The knowing-doing gap

Curiosity and a sense on incredulity occurred when I first read the statistics that essentially said that it takes on average 17 years before evidence of what works makes it into practice and that those that do are merely a slither from the tip of the iceberg – so many great things, things with potential to deliver positive change get lost down the abyss between knowing and doing. Why is that?

But hang on ‘Helen’, this isn’t just about the translation of academia into health and care practice, oh no, no, no…… this goes much deeper into the human psyche. Public health and government campaigns across the globe exhort the virtues and long-term benefits of ‘healthy living’ whether that relates to healthy eating, safe sex, increases in exercise, not smoking or taking recreational substances and limiting alcohol intake etc, however in many cases their words fall on deaf ears with people making a conscious choice to behave in the ways that they do, those behaviours seemingly being far more rewarding, at least in the short term, than the effort of making the required change – even when the pay off is much greater in the long term. What is this all about and what can we do about it?

I was assessing a new HOPE facilitator the other day on their maiden-voyage , sitting quietly at the back of the room, witnessing the delivery and experiencing first hand the impact that the programme was having on real people, when I was struck by the group discussion the developed in front of me.

It was started off from a seemingly simple statement made by one individual, innocently setting the scene for others to chip in. “We are all familiar with the words, we all know what we should do………. but it’s only since starting this course that I’ve been able to start to do these things“.

The person was right of course, all of the people in the room had been through the ‘NHS sheep dip’ of investigations, diagnosis, treatment etc and had all been given the same or similar information in the form of ‘professional advice’, leaflets and video’s etc, but clearly the messages that the NHS is so keen to relay to the public, with the belief that they should soak these messages up, somehow combining them with their DNA, to enact a permanent change in behaviour clearly simply does not work for many people.

The Everett Rogers model of attributes of a successful innovation demonstrates 5 key components to consider if you want the odds of your innovation or behaviour change sticking to be in your favour.

So what is it about the HOPE programme that helps people who for far too long feel that they have been stuck on an inescapable hamster wheel of struggling to overcome physical or mental health challenges, but never really getting anywhere? I suspect that the lesson’s shared by Roger’s can shed much light on the difference that this particular programme offers.

For a start across Devon and Cornwall people are seeing the ‘social proof’ from others, like them, who have tried and not only survived but have thrived as a result of the programme, this offers a sense of hope that things can be better. Relative advantage (tick)

The programme works particularly well when you bring people who share similar experiences together, whether that be health conditions or symptoms, such as chronic pain, fatigue, anxiety etc = Compatability (tick)

When you bring people together with shared experiences or purpose, providing them with a safe and non-judgemental space, you never know what will pop up in conversation!

It is simple and gentle in its format, scooping people up from week one when they embark on their own personal journey, but one that is shared with others treading the same path. The power of the programme is in its simplicity. = Complexity (tick)

we have even had some unexpected guests.

The programme is offered free across the community and although we actively target those people who describe themselves as having lower levels of knowledge, skills and confidence in managing their current health and wellbeing concerns, the programme is inclusive – all who desire HOPE are very welcome to give it a go. We have found that in the main when people join on week one, they stay the whole 6 week course. We have even had a small number of people come back for second helpings! = Triability (tick)

The last of Roger’s attributes for innovation is slightly more difficult to evidence for HOPE. People who attend the programmes are not ‘observable’ – we do not encourage onlookers to peep, reminiscent of a bygone era in Victorian entertainment, however we do offer HOPE to the workforce members of our system wide health, care and wider partners: after all those who care for others often require that same compassionate care, time and understanding for themselves – it is what makes us human. We also share the programmes reported outcomes, letters of HOPE and in the near future plan on recording podcasts where we can hear from participants directly, while maintaining their anonymity. = Observability (oh go on then, let’s have a final tick)

One of the 6 components of Personalised Care is “Building my knowledge, skills and confidence“. On its own it seems barely enough to turn the tide of poor health outcomes that are plaguing many in our society. Across the western world we may be blessed with increasing life expectancy, but without the accompanying health expectancy those extended years of life can be miserable and frustrating for all concerned.

Add “working in partnership with care team” and “connecting with help and support in my community” into the mix and we start to witness phenomenal positive changes, based on building relationships, human to human, where individuals believe that they can create a future that is meaningful to them.

