Slide deck that Helen Bevan presented on 13th May

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
Making change
happen:
Learning from
"positive deviants"

2. What proportion
of organisational
change initiatives
fail to achieve
their objectives?

3. 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
@HelenBeva

4. 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
What can we learn
from thousands of
“positive deviant”
change leaders?

5. 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
1. Relationships aren’t just a
priority, they’re a precondition
@HelenBevan

6. 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

7. Source: Nicola Burgess, WBS
The difference? The level of social connections between
those leading local improvements

8. 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. The ability to make change happen is
about exercising power
@HelenBevan

9. One of the things we know from the earliest studies of
how innovations spread is that change always comes
from the outside….
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

10. 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)

11. 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

12. 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

13. A superconnector:
Lou Rodrigues, Betsi Cadwaladr University Health
Board
• Head of Continuous
Improvement at the Health
Board
• “Lou knows everyone in the
Health Board”
• The 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

14. 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

15. As senior leaders, we may be less
influential than we think
If we want to get the same level of influence through top-down
cascaded change as the 3% get, we need four times more people.
Source: Jeppe Hansgaard, Innovisor

16. 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

17. 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

18. A Dutch proverb
simonterry.com/2017/07/31/trust-is-precious/
Trust arrives on a
tortoise…..
…..and leaves on a horse

19. 3. Change efforts are far more likely to
succeed because people perceive they
have agency for change
Agency: the sense of power,
permission and safety to make
change happen.
More important than improvement
skills or resources or change
methodologies.

20. The hierarchy of capabilities: the further up the pyramid people go, the
more we “humanise” our organisation and maximise the contribution
everyone can make
Qualities that
leaders cannot
command:
people have
to “want to”
Qualities that
leaders can
expect and
command
Source of model: Gary Hamel, Michele Zanini (2020)
Humanocracy: creating organisations as amazing as the people inside them
}
}

21. Ways to build agency
1. Cultivate authentic and sincere relationships with
peers, colleagues & other stakeholders
2. Start with a majority: find people who are as
enthusiastic as you are, willing to support your
idea, to strengthen it and help troubleshoot
3. Actively pursue diversity within your network -
seek connections outside your department, area of
expertise or background
4. Work with (don’t dis) the formal system
- disrupt through relationships
5. Create small changes (social proof)
6. Always follow up
Source of graphic: Dick Close

22. 4. Bring a brick, not a cathedral
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

23. A ten minute breakout discussion
Introduce yourselves
Have a discussion
What insights have you got from your own practice from:
1. Relationships aren’t just a priority, they’re a precondition
2. The ability to make change happen is about exercising power
3. Change efforts are far more likely to succeed because people perceive they have
agency for change
4. Bring a brick, not a cathedral
You don’t need to discuss them all.

24. When human beings are free to
choose anything they want; they
typically copy their neighbours.
Eric Hoffer
on the importance of peers and why we place trust
and confidence in them
5. Shape networks, not opinions

25. Greg Satell: “Don’t try to shape opinions,
shape networks”
• People don’t change their opinions as a result of “effective
communication”
• The best indicator of what people do and think is what the people
around them do and think
• Working to shape opinions is fruitless unless we are able to shape the
networks in which ideas, attitudes and behaviours form
Source: Greg Satell
@HelenBevan #QF24

26. Creating the relational conditions for action
Our
ecosystem
for
change
Source: adapted
from a model by
Bill Bannear

27. People with passion or
motivation to take action
People with the authority or
mandate to drive change
Voice of intent
Our
ecosystem
for
change
Source: adapted
from a model by
Bill Bannear
Creating the relational conditions for action

28. People with passion or
motivation to take action
People with lived experience
of the issue and its context
People who will be a user
of, or affected by, the
changes we make
People with the authority or
mandate to drive change
Voice of intent
Voice of experience
Our
ecosystem
for
change
Source: adapted
from a model by
Bill Bannear
Creating the relational conditions for action

29. People with passion or
motivation to take action
People with lived experience
of the issue and its context
People who will be a user
of, or affected by, the
changes we make
People with resources to
contribute
(money, people power)
People with the authority or
mandate to drive change
People with specialist
knowledge, skills and tools
Voice of intent
Voice of experience
Voice of capability
Our
ecosystem
for
change
Source: adapted
from a model by
Bill Bannear
Creating the relational conditions for action

30. People with passion or
motivation to take action
People with lived experience
of the issue and its context
People who will be a user
of, or affected by, the
changes we make
People with resources to
contribute
(money, people power)
People with the authority or
mandate to drive change
People with specialist
knowledge, skills and tools
People with can broker,
facilitate and/or coordinate
People who can connect
diverse communities
Voice of intent
Voice of experience
Voice of capability
Voice of connection
Our
ecosystem
for
change
Source: adapted
from a model by
Bill Bannear
Creating the relational conditions for action

