements.

CONCLUSIONS: The impact of national quality campaigns may depend on both campaign design features and on the internal environment of participating hospitals.

Social Marketing Podcasts from the Open University

I had a proud moment when listening to Michaela Firth via iTunes talking about Social Marketing. She is really a leader in this field and I'm glad we've shared coffee and brownies over the last ten years. The Open University has a series of podcasts that I recommend to anyone working in the field of trying to spread behaviourally related  good ideas to a wider audience.

Social marketing - Audio

by The Open University

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Description

Have you ever wondered how marketing techniques have been used to promote positive social change? In a series of lively interviews, Professor Gerard Hastings of the Institute of Social Marketing, faces questions from members of ISM-Open (the Institute of Social Marketing at the Open University Business School) on issues such as the ethics of social marketing, branding and advertising, and the morality of shocking or scaring people into changing their behaviour for the better. This material forms part of the Open University course B324 Marketing and society.

Social marketing	View In iTunes
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Ethics and advertising	View In iTunes
Evaluating social marketing programmes	View In iTunes
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Ethics and social marketing	View In iTunes

Learning networks or social movements? Which is best for large scale change?

I'm not sure there is a specific answer as to whether learning networks or social movements are best for large scale change.  However, my personal preference is for learning networks and these are my reasons:

1. learning networks connect the people who are interested in solving the problem, and they do so in an interactive, participative and empowered way. In comparison social movements have the image of someone wanting to make something happen and in manipulating the joining in process and to an agenda they have set.
2. learning networks are about the exchange of information, discussion and both personal and group learning. Personal behaviour may change as a result of learning about something new from within a peer group. When a group discovers new knowledge and feel the creative process of doing so, they may become quite committed to then implementing changes.
3. learning networks can be direct and specific. They can be topic based or professional grouping based.
4. there is a sense of an output with learning networks. Social movements are useful in that they are purpose driven, however, learning networks to me are more concrete, pragmatic and easier to associate with outcomes and results.
5. we know learning networks work in healthcare while social movement theory is in its infancy. I am a proponent of using the existing knowledge we have to best effect.

This doesn't mean social movements are not useful, rather that I am sceptical about their ability to deliver results, especially when we know learning network can have an impact.

There is an excellent paper on Learning networks for sustainable, large scale change which is worth a read. 

Online Clustered Networks Spread Behavior Change Faster

Online communities have different dynamics to face-to-face communities of practice. New research suggests that for online communities, behaviour spreads more quickly when the community is grouped into networks with overlapping connections than when left to develop more random and distant links.

If you are managing online communities then the research is worth a closer look as it may provide hints on how to design and support it so behaviour and influence can spread amongst the participants.

For communities of practice not online this clustering effect is not new. Research has been around since the 1970's which show the importance of bringing groups together geographically, thematically and/or by profession or person type. As humans we like to be with people similar to ourselves and are most influenced by those the same as us - if Joe can make the change then I will probably be able to as well.

There is a lot of buzz about social movements, mobilising and organising for change in healthcare. One of the success criteria for this work will be the depth to which those doing the organising as well as those participating understand network dynamics, and design accordingly.  Random networks are less influential.

Using Twitter in the Classroom or Organisation

Twitter feels like one of those applications that has been searching for its use. Within healthcare, specifically the NHS in England, its use has been limited. Many organisations see it only as another media channel through which they advertise their services. A few, however, have grasped its potential to spread the word  in a personal way and are using Twitter as a means of engaging with patients and staff. A good example is @OBMH (Oxfordshire and Buckinghamshire Mental Health).

While healthcare is prevaricating and the organisations that preach and teach innovation are being slow to catch onto what is now practically a mainstream communication method, education has been stealing a march. An excellent blog post about using Twitter in the classroom includes a framework which made huge sense to me and helped me think through how best to use twitter in a training event as well as for the duration of a healthcare improvement project.

Not only does it help communication for the project it also adds in the "spread" and "Scale up" component that it so often missing.   If you are worried about the word student, then substitute patient or staff member. What I particularly like about this framework is it is a way for organisations using Twitter to self assess their use of it.

(Picture from Prof Hacker http://chronicle.com/blogPost/A-Framework-for-Teaching-with/26223/)

The quickest way to spread scale up change

The most common question I am asked is whether there is a quick way to spread desired change across groups.

My Nobel Prize entry for answering this question is as follows:

"Yes and No"

The fact you are asking the question means you are in a type of powerful relationship over those with whom you want to interact and change. Namely you want them to do something different/ly and you want them to do it quickly.

The "Yes" answer is dependent on the carrot and stick approach. Pay a twelve year old to clean his bedroom and if the reward is big enough, the bedroom will be cleaned. Pay doctors a reward for meeting a quality target and they will achieve it (evidence the NHS and GPs). The stick approach is less effective but still works. It is no longer common to see anyone on their mobile phone while driving in the England. The stick of a fine and points on your license has worked, combined with appeals to common sense.