From what I have witnessed in person, the strength in the HOPE programme, where people build knowledge, skills and confidence around their own health and well-being alongside others in similar situations, is in its ability to bridge that gap between knowing and doing while developing long lasting human connections.

A final couple of questions for you to consider as we end this blog;

  • How many of Roger’s attributes does your change work encompass and what can you do to build more of these into your work?
  • How can you incorporated all or some of the elements of Personalised Care into your change work, taking us one step closer towards flourishing lives and communities?

If this seems daunting don’t fret, we are here to help……. if you need to mull over any of the above, feel free to get in touch and we will assist where we can; after all when we combine forces, anything is possible..

I’m a Firewalker a twisted Firewalker

Guest Blogger: Emma Bewes – an awesomely brave change leader

Photo by Joshua Newton on Unsplash

If I asked you to walk on fire how many of you would actually go ‘hell yeah?” Not many, in fact most people would (did and still do) say are you mad?.

What is it that stops most of us from wanting to take that first step? Of course the obvious answer is that people are afraid they will get hurt (understandably with a firewalk it’s a visible risk) most people believe it can’t be done and more importantly believe they can’t do it, they don’t trust themselves or indeed understand how it can be done?

That was me as I embarked on a truly life changing long weekend run by Mr Tony Robbins called Unleash the Power Within.

Mr Robbins is a giant of a man, with a great heart to share all his learning from 30years plus experience in the world of personal development. His events are long days over 4 to 7 days and attended by thousands of people at a time.

So traveling up from  Devon to London and preparing for 4 long days, rising at 7am to queue  to get a good spot and not getting back to the hotel until gone midnight on several days, I was thinking how on earth am I going to have the energy to do this when I get so shattered after 9.5 hours. Well I smashed that limiting belief to smithereens.

You see in order to walk on fire, you need to understand that fear is the number one reason for most people stopping taking action. Sometimes fear is useful and necessary. Fear triggers the fight, flight or freeze (stress) response in our bodies. However, our brains were wired over 2 million years ago, and whilst parts have further developed there are still parts of it that believe we are being chased by sabre tooth tigers when in actual fact we are sat watching a horror movie.

                                            Photo by Robina Weermeijer on Unsplash

What we can develop is our ability to understand, change our minds and take control of our emotions and bodily responses, Mr Robbins describes this as changing our state.  On the first day, it’s very much about learning how to change your state in preparation for taking that first step on to the Firewalk.

You can change your state in an instant. Think about it, have you ever woken up in the morning dreading going into work because you are thinking about that meeting with your manager, the list of tasks you’ve got to do or that difficult conversation you have to have. You can feel the pressure building inside you (stress anxiety frustration even anger). You become more likely to grab some junk food or nothing at all, hit the caffeine, sugar,  looking to feel better, and forget to say goodbye to your loved ones (in fact you don’t remember that you have loved ones at that point).

You get to work, your manager has cancelled the meeting, you’ve received a compliment in your inbox and that difficult conversation isn’t as bad as first thought. How quickly do you feel lighter happier and less stressed?

There is a way you can change that state before you get to work. You can start your day by deciding what you are going to focus on, changing your physiological state and looking at the language you are using both out loud and in your head.

So for that first half an hour in the morning ( don’t tell me you can’t put half an hour aside for yourself!) here are some examples where you can change your state before work:

Focus –  read something in a book written by someone you admire, watch something funny, write a list of 3-5 achievable goals you will focus on today or check out the priming exercise on

Physiological – do some exercise (doesn’t need to be strenuous just a 5 min workout video) deep diaphragm breathing for at least one minute or more (this helps your body to get into its parasympathetic system which is the relaxed system), meditation.

Language – listen to what your thoughts are saying (write them down)  or how you are speaking to your loved ones and change it if it’s negative. Negative thoughts/language will trigger your sympathetic system (fight or flight stress) unnecessarily. 

Let me take you back to that difficult conversation you are due to have. How do you know it’s going to be difficult? It will be difficult if you focus on it being difficult. However, if you think to yourself my intention is to have an open and honest conversation as I want to get the best out of the situation? Then you have reframed it by changing your language and hence your focus.

The most important piece of learning is to practice practice practice. Success comes from failing, learning from those failures and keeping focussed on the reason you started on this path in the first place. Success is very rarely a straight line.

