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Dr Helen Bevan, OBE
Professor of Practice in Health and Care Improvement, Warwick Business School, England
Strategic Advisor, NHS Horizons, England
Senior Fellow, Institute for Healthcare Improvement, USA
@HelenBevan #RDF24
Leading large scale
change: a life at
the interface
between theory
and practice
To view the slides:
bit.ly/SWFTimprove
When we ask leaders what they think about when
deciding how to go about any major organisational
change, they often struggle to answer. Too often, their
attention is focused on the what of change — [eg, new
operating model or roles in new org structure]— not
the how — the particular way they will approach such
changes. Such inattention to the how comes with the
major risk that old routines will be used to get to new
places.
Rowland D, Thorley T, Brauckmann N (2023) The Most Successful
Approaches to Leading Organizational Change, Harvard Business Review
In every community, organisation or
social group, there are individuals whose
exceptional behaviours or practices enable
them to get better results than their
neighbours with the exact same resources.
Positive deviants
‘
Jerry Sternin
@HelenBevan #RDF24
Step 1
Use routinely collected data to identify positive
deviants who consistently excel in area of interest
Step 4
Disseminate the PD strategies to the community
with the help of key stakeholders
Step 3
Test the hypotheses in larger, more representative
samples of the community
Step 2
Study positive deviants to generate hypotheses
about strategies they use to succeed
Source: Baxter R, Lawton R, (2022) The Positive Deviance Approach. Cambridge Elements
Positive deviance: a research methodology
Willis Towers
Watson says
75%
What proportion
of organisational
change initiatives
fail to achieve
their objectives?
says
60-70%
says
70%
New Study Explores Why Change
Management Fails - And How To
(Perhaps) Succeed
says
66% are less than a clear
success
Demystifying change management
Perspectives on transformation
Organizational Change Management
@HelenBevan
In every community, organisation or
social group, there are individuals whose
exceptional behaviours or practices enable
them to get better results than their
neighbours with the exact same resources.
Positive deviants
‘
Jerry Sternin
@HelenBevan #RDF24
What can we learn
from thousands of
“positive deviant”
change leaders?
Text in Arial Bold
24 point text
Text in Arial Bold
16 point text
500
Text in Arial Bold
16 point text
High levels of ‘social capital’ -
relationships within and between
groups that form trust, relatedness,
and collective capacity - create the
strong foundations that change and
improvement initiatives can build on.
@HelenBevan
#RDF24
1. They regard relationships not just as a
priority, they’re a precondition
@HelenBevan #RDF24
Relationships make the biggest difference when it
comes to our ability to deliver change and
improvement
• Evaluation of NHS hospital systems that undertook
comparable improvement initiatives with vastly different
outcomes
• The difference? The level of social connections between
those leading local improvements
Source: Nicola Burgess, Warwick Business School, evaluation of the
partnership between the NHS and Virginia Mason Institute
@HelenBevan #RDF24
Source: Nicola Burgess, WBS
The difference? The level of social connections between
those leading local improvements
Leaders of change need to be
able to access multiple forms
of power; getting the backing
of leaders with formal
authority in the system AND
the informal influencers who
can make or break the
change.
2. They exercise power to make change
happen
@HelenBevan #RDF24
new power
Current
Made by many
Pulled in
Shared
Open
Relationship
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
old power
Jeremy Heimens, Henry Timms New Power (2018)
Change isn’t top-down, nor is it bottom up.
It emanates from the centre of networks.
Ironically, the way you get to the centre is
by connecting out to small groups, loosely
connected and uniting them with a shared
purpose.
Greg Satell (2024) Change can come from anywhere
The Network Secrets of Great Change Agents
Julie Battilana &Tiziana Casciaro
As an influencer of change, my centrality in the informal
network is more important than my position in the
formal hierarchy
Find the people with the informal power
Just 3% of
people in a
typical
organisation
drive the
conversations
with 85% of
the other
people.
Source: Innovisor Connectivity is broken: so what?
The 3% “superconnectors”
@HelenBevan #RDF24
A superconnector:
Lou Rodrigues, Betsi Cadwaladr University Health
Board
• Head of Continuous
Improvement at the Health
Board
• “Lou knows everyone”
• Go-to person for
improvement advice
• Makes sense of things for
people
• “Where you find improvement resources on X/Twitter and LinkedIn”
• Leads #QIHour and #QITwitter
• The starting point for those who want to use social influence for knowledge
mobilisation
A major cause of change failure is poor dialogue with the
informal organisation.
The 3% informal influencers:
• Have the relationships and connections
• Drive the perceptions of other people
• Are trusted by peers more than formal leaders are trusted
• Are often unknown to formal leaders
• Are typically not the people who start change but act as the key
accelerant for conversion to new ideas through social
reinforcement
Why superconnectors?
@HelenBevan #RDF24
How do you find your
“superconnectors”?
Ask other people!
