What can health and care improvement learn from social movements?

Commentator: Helen Bevan

Posted in: Change Activation
From: Issue 2

The process of assembling this “classics” piece on social movement thinking for health and care improvement gave me many flashbacks to my own development as a change agent over the past 15 years. These ideas have been some of the most influential on my practice.

I first started to understand the potential of social movement ideas for healthcare improvement in 2002. At this time, I was leading programmes across the NHS in England to reduce patient waiting times for care and to improve the outcomes of care for people with cancer and heart disease. I was a strong advocate for these systematic improvement programmes but I always felt that an additional motivational element was needed. Ultimately, if we were going to enable improvements for people who use our services across the whole country, we needed to build a movement of at least a million change agents. What could we, in the healthcare improvement community, learn from the leaders of the great social movements: the Women’s Suffrage Movement, the American Civil Rights Movement, the environmental campaigners of the 1970s? These were leaders who had no hierarchical power and few resources in a conventional sense but were able to mobilise for action that literally changed the world.

I linked up with the academics Paul Bate and Glenn Robert and we started to explore the potential and possibilities. This led to the publication of our White Paper ‘Towards a million change agents’ A review of the social movements literature: implications for large scale change in the NHS. This paper has since been downloaded more than three million times! We also published our thinking in a journal article: The next phase of healthcare improvement: what can we learn from social movements?

Over the years we continued to engage with others, to develop our thinking and test practical approaches using these social movement principles. The next major publication was The power of one, the power of many: bringing social movement thinking to health and healthcare. This was the first handbook on social movement thinking and practice that was truly accessible to the healthcare improvement community. Six years after its publication, it is still widely used.

Paul Bate and Glenn Robert also continued to publish, notably Bringing Social Movement Theory to Healthcare Practice in the English National Health Service in Social movements and the Transformation of American Healthcare.

These social movement ideas started to permeate more mainstream change practice. You can see this in Leading Large Scale Change: A Practical Guide that I published with Lynne Winstanley and Paul Plsek in 2011. Techniques related to “framing and reframing” and “transformational storytelling” sit alongside measurement frameworks and stakeholders analysis. You can also read part two of the guide Leading Large Scale Change: The Postscript which is a commentary on the relevance of the principles for a contemporary audience.

In 2010, we made a connection with Marshall Ganz of the Kennedy School of Government at Harvard University. Marshall taught us many practical approaches, which, combined with our existing approaches, took our change practice to a different level. I particularly like the book chapter Leading Change that he published in 2010 which describes how organisational leaders can build their leadership capability by learning from social movement leaders.

There are now multiple examples of these social mobilisation approaches applied in a health and care context. The first one here is about using social movement principles across Engalnd to reduce unwarranted prescribing of antipsychotic drugs to people living with dementia. The second is about pioneering work in mental health issues with Māori youth in New Zealand. This New Zealand team also took part in a web seminar for NHS Wales on “empowering communities to better health”, linked to the Welsh . You can download the film here.

I made two short films for the NHS in Wales on social movement thinking. The first is about how we can unite and mobilise people around a cause for change: The second is about how social movement leaders think about resources in terms of relationships they build.

The knowledge base on social movement thinking continues to expand. Recently, Hahrie Han published a new book on civic activism. She makes the distinction between “lone wolves” (people who largely work on their own, providing information and resources), mobilisers (who encourage other people to take action) and organisers (who grow the future leaders of social movements). Of course, we aspire to be organisers! You can download the first chapter of this book. We hope that this book will be the subject of our book club in a future issue of The Edge.

Finally, this is my reading and reference list on social movement thinking and related topics relevant to health and care improvement [Social Movement Reading List]. In line with the philosophy of The Edge, every reference has a free link to the publication or a summary.

My conclusions? As activist-leaders, we can learn greatly from leaders of social movements. We need to challenge the status quo as necessary and tackle the tough issues. We need to believe that a different future is possible and that the people we work with and serve have the capability, energy and motivation to deliver the changes. Crucially, we have to understand that we cannot be a change activist or rebel on our own. Success is about our ability to call others to action and move forward on with shared purpose to achieve the outcomes we seek.

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Chief Transformation Officer, Horizons Group, NHS England. Seeking out ideas, learning and connectio...


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