So back to the firewalk, yes I did it, no burns on my feet, a few black marks to remind me I did it (which washed off) How did I feel and what did I learn… I felt freaking awesome. I learnt what great things we can achieve , by taking a few simple steps to change our state and smash those limiting beliefs that aren’t serving us well. 

So I’d love to know what first step you are going to take today in making some permanent changes in your life? 

If you are interested in knowing more feel free to send me a private message on facebook: or

Emma Bewes has over 25 years experience within the Health and Social Care sector, beginning life as a mental health nurse. Over the last 5 years Emma has gained qualifications in strategic intervention coaching and become a workplace coach and mentor as well as leading health and social care teams in South Devon. Emma will be launching her own private practice in 2020

Trial and much error!

Helen and Chris:

In this blog post we are starting to share with you the lessons that we learnt around the flexible use of communication styles, dialogue and messages utilised, through trial and much error, to engage multi-disciplinary, multi-organisational and multi-community groups of people to buy into our vision and commit to join us in our social movement journey. The ride was by no means smooth, so strap in, as the road was certainly bumpy!

At the risk of being accused of trying to teach you to suck eggs, firstly we are going to reflect on what we believe it is about change that makes it seem so difficult, but is essential to achieve for those who are in the sustainability game.

Creating a climate of positive engagement for initiating a social movement for health was never going to be a gentle walk in the park, for a start it’s not what the NHS was initially set up to do. It was set up in 1948 to ‘fix things’ within the framework of a hierarchy, command and control that can now be referred to as ‘old power’. Indeed the seemingly but necessary chaotic essence of a social movement flies directly in the face of the highly controlled and precise, scientific nature of how business is usually done in the NHS and points to the need for ‘new power’, a different, collaborative way of doing things. That said we shouldn’t throw the baby out with the bathwater rather, instead we should be looking to blend the elements of the two, learning how to nimbly respond, improvise and transition, just as if we were playing in a jazz band.

In 1991 William Bridges declared that “It isn’t the changes that do you in, it’s the transitions. Change is situational: new policy, new boss, new site. Transition is the psychological process people go through to come to terms with the new situation. Change is external; transition is internal“. What Bridges described in 1991 was the ‘dis-ease’ resulting in fear that many people experience when change is first suggested or upon them. Brightman (2001) suggests that it is based on perceived threats to a person’s sense of mastery. Asking someone to make a change can call into question the value placed on a their skills and contribution, often challenging their work identity and their sense of purpose. The change that we were suggesting went even further, it encouraged the sharing of power and at times the standing to one side and letting go, enabling another to step into the ‘powerful position’, ie a loosening of the ‘control reigns’, moving from an inward to an outward mindset and to take a leap of faith into a form of social prescription.

Henry Timms & Jeremy Heimans describes the differences between Old and New power, the parts that they play and how best to blend these in the modern world. This is exactly the strategy that we needed to take with HOPE.

Many people working within the NHS are shackled to ‘Old Power’ rules, the way that our services, systems, processes and long cherished hierarchies have been set up. In order to shift the balance of power we needed to blend and adapt our messages and approaches; giving the appropriate amount of expected deference, while managing to introduce a challenge to their ‘world view’ about what is possible and achievable when there is a prepared willingness to try a different way.

Perhaps on paper that doesn’t seem too difficult a task but in reality shifting the balance towards new power takes time, patience and is underpinned by high levels of trust. The NHS doesn’t have the luxury of time to wait before it transforms into the new world, this is something that needs to be acted upon now! However as we all know ‘now’ in the NHS can take an extraordinary length of time.

If only we had spent time from the outset, identifying the team’s and individuals adoption profiles before we entered the ‘colosseum’ of delivering presentations, we would have saved ourselves much time, anguish and frustration. The graphic below will give you a better idea of what we are talking about, however essentially, many working in the health and care arena sit on the right side of ‘THE CHASM’

This is something to celebrate when what you need is a safe pair of hands, who are rarely distracted and are highly skilled in their specialist fields. Having been a patient in the hands of such a skilled professionals it is of paramount value to feel confidence in their profound competence.

