Individual and collective action – what is needed?

• A ‘bottom-up’ or grassroots initiative is one that is people-led.
• Individuals, as change agents, are engaged in action in response to a shared concern and/or strongly desired change that directly or indirectly affects them and that they believe needs to be changed (e.g., stopped, sped up, and/or improved).
• They may be in informal roles of power lacking status and authority; however, because they are affected by the shared concern or a desired change, they have a high level of interest in finding solutions.    
• This approach to change differs from a traditional ‘top-down’ one in which formal leaders (e.g., senior management teams or those with power, status and authority) lead or download a planned change initiative with a varying degree of input or decision-making from point of care staff. Staff’s participation is determined by formal leaders and may include the use of steps, such as coercion, rewards, recognition, or avoiding punishment as external sources of motivation to support change.
• The actions taken are intentional and directed at applying pressure to a situation or issue that has been building over time towards the change; actions are also taken to create solutions or new ways of being.

SOURCES: Bibby et al., 2009; Burbidge, 2017; Campbell, 2020; del Castillo et al., 2016; Grinspun, 2018; Hilton & Anderson, 2018. 

Defining individual and collective agency

Individual agency is made up of:

1. the power or capacity to be able to think and take action autonomously, and make choices to change outcomes;
2. a belief in having the ability and resilience to achieve and expand possibilities, and address and equalize power imbalances;
3. the courage to take action in an attempt to reach goals and change outcomes.   

• Collective agency involves people acting together for a shared cause and using their combined individual agency or power and courage to achieve change. 
• Agency does not occur in isolation but can be influenced by factors including gender, class, ethnicity and institutions (e.g., governments). These social structures can shape individuals’ thoughts, values, behaviours, experiences and choices over their lifetime. For example, an older person may believe they have less power in society because of their age, as defined by social structures that emphasize and favour youth. However, agency is the power and courage to create experiences and outcomes beyond those determined by social structures.

Individual and collective agency in social movement 

• In a social movement, agency is needed because individuals, groups and others must believe that change is possible and that it will occur as a result of their combined actions, power and courage.
• When realized, the power of values, evidence and courage can be key motivators for change agents to speak out leading them to take action such as advocating and protecting the rights and needs of persons and their families to create improved health outcomes. 
• When individual and collective agency is present, it is more likely that change will occur and happen more quickly with bigger results.  
• A social movement is fueled by the shared positive energy of people and their ability to engage in individual and collective action, access to the necessary resources for change, and the scope and scale of the social movement.

SOURCES: Bevan et al., 2011; Bibby et al., 2009; Burbidge, 2017; Grinspun, 2016; Grinspun, 2017b; Grinspun, 2018; Hilton & Anderson, 2018; Tushabe, 2016; University of Michigan School of Nursing, 2020.

• Believe that change can be achieved and is more powerful when people combine their efforts and work together.  
• Seek to include people who are directly and indirectly impacted by the shared concern or a strong desire for change; they will be invested and care about the cause and outcomes if they are personally affected.
• Recognize that change requires a high level of energy, especially where there are barriers or resistance to change. Avoid working in isolation. Recognize and acknowledge the power and results achieved through shared purpose and collaboration.   
• Co-design the change with change agents, staff and others.

SOURCES: Bate et al., 2004a; Bibby et al., 2009; Carson-Stevens et al., 2013, Klaus & Saunders, 2016; Tremblay et al., 2018.

• The success of a social movement can be predicted in part by whether change agents have developed bonds or social ties with one another. This occurs through the shared experiences of mobilizing in collective action and the development of a shared or collective identity.  
• Social ties reinforce participants’ commitment to the shared concern or the strong desire for change and to one another as partners in the change. 
• Change agents are influenced or even pressurized by one another to continue to engage in the social movement, because of their social ties and commitment to the opportunities, concerns and passions about the change needed.

SOURCES: Bate et al., 2004a; Serna Restrepo et al., 2018. 

• A critical mass of committed and motivated people who are committed to working together to achieve change are needed for individual and collective action.
• Support structures, including informal networks and core leadership structures, are also needed. Informal networks act as points of connection amongst change agents and others, and core leadership structures (e.g., change teams, steering committees) support the social movement as it evolves. These components are discussed in the chapters on networks and core leadership structures.

SOURCES: Bate et al., 2004a; Embry & Grossman, 2006.