Who do you
go to for
information
when you have
concerns at
work?
Who’s
advice do
you trust
and
respect?
@HelenBevan #RDF24
What does this mean for me?
Find my 3%
• Get their insights
• Engage them in change
• Consider their role in
the change
• Stay connected for the
long haul
Be a
connector
• Build my own networks
and connections around
the change I’m
passionate about
• Be a role model of trust
and positive behaviour
• Always, always follow
up
@HelenBevan #RDF24
A Dutch proverb
simonterry.com/2017/07/31/trust-is-precious/
Trust arrives on a
tortoise…..
…..and leaves on a horse
A cathedral
A complete and fully formed idea that you
are emotionally invested in and attached to.
It can block collaboration in its tracks.
A brick
Create the space for each person to
contribute (a brick).
You help them have an emotional
connection to the collaborative
process
Brick by brick, you start to create
something better than what one
person would have done alone.
Source: Ally Muller
3. They bring bricks, not a cathedral
4. They grow "Trojan mice“: they
nearly always work better than
"Trojan horses”
“Trojan mice… are small, well focused changes, which
are introduced on an ongoing basis in an inconspicuous
way. They are small enough to be understood and owned
by all concerned but their effects can be far-reaching.
Collectively a few Trojan mice will change more than one
Trojan horse ever could.” (Jarche, 2012).
Having many people across the system who
have the skills and agency to test out small,
well focussed changes to address complex
problems (Trojan mice) nearly always works
better than large pilot and roll out projects
(Trojan horses).
@HelenBevan #RDF24
Trojan mice fail often, fail early and learn
greatly
Cost
of
an
error
Project timeline
Launch
Experiment,
fail and learn
here
Too
late
https://ssir.org/articles/entry/wheeling_in_the_trojan_mice#
@HelenBevan #RDF24
5. They build constancy of purpose for
the long haul
Most large-scale change efforts
just fizzle out; successful change
needs leaders who keep the faith
through interest and energy, don’t
meddle when results don’t come
quickly and stick with the change
priorities.
@HelenBevan #RDF24
@HelenBevan #RDF24
• Prioritise relationships
• Unleash informal power as well as work with formal authority
• Design change collaboratively
• Build a large-scale capability for experimentation (Trojan mice)
• Stick with change for the long haul
To enable change, we should:
How an
expert
thinks
How an
explorer
thinks
EXPERTISE
Source: based on Adam Grant (2021). Think Again: The Power of Knowing What You Don’t Know.
Many times experts fail because
they are experts in a past version
of the world
Vikram Khosia
How an
expert
thinks
How an
explorer
thinks
EXPERTISE

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Leading large scale change: a life at the interface between theory and practice

  • 1. Dr Helen Bevan, OBE Professor of Practice in Health and Care Improvement, Warwick Business School, England Strategic Advisor, NHS Horizons, England Senior Fellow, Institute for Healthcare Improvement, USA @HelenBevan #RDF24 Leading large scale change: a life at the interface between theory and practice To view the slides: bit.ly/SWFTimprove
  • 2. When we ask leaders what they think about when deciding how to go about any major organisational change, they often struggle to answer. Too often, their attention is focused on the what of change — [eg, new operating model or roles in new org structure]— not the how — the particular way they will approach such changes. Such inattention to the how comes with the major risk that old routines will be used to get to new places. Rowland D, Thorley T, Brauckmann N (2023) The Most Successful Approaches to Leading Organizational Change, Harvard Business Review
  • 3. In every community, organisation or social group, there are individuals whose exceptional behaviours or practices enable them to get better results than their neighbours with the exact same resources. Positive deviants ‘ Jerry Sternin @HelenBevan #RDF24
  • 4. Step 1 Use routinely collected data to identify positive deviants who consistently excel in area of interest Step 4 Disseminate the PD strategies to the community with the help of key stakeholders Step 3 Test the hypotheses in larger, more representative samples of the community Step 2 Study positive deviants to generate hypotheses about strategies they use to succeed Source: Baxter R, Lawton R, (2022) The Positive Deviance Approach. Cambridge Elements Positive deviance: a research methodology
  • 5. Willis Towers Watson says 75% What proportion of organisational change initiatives fail to achieve their objectives? says 60-70% says 70% New Study Explores Why Change Management Fails - And How To (Perhaps) Succeed says 66% are less than a clear success Demystifying change management Perspectives on transformation Organizational Change Management @HelenBevan
  • 6. In every community, organisation or social group, there are individuals whose exceptional behaviours or practices enable them to get better results than their neighbours with the exact same resources. Positive deviants ‘ Jerry Sternin @HelenBevan #RDF24 What can we learn from thousands of “positive deviant” change leaders?