This said when you are looking to disturb the status quo and introduce uncertainty into their world, the people comfortably sitting on the right hand side of the graph are not the place to start conversations leading to transformational change – a painful error that we made on several occasions, forcing us to question what on earth we were trying to achieve and retreat to a quiet corner in order to lick our wounds and regroup.

There is a great saying in the world of Organisational Development (OD) “Go where the energy is“, when you are trying to bring about change. On reflection we kicked ourselves that although we knew this, why did we not pay enough attention to this from the outset, and instead repeatedly made same mistake over and over again?

What we found was that those individuals and groups who sit on the right hand side of the diffusion of innovation curve, would readily invite and welcome us to their group meetings, where they would be present in force. They would politely listen to what we had to say and thank us for our time, then ‘politely’ turning us down, before pointing us in the direction of another area who may be interested in our offer. On the other hand, those people who reside on the left-hand side of the curve sought us out for initial conversations, to explore possibilities and we very quickly recognised that they were our local innovators, visionaries and creators who were able to share our vision and passion for the new and join us on our amazonian journey.

On reflection we mistook and misunderstood the apparently open welcome of the teams sitting on the right hand side as the energy that we were seeking to follow. As the jungle drums began to beat, more and more of the same tribe invited us to their meetings, only to respond in similar ways, disappointing to us. Which brings to mind the The Spider and the Fly  poem by Mary Howitt published in 1828 where the opening lines are: ‘Will you walk into my parlour?’ said the Spider to the Fly.

(Note to selves – be mindful of the innovation profiles of those people you seek to engage with)

The energy contained in ‘new power’ has ability to reach and unnerve us all. Why? you might ask. In order for a true shift in power to occur, to be seen and felt as authentic by the receiver, the language that we use needs to be followed through by congruent actions. Whilst this it would seem is not a new concept, the ability to put ones ‘ego’ and self interest to one side isn’t often easy to achieve, particularly in turbulent and frequently chaotic environments that stir the beast of fear in the most level headed and professionally competent of us.

Moving to a position of true partnership between all parties and away from where one person or group holds the perceived power is Utopia in the land of true personalised care however in our experience the Amazon jungle path is fraught with vines, creepy crawlies and ferocious beasts, all sent to floor our well-intentioned attempts.

If you’d like to learn more about old and new power and how you can utilise these to best effect in your situation, NHS Horizons School for Change Agents 2019, is a great place to start. If you missed the formal 6 week online ‘school’ you can still access the live recorded video sessions here:

We tantalised you in our last blog about sharing some chucklesome remarks and terminology that people used in an apparent attempt to deflect our efforts so here you go! (forgive us for being human – we have tamed our typed thought responses so as not to cause offence;)

Next time we meet, Chris will be sharing with you her musings and learning around the power of developing relationships and conversations to help us more easily navigate through the jungle undergrowth.

If you haven’t seen the short film “Your Very Good Health” that introduced the NHS to the population in 1948, it is well worth a watch and shows us how far we have come already – it appears that the NHS has always brought about large scale change after all – who would have thought!

Part two ‘Passing a Movement Forward’


Starting from the assertion that “The NHS belongs to the people” I was intrigued as to how we could harness the deeply ingrained and valued principles of the NHS Constitution into the ‘health as a social movement’ reality espoused by Simon Stevens in 2014.  Clearly some understanding about human psychology was needed to bring onto play as well as a whole heap of convincing and influencing of the ‘great and the good’ to let us give it a try.  We had little to lose and a lot to gain, yet even then, we were expected to leap through fiery hoops of financial assurance, and provide evidence of a realistic ‘route to cash’, after all we were making the bold and audacious request to allocate £7,500 to cover the set-up and implementation of the project in 2018/19.  Clearly our superabundant budget request sent the financial risk worry beads hurtling into orbit

Therein started a series of seemingly endless briefing papers project plans, business cases and presentations to boards and groups of siloed people.  As an aside, we are more than happy to share any of these documents to those of you who may wish to emulate our model and intend to load as many as possible onto the portfolio page on this site, but please be mindful that even when armed with countless eloquently written documents, you are still likely to have a challenge convincing those with ‘the power to permit’, to put aside their incredulity and hysterical laughter for a moment and hear what you have to say.  One piece of advice for you find your allies, you’ll need them to help maintain your resilience, and as Helen Bevan says “Go for no!” ( ). You have to be tenacious and be prepared for many closed doors and rejections if you want to succeed and join the well trodden path of the people in the graphic below.

