Leading improvement through engagement and community: presentations from a workshop with Helen Bevan
On 2 and 3 August 2022, the Health Quality & Safety Commission (the Commission) hosted a workshop on leading improvement through engagement and community, facilitated by Helen Bevan.
Helen is a strategic advisor at NHS Horizons – a specialist team within the Improvement Directorate of NHS England and NHS Improvement. She has been supporting quality improvement within the health care system for nearly 30 years, both in the UK and internationally.
Throughout the workshop, Helen shared a series of approaches, methods and tools for leading improvement through engagement and community, which were then tested out by participants.
On this page, you will find an overview of the various presentations from the two-day workshop. Please credit the authors of the slides below if you wish to reproduce them.
Watch a welcome introduction from Huataki Whareaitu, Pou tikanga, and Dr Janice Wilson, Chief executive, of the Commission.
John Whaanga (Ngāti Rākaipaaka, Ngāti Kahungunu and Ngāti Rongomaiwahine) is the deputy director-general of Māori health at the Ministry of Health, a position he has held since 2019.
John gave the opening address and talked about the health reforms and the future of Māori health from a Te Tiriti o Waitangi point of view.
Watch the presentation by John Whaanga on Youtube or below. View his PowerPoint slides.
Watch Helen as she gives the wider context to participants:
These are the key themes and highlights of this workshop.
- The solutions to our most pressing problems can be found in our communities. Communities have so many skills and so much potential that we cannot know about if we do not engage with them. We cannot know about other stories if we do not explore or listen to them.
- Change is inherently relational – it depends on our ability to work with others. Change spreads most through relationships and building community. Low to moderate connectivity indicates low to moderate capacity for knowledge exchange and learning.
- Building a sense of belonging is one of the most critical tasks in leading change. We build belonging with climate (welcoming uniqueness, openness, fairness, what unites us), leadership (giving perspective, mentorships, inclusion, kindness and civility) and practices (listening and feedback, building agency, collaboration).
- A paradigm is a set of assumptions, concepts, values and practices that constitute a way of viewing reality for that community. The most powerful intervention is one that shifts the paradigm.
- We need to shift from ‘expert’ to ‘explorer’. When you are curious, you shift from expert to explorer, supporting others in their journeys.
This presentation was led by Stephanie Turner, Director of Ahuahu Kaunuku (Māori health outcomes team) at the Commission. Her presentation included the following points.
- The theory of everything from a Māori perspective is whakapapa; everything connects to everything.
- Knowing who you are, where you came from and why you are in this room is a Māori way of looking at things.
- Māori were never conquered, but the impact of colonisation on Māori has been enormous; however, Māori knowledge systems, worldviews and practices remain intact.
- We have been slow to use mātauranga Māori in designing and delivering health systems/services – the way to do this is through the community, they know best what is going to work for them and what is required – Māori specialist knowledge is available.
- What are the structures we need to put in place to ensure it is manageable for mana whenua?
Stephanie posed a series of reflective questions and gave participants some key points to consider before they took part in table discussions.
These included:
- Your experiences inform your beliefs and what you think is important.
- The challenge is around a paradigm shift, but, if we are to do this, we need to understand our own paradigm first and where this has come from and our shared history.
- What is worldview? What has informed your beliefs? What is your cultural landscape? Where do your cultural norms come from? What makes a paradigm?
- Are we caged by our current structures, systems and processes? Are we constrained by current ways and paradigms?
Watch Stephanie's presentation on YouTube or below.
- An accelerated design event (ADE) is a way to get diverse groups of people collaborating, coming together in community to build alignment and ownership, solve complex problems, drive cultural change and get work done.
- ADE methods draw on a broad range of evidence and disciplines, including education, architecture, biology, neurology, psychology and organisation development.
- This is an evidence-based approach to change based on a simple premise that people believe in what they design and own what they co-create.
- These events bring together a group of 30–300 people to quickly work through challenges and issues and develop action. They typically last between one and three days. Having a diverse group of people in these events is more useful than having a few experts.
- Design principles for an ADE are co-designed, facilitated, dynamic, adaptive, connective, iterative, integrated, collaborative, self-organised, emergent and playful.
