Lots of us spend a great deal of time thinking about how to change entrenched organisations and public services, and I think this change model from Helen Bevan and the NHS Horizons team is a really helpful tool for that. It’s also here with animation.

It shows all the things you have to influence to create change in an organisation, system or area. Above the waterline are the familiar things that we try to change when we talk to a council, an NHS organisation or another body: its vision, policies, goals etc. But below the waterline are the other things we need to change which are harder to identify and which the organisation itself may not even recognise: its values, underwritten rules, beliefs, myths….

What this says to me is that when we are trying to introduce Shared Lives, Homeshare or Family by Family to an area or organisation, we need to pay as much attention to what’s below the waterline as what’s above. So we need to use story telling as much as we use data. We need to find and support internal champions in the organisation, who can engage with their organisation’s culture and beliefs, as much as we need to make our more formal external offers such as business cases, options analyses and cost-benefit data. This is why the work done by our Ambassadors, who all have lived experience of using our members’ support, makes such a difference: they have often experienced directly the impact of what happens in organisations below the waterline, and their insights and moral authority reaches the parts that colleagues who lack that kind of experience cannot.

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