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This is my favourite leadership/change book of the last twelve months (and I have read a lot of books). There is so much insight contained in its chapters for system leaders and change activists.

Increasingly in our health and care world, leaders are talking about how to activate employees and the wider health community for improvement. There is a growing appreciation that the classic “top down” levers and incentives aren’t enough to make change happen quickly and radically for our patients and service users. There is much talk of “health as a social movement” and mobilising people through “calls to action” and “patient activation”.

This is a book about how to engage people in change and through this process, shift the balance of power and deliver transformational change. It is based on rigorous fieldwork and field experiments that Hahrie Han undertook to identify the strategic models that civic associations in the USA use to engage their members in civic and political action. “Civic associations” are membership-based groups that are focussed on a specific cause. They range from the National Rifle Association to Health Care for America Now to local parent-teacher associations.

The research shows that what differentiates the groups with the highest levels of activism and participation is the way they transform people’s motivations and capacities for involvement.

The context of this book is completely different to my world of organisational/system change from within the English National Health Service. However, I face the same challenges as the leaders of those civic groups of “getting people to do stuff” (cultivating people’s motivation and capacity to take action towards our collective goal for change).

Hahrie Han identifies three models of engagement:

The first model is lone wolves. Lone wolves are activists who tend to work on their own. Often lone wolves build a strong power base through their personal knowledge and expertise. I see many, many lone wolves in the improvement movement in the NHS. They are people who are highly skilled at quality improvement methods and approaches and often have a long track record of supporting change. They are often called in to advise on change initiatives and are highly valued by their organisations and colleagues. What lone wolves don’t do is engage and mobilise other people as a core part of their activism.

The second model is mobilisers. Mobilisers seek to get as many people as possible involved in their campaigns and causes. They focus on actions that they want people to take, but typically these actions are specific things that people can do on their own. Mobilising is often about quick engagement by lots of people. Many of the campaigns that have been run in the NHS are based on this model. We call on people to take a specific action related to their health or their work place, but what we don’t do when we are mobilising is to try to develop people, or build a network of leaders or cultivate the capacity of those we mobilise for further activism.

The third model is organisers. Organisers build power by building the leadership skills of the people they help call to action. Unlike mobilisers who call a lot of people to action individually and separately, organisers connect people with each other:

“Organizers bring individuals together in a way that creates a collective capacity not present when individuals act alone. Organizers do not simply aggregate individuals but also create new relationships between them that generate new commitments and resources” (p14)

Whereas the work of mobilisers is centralised in the hands of a few leaders who call on people to take action, the work of organisers is distributed through a larger network of leaders. Organising leaders give responsibility and strategic autonomy to the leaders they are developing; by giving away leadership power, they are building power for change. So a lot of the time of organisers is spent building relationships and community and training and coaching leaders, something that mobilisers typically don’t do.

Nevertheless, mobilising and organising are mutually reinforcing approaches. Mobilising helps to identify potential leaders from amongst the people who are called to action. Organising helps to develop the leaders who can then call big groups of people to action and enable change to happen on a much wider scale. Hahrie Han’s research shows that the organisations/ communities with the highest activation and participation rates are effective at both mobilising and organising. The groups with the lowest levels of activation are those that create lone wolves and mobilisers without building organisers.

My reflection after reading this this book is that many of the current approaches to build social movement thinking into the health and care system are creating lone wolves (who know a lot about the topic) and mobilisers who engage people in change. For instance, there are many current attempts across the NHS and wider health and care system to involve service users and communities in our change strategies but we hardly invest any resources in developing the capability of these service user activists to become organisers. I worry that some approaches to “patient activation” are creating lone wolves who become very knowledgeable about their health condition but who don’t necessarily get organised with other service users. If we want to shift the power in the system and deliver transformational as opposed to small scale change, we need to create an army of organisers. We need to think about this in the context of both specific change interventions (for instance, how do we build a mental model of organising into the development of new care models?) AND in our wider leadership development activities.

I recommend that you encourage a group of leaders to read this well researched study and discuss it together. This process is very insightful and it offers some clear, practical steps forward.

Questions to reflect on when reading the book:

  • Thinking about yourself as a change leader; are you a lone wolf, a mobiliser or an organiser?
  • Is your current change initiative based on lone wolves, mobilisers or organisers and what can you do to shift the balance?
  • How might you reframe your current change initiative through the eyes of an organiser?
  • How can we build organising and mobilising capability on a very big scale?
  • How would the power structure of the system need to change to enable more organisers?


Helen-BevanHelen Bevan is Chief of Service Transformation at NHS Improving Quality. Follow her on Twitter @HelenBevan