Making change happen: learning from "positive deviancts"

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? @HelenBevan

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 @HelenBevan

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 @HelenBevan 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. @HelenBevan

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 Cultivate authentic and sincere relationships with peers, colleagues & other stakeholders Start with a majority: find people who are as enthusiastic as you are, willing to support your idea, to strengthen it and help troubleshoot Actively pursue diversity within your network - seek connections outside your department, area of expertise or background Work with (don’t dis) the formal system - disrupt through relationships Create small changes (social proof) 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: Relationships aren’t just a priority, they’re a precondition The ability to make change happen is about exercising power Change efforts are far more likely to succeed because people perceive they have agency for change 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. 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 Engage people here

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

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. C onstancy 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