In my last post, I explored ideas on motivating and mobilising for change from Marshall Ganz, based on his 45 years of experience as a community activist, movement leader, Harvard academic and designer of campaign strategies. This is part two of my reflection on Ganz’s writings, focusing on the art of strategising for large scale change.  I’m going to assume that you have read part one. I will try not to repeat any of the previous content, although it is hard to separate strategising from mobilising within an overall approach to transformation.


In this post, I want to concentrate on some particularly aspects of the story that Ganz tells in his study of the California farm workers movement in the 1960s “Why David Sometimes Wins”. The book focuses on three generic issues:

  • How can those without power successfully challenge the powerful?
  • How can the ability to be “strategically resourceful” compensate for a lack of resources?
  • How can the process and actions of leadership move us from where we are to where we want to be?


These are helpful questions in the context of the unprecedented challenge we face to deliver cost, quality and wellness outcomes across the entire NHS system. Other large industries have undergone the breadth of change we envisage for the NHS, but the pace we seek is largely unprecedented. This is how I would frame Ganz’s questions for our current undertaking:

  • Are there some different ways of thinking about how we can challenge the status quo, the vested interests and perverse incentives in the current NHS system that get in the way of delivering high quality, high value care for all?
  • Given that most of the resources of the NHS are locked up in the current ways that we deliver care, how can we unlock resources to support and deliver the transformational changes we need?
  • What should NHS leaders do to get us to where we need to be?


Ganz highlights creativity in strategising as a key characteristic that defines great social movement leaders. Such leaders devise novel ways to challenge the status quo and those with more power. People who challenge the existing order rarely have access to the conventional resources that are available to those who defend the status quo so they have to find novel and creative ways to compensate for lack of resources by being strategically resourceful. “Strategic resourcefulness” is how we turn what we have into what we need to get what we want. It is about transforming our resources into the power to achieve our purposes.


In the book, Ganz illustrates the use of creativity and strategic resourcefulness through the story of a group of grape workers in 1966 who had been on strike for five months for union recognition. Little progress was evident. Therefore, the movement leaders decided to organise a march to Sacramento, the state capital, to “put heat” on the Governor. However, as Lent was approaching, they ingeniously decided to frame the march as a pilgrimage, a “peregrinacion”, asking for penance and forgiveness, complete with a massive wooden cross, draped in black cloth. The march achieved massive public support and mobilisation, with thousands lining the streets each day. The movement leaders were able to connect with the profound sense of grievance and injustice within the Mexican-American community and reframe the struggle from an industrial dispute to a farm workers’ call for justice and the community’s call for a voice in public life. They interpreted themselves as an oppressed minority struggling for its freedom rather than as just another union. In the face of nationwide negative publicity, the grape producers (the employers) caved in and the movement leaders signed the first real union contract in Californian farm labour history.


Ganz also uses this example to stress the need to focus the resources and energy of the movement on a single strategic outcome for a sustained period of time. Often, people join up to movements with different positions on key issues or different ideas about priorities. In wanting to keep everyone happy, the leaders allow “a thousand flowers to bloom”. The result is diffusion of effort, wasted resources, confused supporters and devaluing of individuals’ contributions. What is the relevance for our movement for quality and value moving forward? One of our biggest challenges will be to keep our strategic focus on a small number of key issues based on evidence and buy-in, rather than a hundred thousand well intentioned but isolated initiatives.


Motivation is a critical component in creative strategy. I know that I am straying into “blog part one” territory but I wanted to make the point that people who are highly motivated are more focused, persistent, willing to take risks and sustain high energy. In addition, strategic capacity is more effectively developed by diverse leadership teams than by individual leaders. Teams with disparate interests and experiences bring a wider set of perspectives ideally with both “insiders” and “outside” perspectives on a situation. They bring a range of different ties and connections to different peer groups and they bring a wider range of experience of collective action.


I relate this to our current context and the fact that quality improvement and cost containment have nearly always been the responsibility of separate sub-groups within the NHS system. Quality has typically been led through clinical governance, or by improvement specialists or clinicians with a special interest. Cost reduction has generally been led by the Director of Finance or operational managers. We need to raise the bar by enabling an uncommon alliance between these ‘camps’ and by truly understanding what it will take to make quality and cost everyone’s business and deliver rapid whole-system change, just like the diverse teams that changed the world in Marshall Ganz’s writing.


The final big message that I take from the writings of Marshall Ganz is that, contrary to much change thinking in the NHS, it is impossible to mobilise at scale by appealing to people’s self interests, “what’s in it for me?” You can only create and sustain large scale change through a foundation of core values that are shared by leaders and followers alike. Shared values are a prerequisite for the commitment, courage and sense of common purpose required for transformation. We need to focus on hope, opportunity and a different future. As Ganz puts it:


“We got used to the politics of disappointment — figuring out how soon we are going to be let down. …There’s a different dynamic in the politics of hope. It’s much more challenging. It means you’ve got to get up and do something. There’s opportunity. If you don’t take advantage of that opportunity, you really have to bear responsibility for not doing so. That’s how I see the time we’re in.”                                   

We are at an extraordinary moment in the history of the NHS, a time of both possibility and uncertainty. It requires an extraordinary leadership response. The power is in the status quo, in the ways that we have traditionally worked, in our professional and organisational silos. As Ganz says, leadership involves “taking responsibility to enable others to achieve purpose in the face of uncertainty”. Strategic resourcefulness becomes a core leadership capability in our brave new world.