View the PowerPoint slides for this session.
Watch Helen's presentation on YouTube or below:
Helen introduced five things to think when designing an ADE.
Purpose
- Purpose drives everything
- Think about the changes you are trying to make. What can and can’t you change? Always start with defining your purpose.
Players
- Who needs to be invited to be part of the community/design team/working group?
- Diverse communities get better outcomes – how do you build diversity into the process?
- People are often engaged once the choice has already been decided and will therefore be resistant. It is better to engage people when the issue has been identified and ask them to help create the solution.
Structure
- What time, place and planning do you need that best supports the purpose?
Process
- What are the most effective and engaging ways of learning? Who are the contributors that you need?
- How will the event be facilitated?
Sharing
- How will the results of the day be shared with the group after the day?
- What deliverables will you produce and who will you share them with?
Helen demonstrated the SessionLab software, which teams then used to create a one-day event for their own topic. The teams practiced creating blocks for their agendas and accessing the SessionLab library to find different types of activities.
Watch Helen’s presentation: Blocking an accelerated design event on YouTube or below.
Crowdsourcing is the practice of obtaining ideas, solutions or content by getting contributions from a large group of people online. On day two of the workshop, Helen worked through an example of a crowdsourcing challenge she had been involved in. Participants then spent time working on various crowdsourcing challenges, creating a process and designing an engagement strategy.
Watch Helen’s presentation: Using crowdsourcing and open innovation to hear many voices.
Watch this video on setting up a crowdsourcing challenge.
Watch this Horizons NHS video: Let your project find strength in numbers … with crowdsourcing!
In this session, Helen explained the positive deviance improvement methodology. The definition she used was from Jerry Sternin, founder of the positive deviance approach which states that in every group, there are a minority of people who find better and more successful solutions to the challenges at hand. Even though they have access to exactly the same resources as the rest of the group, their uncommon practices or behaviours allow them to flourish.
Helen gave an example of a positive deviance project in Western Province, Zambia which led to improvements in nutritional status, knowledge, attitude and feeding practices. Participants then spend time in smaller groups designing their own positive deviance initiative.
Watch Helen’s presentation: Principles of positive deviance with a community.
Watch more about designing a positive deviance initiative.
Welcome and introduction
Watch a welcome introduction from Huataki Whareaitu, Pou tikanga, and Dr Janice Wilson, Chief executive, of the Commission.
A pathway to Pae Ora
John Whaanga (Ngāti Rākaipaaka, Ngāti Kahungunu and Ngāti Rongomaiwahine) is the deputy director-general of Māori health at the Ministry of Health, a position he has held since 2019.
John gave the opening address and talked about the health reforms and the future of Māori health from a Te Tiriti o Waitangi point of view.
Watch the presentation by John Whaanga on Youtube or below. View his PowerPoint slides.
The wider context from Helen Bevan
Watch Helen as she gives the wider context to participants:
Principles for building community and engagement for large scale improvement
These are the key themes and highlights of this workshop.
- The solutions to our most pressing problems can be found in our communities. Communities have so many skills and so much potential that we cannot know about if we do not engage with them. We cannot know about other stories if we do not explore or listen to them.
- Change is inherently relational – it depends on our ability to work with others. Change spreads most through relationships and building community. Low to moderate connectivity indicates low to moderate capacity for knowledge exchange and learning.
- Building a sense of belonging is one of the most critical tasks in leading change. We build belonging with climate (welcoming uniqueness, openness, fairness, what unites us), leadership (giving perspective, mentorships, inclusion, kindness and civility) and practices (listening and feedback, building agency, collaboration).
- A paradigm is a set of assumptions, concepts, values and practices that constitute a way of viewing reality for that community. The most powerful intervention is one that shifts the paradigm.
- We need to shift from ‘expert’ to ‘explorer’. When you are curious, you shift from expert to explorer, supporting others in their journeys.
Building community for improvement and te ao Māori worldview
This presentation was led by Stephanie Turner, Director of Ahuahu Kaunuku (Māori health outcomes team) at the Commission. Her presentation included the following points.
