I was very proud to graduate from the School for Health and Care Radicals in 2014. Taking part in this inaugural and revolutionary programme marked a real turning point in my career, not only helping me make a very important (and long overdue) decision about my next steps, but in firming up my thinking and psychological resilience.

A risk factor is usually defined as something that increases the likelihood of a future negative outcome. The converse of risk being a protective factor: a variable that decreases or buffers against such probability. As individuals, with very differing DNA, backgrounds and experiences, we all possess our own repertoire of risk and protective factors that may be activated in a high demand or challenging environment; probably just the kind of environment that we encounter as agents of change! I don’t want to dwell on risk factors in this piece; it isn’t necessarily helpful, and it isn’t in the spirit of what I’m trying to convey. I’d rather “flip it” and look at a couple of the concepts revealed for us by the discipline of Positive Psychology.

You may well be familiar with the work of Abraham Maslow, most famously his model of ‘Hierarchy of Needs’ but also his major contributions to psychology with theories on motivation, needs and self-actualisation and peak experience. Maslow commented that,

“The science of psychology has been far more successful on the negative than on the positive side; it has revealed to us much about man’s shortcomings, his illnesses, his sins, but little about his potentialities, his virtues, his achievable aspirations, or his psychological height.” (Maslow, 1954)

Applied to change activism in health and care, I wonder if Maslow’s quote resonates with anyone reading this piece? How often are we forced to focus (and left to dwell) on shortcomings, failures and criticisms? Other than at the opening ceremony of the 2012 Olympic Games, when was the last time we really celebrated the NHS for its achievements, greatness and worldwide respect? How often do we reframe illness or deficits as wellness or assets? As an employee, manager, parent, partner…what is the likely ratio of negative to positive comments we make in any given day?

As human beings, it’s unsurprising that we may be programmed to attend to the negative before the positive. This ‘negativity bias’ is an entirely functional evolutionary sensitivity to risk – to keep us out of harm’s way. As a species, it has served us well, but as change activists, it can lead us astray from our goals or begin to doubt our ability to cope and succeed.

Positive psychology is concerned with the science of wellbeing and optimal functioning, particularly the concepts of happiness, optimism and helplessness, mindfulness, character/strength/values, positive thinking, hope and resilience.

Of particular relevance to change agents is the notion of perceived self-efficacy, “People’s beliefs about their capabilities to succeed in specific situations” (Albert Bandura, 1986). Self-efficacy influences how we feel, think, motivate ourselves and behave; it will determine whether a. we decide to take action b. how much effort we need to put into the action and c. how long we persevere in the face of obstacles or setbacks. These are all critical to change activism.

Bandura said, “People’s levels of motivation, affective states, and actions are based more on what they believe than on what is objectively true.” Self-efficacy is key concept taught by the School for Health and Care Radicals (Module 1: : Being a Health and Care Radical – Change starts with me, slides 40-47) originating from Deborah Meyerson’s book “Tempered Radicals: How People use Difference to Inspire Change at Work” (Meyerson, 2001). Self-efficacy is about our belief to personally be able to create change, and there is a positive, significant relationship between self-efficacy beliefs and their ability to facilitate change and get good outcomes.

Social reformers hold strong the belief that they are capable and equipped to mobilise the collective effort needed to bring about social change. Although their beliefs are rarely fully realised, they can sustain reform efforts that achieve important gains. Were they to be entirely realistic about the prospects of transforming social systems, they might either forego the endeavour or fall easy victim to failure and doubters. Realists may adapt well to existing realities, but those with a tenacious self-efficacy are likely to change those realities.

The good news is that self-efficacy can be learned and nurtured. The School for Health and Care Radicals gives us some tactics to build our own sense of self-efficacy:

  1. Invest in your own change agent development; this is an easy one to achieve, simply register for the 2015 School for Health and Care Radicals)
  1. Create a change one step at a time: otherwise termed ‘mastery experiences’ by Bandura, this involves repeatedly achieving small goals through perseverance and overcoming obstacles. However, if the goals or tasks are always easy or too similar to the last and difficult, more anxiety-provoking goals are always avoided, then a strong sense of self-inefficacy will develop. The message here is to regularly (yet kindly) strive to push ourselves outside our comfort zone.
  1. Reframe your thinking: this is where failed attempts are learning opportunities and uncertainty becomes curiosity (by sticking it out through tough times, we emerge stronger from adversity). I particularly enjoyed a recent blog post by Paul Taylor @PaulBromfordHow to get better at failing”. Paul shared this wonderful quote from Neil Gaiman (writer and producer), “Make new mistakes. Make glorious, amazing mistakes. Make mistakes nobody’s ever made before.” In this short interview with Malcolm Gladwell, we hear a heart-warming perspective on, “Why you need adversity to succeed” where the notion of ‘undesirable difficulties’ is turned inside-out into ‘desirable difficulties’.
  1. Make change and learning cycles from change routine rather than an exceptional activity.
  1. Get social, get support! Referring to the work of John Cacioppo et al. (2011), we know that early in our history as a species, we survived and prospered only by banding together – in pairs, families, tribes – to provide mutual protection and assistance. We also know that social support predicts both psychological and physical outcomes during times of disruption and stress (The Stress Buffering Hypothesis: Cohen and Wills, 1985). Social movements are a powerful force for change, as described in this previous classics piece by @HelenBevan in Issue 1 of The Edge: What can health and care improvement learn from social movements? When we look at the common characteristics that underlie social movements: energy, mass, passion, commitment, pace and momentum, spread and longevity (Bate, Bevan and Robert, 2004) the case for ‘getting social’ in our efforts gets stronger still.
  1. Learn from the best; seeing others who are similar to ourselves succeed, raises our beliefs that we too possess the capability to achieve. Interestingly, we are more likely to benefit from role modelling (vicarious experience) when we can see that our role model has struggled imperfectly, but succeeded in a similar task. This reminds me of one of the values of Working Out Loud, (by @JohnStepper) which is described perfectly by Moyra Mackie in her blog, ‘Why everyone should be working out loud‘, “…in becoming visible we become vulnerable and in seeking to make our work better we show ourselves as fallible…”  Indeed, the most courageous and compelling leadership I have witnessed stands out to me because of its readiness to show ‘working outs’ and human fallibility.
  1. Get encouragement from people whose opinions you value; have a think about who you can identify that you trust, who has the competencies and proficiency to which you aspire?

Alongside self-efficacy neatly sits the phenomena of optimism.

“What we want is not blind optimism, but flexible optimism – optimism with its eyes open. We must be able to use pessimism’s keen sense of reality when we need it, but without having to dwell in its dark shadows.” (Martin Seligman, Learned Optimism, 2006).

I really enjoy the website BrainPickings from Maria Popova, @BrainPicker, which alongside a wealth of resources, information and thinking about what Maria calls, “…that grand question of how to live, and how to live well”, gives a concise overview of ‘Learned Optimism’ the renowned book by Martin Seligman.

“Optimism Lifts” is a great blog post by @LoisKelly, one half of the duo of the essential reading for change activists, ‘Rebels at Work: A handbook for leading change from within’ (Lois Kelly and Carmen Medina, 2014). Lois tells us how (unsurprisingly) optimistic people achieve more but equips us with some key practices to help us inject a little more optimism into our day-to-day life. Lois quotes from, ‘Rainy Brain, Sunny Brain’ (Elaine Fox, 2012).

“Optimism is not so much about feeling happy, nor necessarily a belief that everything will be fine, but about how we respond when times get tough…optimists tend to keep going, even when it seems as if the whole world is against them.” (Elaine Fox, 2012)

This isn’t about ‘happiology’ or blindly ignoring risks, pitfalls and hunches at the expense of being an unwavering positive beam of optimism. The notion of this classics piece is to remind us that we all have a choice about how we respond to any given situation. We also have a choice as to how we respond to our thoughts. The great thing about thoughts is that they are just that, thoughts. They are not facts, predictions or premonitions. You may well find your thoughts to be (on the whole) accurate and grounded, but this doesn’t mean that you don’t fall foul of the odd negative or unhelpful thought that might block your progress or success as a change activist. In order to be courageous and enigmatic in our attitudes and behaviours, in a way that mobilises others, we can all benefit from building our own mental toolkit of resources.

A man is but a product of his thoughts. What he thinks, he becomes.” (Mahatma Ghandi)

Further learning:

If you’re interested in Positive Psychology and would like to learn more, why not sign-up for this free MOOC (online course) with Dr. Barbara L. Fredrickson from The University of North Carolina at Chapel Hill. The MOOC starts on 9th February 2015 and runs for six weeks.

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