The "No" answer comes from asking questions like those listed below. If I get more than two or three "No's" in response then I suggest to the person asking that they have probably answered their own question.
- are you making the change yourself?
- can you describe to me the three main reasons why the person you want to change thinks this will be a good idea?
- do you apply the methods you are proposing in your own work and/or personal life?
- is your reason for this work more than doing a good research project you can publish later
- will the person/group you want to change see the change as coming from somewhere other than yourself?
- do your plans involve more than a communication exercise?
and so on

Spending Challenge - HM Government using crowdsourcing

The UK government is using a simple online webpage to gather ideas on how to save money. It is called the Spending Challenge. You can input your idea, some words about how it can be implemented, add a tag or two and then post it. You can read through others' ideas, add tags and ratings. The system allows you to search by tag, new ideas, most commented or highest rated.

This is crowdsourcing at its most pragmatic. I doubt they spent more than £1000 setting up the system. The addition of a rating system gives it power and meaning. Especially as anyone can rate any idea - not just those in power.

In the same month this is launched I've worked with a variety of public sector teams who range from denying the existence of technology, denying they have permission to use anything remotely interfacing the public (or their staff) unless there are controls, or want to create their own thing. Probably worse, some are still working at the level of theory and concept for social movements, mobilisation and networking, running workshops and developing programmes to spread the word of change. By the time they've spent a fortune on their programme, a huge part of the UK population will have been mobilised using simple techniques such as this Spending Challenge one.

I feel that so often we get lost in the theory and concepts, and the need to develop eloquent (and controllable) solutions, that we overlook the most simple mechanisms, complemented with speed and pragmatism.

Well done HM Treasury for getting the Spending Challenge social movement underway.

Social Movements and Healthcare; a confused application of theory?

I am perplexed by the rhetoric of applying social movement theory to healthcare. It seems strange to me that those in charge, with the power are creating what they they believe are "social movements". I suspect they are usefully taking some learning from social movements and then applying this learning to improve both project and programme management performance. This is a good demonstration of organisational learning and improved programme management.

My understanding of a social movement is it is started by the powerless, the forgotten voices. These people are united by a common cause and willingness to belong of a group identity. They push against those with power because they believe what the transformation change they desire is morally important, just and necessary. Anyone who opposes the social movement is seen as corrupt and unjust. The social movement wants to change the laws, wants political and social impact.

So when the power-full start to talk about creating a social movement I am a bit at sea. Yes, leaders can be trained to tell stories and speak with more passion (good leadership practice), though I believe the passion that social movement leaders exhibit is one of deep moral justice. This cannot be implanted into someone's heart or soul (let alone by those who hold the power)

Social movements are not narrow interest groups. They seek social transformation. An example in England right now is the EDL (English Defence League). They exhibit all the signs of a social movement. They are organised into divisions, protest, annoy those in power, and have a strong personal sense of what they believe is right.

How do social movements start? I suspect they are not created in the corporate boardroom. Certain events may trigger one as the publicity garners activist together. It could also be a compelling leader who knows how to speak to their people. Or a new generation that no longer wants the status quo. Teachers, writers and evangelists have also triggered movements.

Those power-full who want to create social movements are also perhaps ignoring the messiness and darker side of the process. Movements push against something. It is often not pleasant to be part of a process where the push against the established way of thinking results in a physical, intellectual and emotional battering. However, it is this side of the movements that provides their success. There is a persistency that only passion can bring. Taking just the nice bits and ignoring the other consequences is irresponsible.

Here are some tips if you are the power-full and want to try and benefit from the power of social movements.

a) find out who is doing what already on your area of interest. Can you support, in the background, so they move from being an interest group to something bigger (note, you work through them and don't enrol them into your own power-based program)
b) find out who the leaders are that people listen to, and support them to get their message heard. You will recognise a social movement leader when their rhetoric gets under your skin...
c) build in the story telling and organising principles of social movements into your own programmes, but know, always, that the goals of the program are yours from the power-full and may not be those of the grassroots.
d) If you are a corporation or large organisation then the grassroots are your customers - not your employees
e) when you feel a push against your power, stop, think and listen. In there may be the seeds of the same change you want, just presented differently.

Leave your comments below

SMS Texting Campaigns; awareness to action

Mobile phone technology has the means to change lives. A number of campaigns have been running where SMS/texting technology is being used not to raise awareness but rather to deliver action. I'm interested in this as it is breaking some of the "communication rules" and what is in the old research about how ideas spread and are adopted.

An excellent example is from UK Transplant where there are a number of campaigns running to increase the number of people prepared to donate tissue and organs. In the South West of England a campaign is running until April 2010 combining regular advertising and sms texting. The posters create awareness and then if anyone standing int he bus shelter wants to act by registering on the UK Transplant Organ Donor site they can send a simple test to a number with the word GIVE. This is still a pilot and the resulst will be interesting. I am all in favour of innovative ways of moving from awareness to action and this method is modern and relevant to societal trends.

If you want to add your name to the register then go to become a donor
If you want to read about this campaign go to sms campaign

Stories and Examples are different

We know that stories engage hearts and minds more than bullet points on a PowerPoint or a three page proposal. I believe there is a very important difference between stories and examples.

