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

The slides that Helen Bevan shared at #RDF24

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, Brauckman n 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 #RDF24

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 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

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 #RDF24

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 #RDF24

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

19. 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

20. 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

21. 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

22. 5. They b uild 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

23. @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:

24. 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.

25. Many times experts fail because they are experts in a past version of the world Vikram Khosia

26. How an expert thinks How an explorer thinks EXPERTISE