31. People with passion or
motivation to take action
People with lived experience
of the issue and its context
People who will be a user
of, or affected by, the
changes we make
People with resources to
contribute
(money, people power)
People with the authority or
mandate to drive change
People with specialist
knowledge, skills and tools
People with can broker,
facilitate and/or coordinate
People who can connect
diverse communities
Voice of intent
Voice of experience
Voice of capability
Voice of connection
How do we connect people who want to do something, with people who can help and support them,
while staying grounded in real world need and experience to ensure it works?
Our
ecosystem
for
change
Source: adapted
from a model by
Bill Bannear
Creating the relational conditions for action

32. Bill Bannear
The new zeitgeist: relationships and emergence
Value is created, and breakthroughs are
made through the strength, number and
quality of relationships in these systems.
Exactly what these relationships will produce
isn’t determined — but they create [the
system conditions] allowing for the
emergence.

33. 33 |
• Identify the different capabilities needed to get traction on an
issue, and to create the relationships and networks for them to
connect.
• Less centralised designs and roadmaps, and more structures
that enable distributed leadership and emergent action.
• Creating “investors” in change, not “buyers”: when we ask
people to “buy-into” a preconceived change solution, it’s
probably too late.
• Value relationships as a key outcome in their own right.
Implications for leading change

34. Mark Jaben on the science behind resistance to change
What NOT to do
(but what we usually do)
Issue
Desired outcome
Options
Choices

35. Mark Jaben on the science behind resistance to change
What NOT to do
(but what we usually do)
Issue
Desired outcome
Options
Choices
What TO do
Issue
Desired outcome
Options
Choices
Shared outcome
We don’t need “buyers” who buy-in to change
We need “investors” who invest in change from the beginning

36. 36 |
• Identify the different capabilities needed to get traction on an
issue, and to create the relationships and networks for them to
connect.
• Less centralised designs and roadmaps, and more structures
that enable distributed leadership and emergent action.
• Creating “investors” in change, not “buyers”; when we ask
people to “buy-into” a preconceived change solution, it’s
probably too late.
• Value relationships as a key outcome in their own right.
Implications for leading change

37. Programme manager vs. convenor
• Designs a programme
plan
• Accountability within a
governance system
• Ensures that delivery
milestones are met
• Communicates progress
• Deals with risk and
ensures that barriers
are overcome
• Builds community
• Boosts commitment to a
collective goal
• Enables trusting relationships
• Seeks win/wins
• Makes sense of things for
community members: the
why?
• Helps spread learning across
a whole system
PROGRAMME
MANAGER
CONVENOR

38. 6. "Trojan mice" 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

39. 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

40. 7. Build a sense of belonging
.
Deborah Rowland and Paul Pivcevic
Leading change post pandemic: belonging
https://blogs.lse.ac.uk/businessreview/2022/04/08/leading-change-post-pandemic/
Our most recent research into the successful leadership of large-scale
complex change, pinpointed a vital ingredient omnipresent in all human
systems: our fundamental need to belong – to feel secure, included and
part of something significant. If you feel you belong, loyalty follows, and with
that the permission for risk-taking and innovation.
‘
@HelenBevan

41. A sense of belonging is a key driver
(arguably the TOP driver) of
engagement at work
When people feel a sense of belonging at work, they are more
likely to collaborate, engage in change, share ideas, speak up
confidently and contribute to the success of the organisation.
Herbert C (2022) Belonging at Work: The Top Driver of Employee Engagement, Qualtrics XM
Skerik S (2023) Employee Engagement Trend: Belonging at Work, Engagement Multiplier
Carr, E. W., Reece, A., Kellerman, G. R. and Robichaux, A. (2019) The value of belonging at work, Harvard Business Review
Research by Qualtrics XM
(2022)
• 20% of employees who feel
they don’t belong are
engaged
• 91% of employees who feel
they do belong are engaged
Source: Qualtrics (2022)

42. Belonging: aim for the top right box
Sources: Inclusion and Diversity in Work Groups: A Review and Model for Future Research (2010) Lynn Shore and colleagues and Why belonging is
such a big issue in business today (2020) Josh Bersin
@HelenBevan

43. Based on Why belonging is such a big issue in business today (2020) Josh Bersin, with additional content, including from The value of belonging at work (2020)
BetterUp
How do we build belonging?

44. 8. 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

45. @HelenBevan
• Prioritise relationships
• Unleash informal power as well as work with formal authority
• Support people to build their own agency and power
• Design change collaboratively
• Build a large-scale capability for experimentation (Trojan mice)
• Foster a sense of belonging
• Stick with change for the long haul
To enable change, we should:

46. A ten minute breakout discussion
Have a discussion
What insights have you got from your own practice from:
5. Shape networks, not opinions
6. "Trojan mice" nearly always work better than "Trojan horses”
7. Build a sense of belonging
8. Constancy of purpose for the long haul
And the overall messages from this session