Stories are personal. I know a story when the person telling it comes alive with the emotions attached to the story. I can feel their passion, enthusiasm, sadness, delight - whatever. I am drawn into their personal experience. It is stories like this that engage me.

When someone stands on a stage and tells someone else's story - then for me that is an example. No matter how much we resonate with the other person's story their passion, enthusiasm, sadness, delight - whatever - is unlikely to be captured by the example-teller. Examples are helpful, though I suggest they are no different from the paragraphs in papers. They are second-hand and no longer associated with the context and emotions that go with them.

I am sometimes asked if a story I have used can be used by someone else. I usually recommend they find a way of developing their own reservoir of stories. This is sometimes difficult. Those who develop and advance theories may find their work disconnected from the reality of practice. The best way to both test the theories and develop your own stories is to test them out on a small scale. Not only will this provide self-confidence, it will also demonstrate the practicalities of your theory or suggestion and increase your personal credibility as you have a personal story to tell.

In the event you are unable to experience your own story, then I suggest capturing someone else's using a short video. Then allow their story to be told as they wish.

In the next week, try to focus on gathering, maintaining, treasuring your own stories. If you find yourself giving an example - telling someone else's story - then take a breather and see how you might do something differently to get the outcomes you desire from your listeners.

Photo from www.freephoto.com

Social media kits: CDC as a good example

Whatever your position on H1N1 swine flu, there is no doubting the news spread fast across the world.  Many change programs would like to emulate this type of activity; it is the Holy Grail of large scale change.

The CDC (Center for Disease Control and Prevention) in the USA is an excellent example.  I challenge organisations to respond as quickly, thoroughly and extensively as them.  In the case of H1N1 they didn't have a vast amount of planning time, though I suspect they had some contingency plans in place, to come up with a range of social media / social marketing tools.  So the first point to note is these were available almost instantly.  No waiting 2 - 3 months for a communications and marketing department to negotiate with an IT department following the meetings of the Change program division etc.... in order to get something done.

Secondly the CDC appreciates and understands the value of social media in getting messages out and helping them to spread, hopefully quicker than the virus they are focusing on.  Their H1N1 swine flu social media page  has:

• widgets; a whole variety to suits your own needs
• mobile information
• buttons
• online videos
• podcasts
• ecards
• rss feeds
• twitter link
• image sharing
• as for social networks you can find them on Facebook, mySpace, DailyStrength

Using social media is not the only way to communicate.  However, well done CDC for showing the way, probably breaking some rules in the process, and demonstrating to laggardly public sector organisations and departments how social media can be of value and no great sweat to implement.

Alignment or attunement for large scale change?

(Photo by Goodshoot Photos)

The term "alignment" is often heard in leadership groups, team meeting and in programme documents. Do we mean alignment when we use it?

I came to this question of alignment vs attunement on reading a review on the book "Enterprise-Wide Change; superior results through systems thinking" http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0787971464.html and the review is here: http://articles.directorym.net/Business_Alignment_and_Attunement-a1128711.html

Most of us working in the Public Sector and in healthcare will recognise that we are working within living systems. The nature of people interacting, interfacing, creating and constantly altering interdependencies - all creates a perpetually shifting culture - with the consequence of perpetually shifting performance.

Dictionaries suggest the meaning of "alignment" is to arrange to in a straight line or in parallel lines. It is a term that comes from a mechanical and industrial age and is an important one in engineering.

In contrast, "attunement" means to bring into a responsive or harmonious relationship. I like this term. For your large scale change or mechanism to spread good practice, are you conducting a quartet, a 12 piece orchestra, a 120 piece orchestra or even a series of large orchestras all required to play the same tune in different places at the same time? Imagine helping each member of this orchestra to perform their best. They are professionals and know how to tune their instruments, the great music will come from arranging their performance in a way that it harmonious.

How do we lead professional individuals and teams so they use their skills and capabilities to their maximum, yet do so in harmony with others around them? I like to think of the attuning process as including:

• future orientation; you may call this a vision, it may be a picture of what the future looks like, it may be taking time to feel what the end results needs to be like. An orchestra may listen to a previously recorded version. A programme team may visit a place where similar results have been achieved. It is about creating a collective sense of possibility
• a high level plan; for the orchestra this is the score. This may look like detail though there will also be a high level interpretation of the score by the conductor. The leader cannot do the playing for someone else, they can only guide their interactions with others, to create the overall result
• using individual excellence and surrendering this to the collective experience. By this I mean that it is essential for individuals to do their best, to work at their optimum, yet do so as a servant to the group. An individual may have a soloist part, though this is a contribution to the whole and is not the result in itself. In my experience we have many soloists playing well and being praised for their individual achievement with little leadership effort placed on containing these performances

When I am working with individuals, teams, organisations and systems in enabling large scale change my focus is not on seeing them in organised rows, neatly lined up. Instead my aim is to help them identify their tune, make conscious their personal capabilities and to discover ways to build responsive relationships and work in a harmonious way.