Enabling Change and Change Leaders

Posted by: NHS Horizons - Posted on:

Originally published by Helen Bevan – 27th June 2019

This blog is written as a narrative of the talk I gave at the Rainmaker conference on 27th June 2019 on the topic of “enabling change and change leaders in the NHS”. You can read the slides here.

In big complex systems like the NHS, we need to manage a tension between delivering our services today in operationally excellent, standardised ways AND disrupting the system to deliver care in new ways in the future.

It is helpful to think about power in organisation. There is a battle going on in our organisations between old power and new power, as described by Jeremy Heimens and Henry Timms:

Old power is positional power in an organisation or system. In an old power world, the people who can make change happen are those with the authority to push commands through the system. Old power is like a currency; some people have a lot of money but most people don’t. Largely, old power is transactional. People are held to account in a rational way for performance agreements and quality standards. By contrast, new power is like a current; it surges with energy when people come together with a shared purpose. The more that people participate, the more power is created. New power is relational; people engage in new power ways because they want to and it fits with their own priorities and values, not because they have to.

There is no judgement about whether old power or new power is good or bad. The most effective leaders work with both kinds of power. If we consider the great social movements that changed the world, such as the women’s suffrage movement, environmental campaigners and the civil rights movement, one characteristic they all share is that they were able to operate in what I call the difficult “zig-zaggy space” between old and new power. Leaders of change need to be able to operate with the levers and opportunities of both kinds of power.

Neither should we assume that old power outplays new power. People often say to me “I can’t make change happen. I’m only a staff nurse/student/junior doctor/middle manager”. Yet research findings suggest that, in terms of being an effective change agent, the extent to which a person is at the centre in the informal network (new power) is significantly more important than their position in the formal system (old power). In addition, people who are highly connected have twice as much power to influence change as people with hierarchical power. If we look at the reasons why large scale change projects fail to achieve their objectives, the reasons are complex and multiple. However, the failure is less likely to be about old power issues such as the programme management system, formal accountabilities and the structure of the plans that are put into action. Failure is more likely to be about lack of engagement with the informal networks that can make or break the change. If we want to make big change happen, we need to think new power as well as old power, connecting with networks of people who ‘want to contribute.

A pattern that we see often is that around 3% of the people in the organisation or system drive conversations and influence 85% of other people.

 The 3% informal influencers are the people who can make or break change. 


  • Have the relationships, networks, content and context
  • Drive the perceptions of other people
  • Are the go-to people for advice
  • Make sense of things and reduce ambiguity for others
  • Are trusted by peers more than formal leaders are trusted
  • Are largely unknown to formal leaders

We can find these “superconnectors” through organisational analysis or we can ask other people to find out who they are.

There are two key questions that we need to address to enable change in this complex world:

  1. How do we work inter-dependently rather than independently?
  2. How do we build shared purpose?

To work inter-dependently means having your own goals and approach but understanding that you are dependent on other people for achieving these. For leaders, this means developing an outward rather than inward mindset:

If we are going to work interdependently, and we are going to create change on this basis, we have to start from a place of shared purpose. In the context of the NHS, this means working with many different people: patients, families, community leaders, healthcare professionals, leaders and people from other sectors. We talk about building our shared purpose and we discuss each aspect separately. In terms of the “our”, we identify everyone who will be impacted by the change process or needs to be part of the change process. In terms of “shared”, we identify the factors that unite us, and finally, purpose means connecting with the profound sense of who we are and the thing that drive us.

Often, change leaders confuse purpose with aim. An aim is setting a determined course in order to achieve a set goal within a specific timescale. Purpose seeks to make explicit the reason behind something that is being done. Purpose defines WHY we are doing what we are doing, and WHAT we hope to achieve from it. The evidence is clear; if we want to mobilise people to engage in change, we need to connect with emotions through values. Starting from a place of shared purpose, and being explicit about shared purpose is a powerful way of doing this.