Committed individuals who are drawn to working to improve the lives of others are found in their masses in the UK ‘caring industry’,  however regulatory and financial targets have increasingly become key focusses for organisational leaders, severing  in the minds of some, the connection between what makes the NHS the ‘National Treasure’ that it is and the constant struggle and demands to deliver commissioner driven targets.

Integration is the way forward, we are told, however in the minds of many commissioners, regulators and leaders, provider organisations need to be directed and commissioned by way of hard negotiated contracts to deliver services.  This has a tendency to create  and reinforce the silo working that we are told to disassemble and in a way works against the very essence of integration that we strive towards – after all contracts = £’s, which therefore introduces competition and rivalry into the equation.

The social movement that started in South Devon in 2017, pushed back against the usual way of developing services, refusing to capitulate to the ‘way we do things around here’ mentality and yet still has a governance structure (albeit a loose one), quality assurance frameworks, is building a qualitative and quantitative evidence base and most of all an energy built on passion, a desire to give something back, a drive to improve the lives of others and a drive to maximise our purpose. Dan Pink beautifully illustrates what drives human being to be purpose maximisers here: .  This 11 minute video at the time of writing has had over 17,124,458 views, if you haven’t watched it yet don’t be the one who misses out because grasping the knowledge that Dan Pink shares will ease your journey into orchestrating your own social movement for health and wellbeing.

We built a collaborative partnership between primary, secondary, community and social care; mental and, physical health the voluntary sector and most importantly people with lived-experience. Our work was and is still not formally contractually ‘commissioned’ but was supported in bucket loads by our organisations Chief Executive. We believe that the movement has been possible in part by it’s lack of contractural commissioning. Without contracts we were able to engage with, collaborate and work flexibly and creatively together as an ever growing community of people with a shared purpose, maximising it’s impact across our geography.

Oh and by the way, that hard won budget of £7,500 for 2018 …………. ended being underspent by £5,000. The £2,500 that was spent, mainly went on:

  • Funding of community venues (we were very keen to focus this away from the acute hospital as the vast majority of health and wellbeing occurs in the community that a person lives in),
  • Training resources for facilitators (the model that we use is each HOPE programme ideally being co-facilitated by two facilitators, a member of the ‘workforce’ and a facilitator with ‘lived-experience’)
  • out of pocket expenses for volunteers
  • and a very small amount went on volunteer drivers who transported the few in number who were unable to get to the courses on their own.

The first part of this series set the scene for our journey , go back and have a quick read, if this is the first of our blogs you have read – it will give you the context. Next time, Chris and I will focus on the different messages that we utilised through trial and much error, when presenting our idea to differing groups of people, including the chucklesome nuances of communicating with some male doctors in senior consultant positions.

Please sign up to follow this blog by entering your email at the bottom of the home page here: . Share with us your thoughts about what you have read, in the pages comment box. We want this blog to be interactive and welcome comments and questions from readers as we believe that as a community we can all learn from each other.

In order to be of service to you, we need to understand what you’d like us to describe and share with you to help you make sense of the opportunities that you have in your local system. Interventions are rarely ‘lift and shiftable’ in facsimile form. According the the Health Foundation (2018) For things to be spreadable and scaled we will need to codify how and what we have done so that you may take the bits that are relevant to you, enabling you to then emulate and improve on our current model, in your local system – by making it your own you can avoid the ‘Not invented around here’ syndrome of non-engagement by stakeholders.

Things take longer than we usually expect, here is a basic outline to give you an idea of how long it has taken to date. The below timeline was created for you on advice from a twitter follower- Thanks, ‘Alison Waters’!

Until next time take care and embrace your inner possibility architect, you won’t know what you are capable until you try.

P.S. Huge thanks to Lyn and Jonathan Ward for the gorgeous photo of Fistral Beach Cornwall.