- The theory of everything from a Māori perspective is whakapapa; everything connects to everything.
- Knowing who you are, where you came from and why you are in this room is a Māori way of looking at things.
- Māori were never conquered, but the impact of colonisation on Māori has been enormous; however, Māori knowledge systems, worldviews and practices remain intact.
- We have been slow to use mātauranga Māori in designing and delivering health systems/services – the way to do this is through the community, they know best what is going to work for them and what is required – Māori specialist knowledge is available.
- What are the structures we need to put in place to ensure it is manageable for mana whenua?
Stephanie posed a series of reflective questions and gave participants some key points to consider before they took part in table discussions.
These included:
- Your experiences inform your beliefs and what you think is important.
- The challenge is around a paradigm shift, but, if we are to do this, we need to understand our own paradigm first and where this has come from and our shared history.
- What is worldview? What has informed your beliefs? What is your cultural landscape? Where do your cultural norms come from? What makes a paradigm?
- Are we caged by our current structures, systems and processes? Are we constrained by current ways and paradigms?
Watch Stephanie's presentation on YouTube or below.
Principles and blocking for accelerated design
- An accelerated design event (ADE) is a way to get diverse groups of people collaborating, coming together in community to build alignment and ownership, solve complex problems, drive cultural change and get work done.
- ADE methods draw on a broad range of evidence and disciplines, including education, architecture, biology, neurology, psychology and organisation development.
- This is an evidence-based approach to change based on a simple premise that people believe in what they design and own what they co-create.
- These events bring together a group of 30–300 people to quickly work through challenges and issues and develop action. They typically last between one and three days. Having a diverse group of people in these events is more useful than having a few experts.
- Design principles for an ADE are co-designed, facilitated, dynamic, adaptive, connective, iterative, integrated, collaborative, self-organised, emergent and playful.
View the PowerPoint slides for this session.
Watch Helen's presentation on YouTube or below:
Helen introduced five things to think when designing an ADE.
Purpose
- Purpose drives everything
- Think about the changes you are trying to make. What can and can’t you change? Always start with defining your purpose.
Players
- Who needs to be invited to be part of the community/design team/working group?
- Diverse communities get better outcomes – how do you build diversity into the process?
- People are often engaged once the choice has already been decided and will therefore be resistant. It is better to engage people when the issue has been identified and ask them to help create the solution.
Structure
- What time, place and planning do you need that best supports the purpose?
Process
- What are the most effective and engaging ways of learning? Who are the contributors that you need?
- How will the event be facilitated?
Sharing
- How will the results of the day be shared with the group after the day?
- What deliverables will you produce and who will you share them with?
Helen demonstrated the SessionLab software, which teams then used to create a one-day event for their own topic. The teams practiced creating blocks for their agendas and accessing the SessionLab library to find different types of activities.
Watch Helen’s presentation: Blocking an accelerated design event on YouTube or below.
Using crowdsourcing and open innovation to hear many voices
Crowdsourcing is the practice of obtaining ideas, solutions or content by getting contributions from a large group of people online. On day two of the workshop, Helen worked through an example of a crowdsourcing challenge she had been involved in. Participants then spent time working on various crowdsourcing challenges, creating a process and designing an engagement strategy.
Watch Helen’s presentation: Using crowdsourcing and open innovation to hear many voices.
Watch this video on setting up a crowdsourcing challenge.
Watch this Horizons NHS video: Let your project find strength in numbers … with crowdsourcing!
View the PowerPoint slides for this session.
Principles of positive deviance within a community
In this session, Helen explained the positive deviance improvement methodology. The definition she used was from Jerry Sternin, founder of the positive deviance approach which states that in every group, there are a minority of people who find better and more successful solutions to the challenges at hand. Even though they have access to exactly the same resources as the rest of the group, their uncommon practices or behaviours allow them to flourish.
Helen gave an example of a positive deviance project in Western Province, Zambia which led to improvements in nutritional status, knowledge, attitude and feeding practices. Participants then spend time in smaller groups designing their own positive deviance initiative.
Watch Helen’s presentation: Principles of positive deviance with a community.
Watch more about designing a positive deviance initiative.