  • 7. Text in Arial Bold 24 point text Text in Arial Bold 16 point text 500 Text in Arial Bold 16 point text High levels of ‘social capital’ - relationships within and between groups that form trust, relatedness, and collective capacity - create the strong foundations that change and improvement initiatives can build on. @HelenBevan #RDF24 1. They regard relationships not just as a priority, they’re a precondition @HelenBevan #RDF24
  • 8. Relationships make the biggest difference when it comes to our ability to deliver change and improvement • Evaluation of NHS hospital systems that undertook comparable improvement initiatives with vastly different outcomes • The difference? The level of social connections between those leading local improvements Source: Nicola Burgess, Warwick Business School, evaluation of the partnership between the NHS and Virginia Mason Institute @HelenBevan #RDF24
  • 9. Source: Nicola Burgess, WBS The difference? The level of social connections between those leading local improvements
  • 10. Leaders of change need to be able to access multiple forms of power; getting the backing of leaders with formal authority in the system AND the informal influencers who can make or break the change. 2. They exercise power to make change happen @HelenBevan #RDF24
  • 11. new power Current Made by many Pulled in Shared Open Relationship Currency Held by a few Pushed down Commanded Closed Transaction old power Jeremy Heimens, Henry Timms New Power (2018)
  • 12. Change isn’t top-down, nor is it bottom up. It emanates from the centre of networks. Ironically, the way you get to the centre is by connecting out to small groups, loosely connected and uniting them with a shared purpose. Greg Satell (2024) Change can come from anywhere
  • 13. The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro As an influencer of change, my centrality in the informal network is more important than my position in the formal hierarchy
  • 14. Find the people with the informal power Just 3% of people in a typical organisation drive the conversations with 85% of the other people. Source: Innovisor Connectivity is broken: so what? The 3% “superconnectors” @HelenBevan #RDF24
  • 15. A superconnector: Lou Rodrigues, Betsi Cadwaladr University Health Board • Head of Continuous Improvement at the Health Board • “Lou knows everyone” • Go-to person for improvement advice • Makes sense of things for people • “Where you find improvement resources on X/Twitter and LinkedIn” • Leads #QIHour and #QITwitter • The starting point for those who want to use social influence for knowledge mobilisation
  • 16. A major cause of change failure is poor dialogue with the informal organisation. The 3% informal influencers: • Have the relationships and connections • Drive the perceptions of other people • Are trusted by peers more than formal leaders are trusted • Are often unknown to formal leaders • Are typically not the people who start change but act as the key accelerant for conversion to new ideas through social reinforcement Why superconnectors? @HelenBevan #RDF24
  • 17. How do you find your “superconnectors”? Ask other people! Who do you go to for information when you have concerns at work? Who’s advice do you trust and respect? @HelenBevan #RDF24
  • 18. What does this mean for me? Find my 3% • Get their insights • Engage them in change • Consider their role in the change • Stay connected for the long haul Be a connector • Build my own networks and connections around the change I’m passionate about • Be a role model of trust and positive behaviour • Always, always follow up @HelenBevan #RDF24
  • 19. A Dutch proverb simonterry.com/2017/07/31/trust-is-precious/ Trust arrives on a tortoise….. …..and leaves on a horse
  • 20. A cathedral A complete and fully formed idea that you are emotionally invested in and attached to. It can block collaboration in its tracks. A brick Create the space for each person to contribute (a brick). You help them have an emotional connection to the collaborative process Brick by brick, you start to create something better than what one person would have done alone. Source: Ally Muller 3. They bring bricks, not a cathedral
  • 21. 4. They grow "Trojan mice“: they nearly always work better than "Trojan horses” “Trojan mice… are small, well focused changes, which are introduced on an ongoing basis in an inconspicuous way. They are small enough to be understood and owned by all concerned but their effects can be far-reaching. Collectively a few Trojan mice will change more than one Trojan horse ever could.” (Jarche, 2012). Having many people across the system who have the skills and agency to test out small, well focussed changes to address complex problems (Trojan mice) nearly always works better than large pilot and roll out projects (Trojan horses). @HelenBevan #RDF24
  • 22. Trojan mice fail often, fail early and learn greatly Cost of an error Project timeline Launch Experiment, fail and learn here Too late https://ssir.org/articles/entry/wheeling_in_the_trojan_mice# @HelenBevan #RDF24
  • 23. 5. They build constancy of purpose for the long haul Most large-scale change efforts just fizzle out; successful change needs leaders who keep the faith through interest and energy, don’t meddle when results don’t come quickly and stick with the change priorities. @HelenBevan #RDF24
  • 24. @HelenBevan #RDF24 • Prioritise relationships • Unleash informal power as well as work with formal authority • Design change collaboratively • Build a large-scale capability for experimentation (Trojan mice) • Stick with change for the long haul To enable change, we should:
  • 25. How an expert thinks How an explorer thinks EXPERTISE Source: based on Adam Grant (2021). Think Again: The Power of Knowing What You Don’t Know.
  • 26. Many times experts fail because they are experts in a past version of the world Vikram Khosia