Passing a Movement Forward

Helen Davies-Cox

It was back in 2014 that I first came across an interview with the then new Chief Executive of NHS England ‘Simon Steven’s’. When asked about the challenges ahead for the health of the population and how the NHS needs to respond, he referred to the need to create a  “social movement for health’

This was both a curious and intriguing concept for my ‘NHS brain’ to consider, having had 29 years’ experience on the job.  Surely the NHS, ‘our National Treasure’, an institution held in international envy and esteem, an organism with its own set of peculiar cultures, sub-cultures and training, a monolith of gigantic proportions, couldn’t design and create a social movement.  For a start, the NHS is recognised as being risk averse and social movements by their very nature are uncontrollable, flexible and adaptable with few governance structures, the very opposite of how the NHS has been designed and developed. How on earth could the NHS become a social movement, generating social change from the ground?  

The challenge therein certainly got me thinking and at first it felt like an impossible ask, yet here I am today orchestrating a personalised care social movement based around peer-support, self-management education and health coaching.  A social movement that appears so incredible and amazing that people from all walks of life, near and far afield want to understand and emulate what we have done.  It is worth emphasising here, the most important two letter word in the last sentence you have just read ‘we’, it may seem a small point, however if you indulge me with your attention it will soon become apparent that although I am seen locally to be leading this programme, in fact it is the many, the people of Devon and increasingly the people of South West of England who are the ‘we’, I refer to, without whom our social movement ‘HOPE’ would merely be a figment of my possibility architect brain.

We are only too aware; having been an NHS England ‘Demonstrator site’ for Integrated Personal Commissioning and now an ‘Exemplar site’ for Personalised Care it can bring many demands and tribulations in the form of reporting and ‘feeding the beast’.  However what it also brought was an opportunity to draw down funded support from the Voluntary, Community and Social Enterprise (VCSE) sector.  One of the offers available in 2016/2017 was to work with Coventry University’s professor Andy Turner  Andy Turner is an innovator who created the HOPE programme.  Andy’s work at Coventry included evaluating several successful and popular self-management programs. By taking the best bits of these programs and synthesising them together within a positive psychology framework, he and his colleagues have created a program which they call Help to Overcome Problems Effectively or ‘HOPE’. HOPE is a six week programme that runs for 2 ½ hours a week and blends peer-support, self-management education and health coaching into a seemingly magical combination. It has become the catalyst that is bringing personalised care approaches to life across Devon and is now spreading further afield into the wider South West Region and gathering interest from across England.

Let me take you back a few steps…..”HOPE, why call it HOPE Andy?” I asked (Andy Turner’s following response is paraphrased).  “When we first developed the program we tested it out on several groups.  At weeks one and five, we ask the participants to each identify and write down three emotions that they are feeling.  We then create a word-cloud.  At week six we show them the before and after word-clouds to demonstrate how far they have come.  The one word that stood out time and time again in the second word cloud was ‘Hope’, so we decided to make an acronym out of it, Help to Overcome Problems Effectively. But it also simply means ‘Hope’ – the program seems to bring a real sense hope to people!” Trust academics to turn it into an acronym!

The possibility architect in me then started thinking………………… the system in which I was working, like many other systems, was experiencing significant pressures in terms of capacity and available finances.  This environment brings about challenges and also opportunities; after all it is often when our backs are to the wall as a species, that we are our most creative and innovative.  What if supported self-management in the guise of HOPE could be the thing that helps us to cement personalised care approaches across our system? Integrating primary, secondary, community and social care; mental and, physical health the voluntary sector and most importantly people with lived-experience, a truly holistic approach to creating the social movement for health that Simon Stevens challenged us to create in 2014?

If this is something that interests you; and you wish to orchestrate your own local or even national social movement for health, utilising personalised care as the chassis of choice, in the weeks to come we shall share with you our journey, the hill climbs, the pot-holes, the dead ends and the high speed stretches of road where there are no ‘National speed-limits’, only clear roads ahead and the wind in your hair, after all who doesn’t love to go topless! 

You are very welcome.

This our first foray into the blogging world, where we intend to describe and demonstrate what it takes to architect and deliver change that makes a real difference to people, organisations, communities and most importantly you.

The blogs will be mainly written by us, Helen or Chris, but we will occasionally publish guest blogs from people whose work or life stories we admire and who share our closely held values of inclusivity, compassion, honesty and insatiable curiosity for the possible in making this world and our health and care services, the very best that they can be.

Join us on this exciting journey, interact, comment, share your views, insights and ideas, after all ‘It takes a village to raise a child’ or in this case ‘a whole bunch of possibility architects and change agents to change the world’.

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