Having helped to promote it since 2019, I was privileged to be able to finally attend the Spread and Scale Academy in October 2021. I was participating as part of a project to change the model of outpatients’ follow-up appointments in Cardiff and Vale University Health Board but what I learnt from the Academy will go far beyond any individual project and will certainly affect my everyday practice as a communications professional.
The three-day programme is run by the Dragon’s Heart Institute in partnership with an organisation called the Billions Institute. It’s designed to help teams who have developed a successful project or innovation in one area take their work and spread it across the system in which they work. The inability to spread innovation and ideas is a huge barrier faced by staff in the NHS even though as staff we all simply want to do what’s best for the patient. The Spread and Scale Academy gives teams the tools and the knowledge, about both themselves and the systems they work in, to begin to address this conundrum. When they crack it, the changes they bring about are nothing short of revolutionary.
From writing about the successes of the teams who had been through the programme in the previous two academies, I had some familiarity with the course’s concept and was excited to participate. However, I must admit that I did hold some reservations about it: how could a three-day programme really be so ground-breaking? Could it truly change the way its delegates operate in trying to affect change or does the status quo seep back in when they go back to the office? Are its core lessons really fundamental to the success enjoyed by past teams or did they simply have luck on their side? By the end of the first day, the programme had met and already exceeded each of my expectations; it could be, and was, all of these things.
The Academy is taught by Becky Margiotta from the Billions Institute and is facilitated by a number of alumni who you can tell with just a glance are getting as much out of being there as you are (and as they did the very first time they attended). On the Billions Institute website, Becky’s bio states that she “inspires and supports leaders … to step all the way into what they’re here to do on this planet.” This isn’t hyperbole. Becky and the facilitators speak with such enthusiasm for the course content and the projects the attending teams bring, that they quickly instil in the delegates a concrete belief in their ideas and their purpose.
Before establishing the Billions Institute and developing their model for large-scale change, called The Model for Unleashing, Becky led the 100,000 Homes Campaign in the USA. This campaign mobilised 186 cities to house 105,000 people off their streets in just four years. Much of the programme’s teaching is grounded in this experience and Becky takes you, with genuine authenticity, through the story of how after serious burnout she and her team came to the realisation that they could never meet their aim if they insisted on retaining control and undertaking all of the work themselves.
The Model for Unleashing is framed in direct opposition to this way of working and the Billions Institute actually define successful large-scale change as “orchestrating the loss of control of thousands of people you’ll probably never meet moving in the generally desired direction.” Or as Becky puts it, “When someone on the other side of the world is doing your thing their way and they know nothing about you, you know you’ve made it.” The scale of the change envisioned is that when you look back, you hardly believe there was a time before its existence. But how do you achieve this?
One of the first activities you do at the Spread and Scale Academy is to create a map of your life and the major events that have led you to where you are now. From this first task, the Spread and Scale Academy sets itself apart from other programmes as one which deftly combines technical aspects of improvement theory with deep introspection. It allows you to reposition yourself in relation to the work you’re attempting to undertake while recognising the values, perspectives and biases you hold to mitigate the risk of unconsciously perpetuating the status quo.
Breaking down both the events of your life and the work you aim to spread into constituent parts as if they were beats in a narrative was an incredibly difficult undertaking, one which really stretched everyone’s thinking and pushed the teams into challenging discussion and debate from the off. I know that I wasn’t alone in leaving the first day of the Academy exhausted, overwhelmed, and nursing a serious headache.
But in this task, our team connected over the stories we told to each other. Colleagues became friends as we empathised with the respective events of our lives and the values we hold as a result of going through them. Our mission and purpose became clearer as we bonded over those values and common aims for the project. This work became the foundation upon which rested the remainder of our time together at the Academy and is the cornerstone for the work of our team going forward.
Returning to the Academy on the second day, the power of the stories which we tell ourselves and each other was a major recurring theme. She could not overstate the importance, Becky said, of keeping the human element at the front and centre of any aim we set. For example, the aim of implementing a particular pathway in 20% of services, viewed in the context of the direct impact on the beneficiaries of the work, becomes an aim to save the time or even the lives of a set number of patients within a set timeframe.
This subtle re-framing of what we set out achieve truly resonated with me. In this way, we are accountable to ourselves and those patients whose lives we are committing to improve. It empowers us to tell the story of the project in a much more compelling way, ensuring what matters is kept in the front of the mind and increasing the likelihood of others answering our team’s call to action by adopting and adapting the proposed solution.
As the Academy continues, this central theme of storytelling is revisited time and time again. “Information does not equal motivation!” Becky tells us, highlighting the misconception that when presented with data or statistics alone, people will act to address them. This is not the case, even if they are particularly shocking; data does not change human behaviour, emotions do.
This is certainly something I empathise with. We have the data, we have reams and reams of the stuff. Often your audience will also have (or at least be aware of) the data but will overlook or dismiss it as they cannot and do not connect to it on an emotional level. We can present it over and over in different ways but until we find a way to make this connection, it with not create empathy and it will not inspire action.
Telling the story around the data can and does generate the empathetic, emotional reaction in the listener to motivate them to at least try something different. By establishing simple narrative structures of context, conflict, and outcome, you can build suspense to grab and maintain your audience’s interest, building in their heads an idea that they can never shake off.
This is a core piece of teaching in the Model for Unleashing. Storytelling is a way of establishing leverage within your system, and a key method of affecting change: tell your story, create empathy, inspire action. It is also something in which I believe very strongly. When completing my own life map, I felt compelled to include the first time my father read me The Hobbit at young age (I still have that same copy of the book on my shelf today). In The Hobbit, Tolkien writes “If more of us valued cheer and song above hoarded gold, it would be a merrier world.”
Did a five-year-old me internalise this, setting me irrevocably down the path to where I am today? I doubt it, but it is one of those ideas that has stuck with me, something that I still cannot shake off all these years later. From being gripped by the tales of Bilbo Baggins and hiding under the covers from the terrible Smaug, to going to university to study English Literature, to ending up in the privileged position of helping incredible NHS staff tell their stories as a communications professional, I realised that the story of my own life has in fact been shaped by stories and while a good story can change your mind, a great story can change you.
With the emphasis placed on storytelling as a central tenet to achieving large-scale change in the Billions Institute’s Model for Unleashing, I believe that the practice will be key in the for the teams who have attended the Spread and Scale Academy going forward. As the power of their stories is realised, it will become increasingly commonplace in the communications practices of NHS Wales complementing the essential, operational communications we are all familiar with.
For future Spread and Scale Academies, I would sincerely recommend that teams reserve space for their communications colleagues on their tables. The worth of your stories cannot be overstated and having a colleague there to help you tell them while giving you a platform to do so will be invaluable to your project from day one.
As for me, the launch of the Dragon’s Heart Institute has gifted us with a platform upon which we can share the incredible stories of people within and outside of NHS Wales who are working to make it better however they can and I will continue to help them tell their stories as long as there is a story to tell. As another literary great, Terry Pratchett, writes, “There’s always a story. It’s all stories, really. The sun coming up every day is a story. Everything’s got a story in it. Change the story, change the world.”