There is a lot of talk about social movements at the moment. Social movements are not created they emerge and they are dynamic. They often arise as a response to intolerable conditions or societal behaviours. The leaders of social movements create the conditions for others to achieve a shared purpose (Ganz 2010). They facilitate trust, motivation and commitment and are in the end about;
‘changing the world, not yearning for it, or just thinking about it’ (Ganz 2010)
Over time they need to be organised. Surprisingly, after a while social movements require specific actions with real deadlines (Ganz 2010). Without this the initial spark will simply die down and become a distant memory. These actions need careful thought, one of the main reasons movements avoid committing to them is the fear of demotivating the people who think the movement has turned into a ‘must do’ task. Being organised reminds people what needs to be done, what’s important and what will happen next. This requires consistent coaching which avoids both micromanagement and hands off management (Ganz 2010).
Social movements think of time as an arrow. They begin at a specific moment and end at a specific moment. In the middle is the change. This ‘time as an arrow’ framework is more generally described as a campaign (Ganz 2010) and is the most effective way to organize the most valuable resource of time. Campaigns are strategic and motivational ways to target effort and organize change activity; it provides a rhythm for others to follow. They unfold over time with a rhythm that slowly builds foundation, gathers gradual momentum with a few peaks along the way. A good campaign can be thought of as a symphony of multiple movements that adapts to the rhythm of change (Ganz 2010).
The solidarity of collaborating with others in a common cause energizes us. Sign up to Safety campaign was formed in order to create a ‘social movement’ to promote and help people build the right safety culture in the NHS in England. Launched in June 2014, as a three year campaign, it has been built using the experience of a small team who have over twenty years in patient safety, two years of patient safety campaigning and the benefit of time to think about what could be done differently. In particular Sign up to Safety has used social movement principles to create a locally owned, self-directed approach to improving patient safety. We know that change is more likely to be successful if locally owned rather than because of instructions from the top so as a campaign we do not tell people what to work on and have not added to the mass of targets and central commands.
History has shown us that central commands are only likely to be complied with in the short term and often fail to embed changes in the long term. They lead people to feel intense pressure to comply with a set of priorities that are not the same set of priorities that are important to them. The expected interventions move individuals and organisations away from their own priorities and also inhibit the development of local knowledge and ownership of safety. We have found that by not telling people what to do we have in fact energized them; we have surprised them and some have told us they have found this really exhilarating.
Social movements counter feelings of isolation with a feeling of belonging. Sign up to Safety has created a brand for people not only to trust but to belong to. We have over 400 members who have something to belong to. Sign up to Safety has used the Ganz model of leadership (Ganz 2009);
the difference between leadership as a position, and leadership as a practice, and accepted responsibility for enabling others to achieve purpose under conditions of uncertainty.
One way of looking at our leadership style is to see how we reach out to mobilize the community and help them turn the campaign aims into their own aims. It is a form of collaborative and distributed leadership, not becoming ‘structure less’ (as that would be chaos), it’s about creating an interdependent relationship between the central campaign team and the members.
We have purposefully used a particular tone and style and created a brand that is synonymous with kindness, caring and compassion. In today’s stressful and challenging healthcare environment the last thing people need is another stick. We have shown that kindness works; thanking people, valuing them and being thoughtful of all around us are vital to creating the right culture for safety and are leadership traits that we both embody and promote.
Key to achieving this is being positive, personalized and telling stories with hope. The stories are about why patient safety matters, why we need to act. This is challenging when there is a great deal of inertia, apathy, change fatigue, and exhaustion. We are exploring a way of giving back some hope and motivation. Everyone whether providing healthcare, monitoring, inspecting, guiding, commissioning, should do so with a positive purpose, providing hope and energy that inspires rather than crushes.
Hope is what allows us to deal with problems and is one of the most precious gifts we can give each other and the people we work with (Ganz 2009).
We have therefore started to experiment with a method of experiential learning using conversations and storytelling. Stories of powerful personal narratives of individual learning which can inspire people to keep going. They are not a set of messages or sound bites. As we listen, we evaluate the story; we hear it in different ways depending upon who we are and who the story teller is. The story teller will also tell it in different ways depending upon who is listening. Story telling is therefore an interaction, a shared experience.
For a collection of people to become an ‘us’, requires a story teller, a listener and an observer (Ganz 2010).
We are testing conversations and storytelling by gathering people together and sharing their challenges, obstacles and how they are learning to overcome them. Stories that demonstrate how they are implementing their plans, stories to illustrate the impact of local activity for safety, stories about how they overcame a challenge and stories of possibility. Stories can make a significant contribution to personal and professional growth as they communicate our values through the language of the heart; our emotions (Ganz 2009). We look forward to sharing with you what we learn.
Patient Safety Now 