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Hello. I’m Domhnall MacAuley. Welcome to this BMJ Leader conversation.
Today I’m talking to Helen Bevan. Helen used to have one of the trendiest job titles I’ve ever heard – “Chief Transformation Officer” and, I have even heard her described as the world’s leading medical social media influencer. Tell us about your life and work…
HB: I have a great life because I’m at the stage and age in my career that I can choose what I want to do. I’ve spent 30 years as an internal change agent in the National Health Service in England and, over the last few months, my role has changed. I still work as part of the NHS for part of my time but, for the rest, I work with a lot of different organizations and systems supporting large-scale change. Most of my work is still in the UK but I also work with healthcare systems in many other interesting places.
Essentially, I work with leaders and systems that want to change the way that they’re doing things, and want care to be better. What I focus on is the ‘how” of change because often leaders are very clear about what they want to do, the areas that they want to focus on, the kind of care that they want to make better. But, I think the real issue is – how do you make big change happen in a system. We can have all the plans and program management systems in the world but, this is complex system made up of people with different goals, ambitions, and priorities so, when you’re trying to make change happen in people systems it’s a lot trickier than a transformation plan or a program plan.
DMacA: Is there a is there a formula? Are there particular steps we need to take?
In any change, there are things that we should always do. First, think about the people who will be impacted by the change or need to be part of the change, and start working with those people right from the beginning. The second is to create a sense of, “Our Shared Purpose”. The “Our” is – who are the people. The “Shared” is what unites us. And, we will often be very different people with different perspectives, different levels of power, and different levels of privilege. But, we have to find those things around change that bring us together. And then “Purpose”. What are we trying to do here, what are we trying to change, and how does it connect with the things that really matter to people.
Also, there are different ways that we can ‘do’ change. We can do change to people, we can do change for people, we can do change with people, and we can have change that’s done by people. In my 30 years, the one thing that I have learned, more than any other, is that if you do change with people or by people, it’s so much more successful than if you do change to people or for people. I look at so many Health and Care Systems where they are doing change for people; senior leaders are creating the change program and telling people what the changes are going to be and very often it’s done with a really good intention. But, every time you do change for people it feels like it’s imposed. It feels like it’s being done to people and people are going to resist. So, I don’t think there’s any kind of formula of change like…here are the eight steps of transformation, but I do think that there are ways that we can go about it and ways that we can think about change. And, there are ways that we can act, in our own behaviour as leaders of change working with integrity and building trust, that are absolutely universal.
DMacA: I’m absolutely fascinated about what you do. But I don’t remember hearing about that job when I was taking career’s advice. Tell us what brought you to this position in life?
HB: It’s interesting because I’ve never done anything apart from be a ‘change agent’. I’ve never been a clinician and I’ve never had a typical managerial job. I did a degree in in Social Science and then began my career as a change agent and, essentially, I’ve always had the same role, although now I may be doing it at a more senior level. It’s who I am and what I do and, I must like doing it because I’ve just kept doing it.
It’s also probably one of the most misunderstood jobs and sometimes it’s really difficult. People in very senior roles may want to make change happen very quickly – i.e. here’s our program plan and we have to deliver this by a certain point in time. When people like me come along and say – ‘Well, actually, we need to take our time because we need to engage people, and we need to work with people at the point of care, and we need to work with people that use services, and we’ve got to do this at the beginning to create strong foundations, senior leaders, who are trying to make things happen, often see this as soft and pink and fluffy and not hard and tough. And, other times, when you’re trying to make change happen that isn’t meaningful to people, you can get a lot of resistance and reaction to the change. So, it can be a pretty tricky job.
One of the things that I learned a very long time ago is that the people who are the best change agents aren’t necessarily those with formal power that can cascade or push change down from the system. The best change agents are the people that build relationships and connections. Much of effective change is about relationships and collaboration and trust. There are no shortcuts. You’ve got to take the time, and you’ve got to take the time to build. Yes, I was a Chief Transformation Officer before it was even trendy or fashionable and I just kept on being one. It’s a pretty cool thing to be.
DMacA: You describe this as a career of change, as if this was in the past tense, but you haven’t actually stopped. You are a fabulous communicator. But you’ve moved beyond traditional modes of communication. I’m really interested in what you’re doing with social media and how you feel we will communicate in the future.
HB: In any change situation you have a formal system and the informal. In the formal system, there are people with authority that can command or are held to account for change in a formal way. And then there is the informal system, those people who are the informal influencers, who very significantly influence other people. There is a new branch of thinking and practice called Social Analytics that can help us identify the influencers. In a typical organization, social analytics tell us that around three percent of people drive 85 per cent of the communication. If you are a senior leader that wants to make some change happen, the quickest way is, not to try to drive it or cascade it down, but to find the informal influencers. If you want to push change, or drive change, from the top of an organization it takes four times more people than if you work through the social influencers. The same is true when it comes to wider social influence with the ratio quite similar in studies from the Health and Care sector. If you look at Twitter for example, 85% of content retweeted comes from just three percent of people who influence. So, if you want to get messages out, find those super connectors and those influencers.
In medicine, the really big influencers are people like Rachel Clark ‘Dr Clark’, Trish Greenhalgh, and David Oliver and, because they are well trusted and respected in the system, they are hugely influential. If, for example, I want to help make change happen in the National Health Service in England, if I’m doing work in Primary Care Improvement, I’ll look to social analytics to find the key influencers on social media in Primary Care and I’ll link up with them. You can’t do this like some great blunderbuss saying let’s just put the message out there. Sometimes it’ll happen but that’s not the nature of it. Twitter is great for certain audiences. Again, if you are doing Primary Care Improvement, there is a fantastic group of Primary Care activists who are brilliant at connecting and communicating.
It’s the same in my world of Health and Care Improvement but it’s not right for every audience as, for example, few people under the age of 35 are on Twitter. Where are the clinicians in training, where are the young Health and Care managers? They’re on Tic Toc, they’re on Instagram, so we’ve got to be there because it’s where the world is, it’s where the world is going.
We have to do all the formal stuff, of course, including broadcast communication, where we’re putting messages down on people. It has its place but increasingly, change communication is becoming much more relational, it’s happening in different places and becoming less synchronous, in a sense of- ‘come to this meeting at a particular time’. It’s now becoming much more asynchronous. The world is changing and we have to go with it.
DMacA: Now I have one final question, and it’s the hardest question of all. When we look at the NHS it looks pretty broken, how would you change it?
HB: I don’t think there’s any miracle cure for the NHS. However, when I look back, from 1948 onwards, what we’ve seen in the whole history of the NHS is just how amazing and resilient and responsive our NHS people are. All the ideas, all the talent, all the perspectives are there in our system already. We have to work with that, we have to enable, and we have to create the space. In a sense it’s almost paradoxical because everybody is so busy that nobody’s got time to think. And yet, if we look at the organizations in the NHS that actually do best, they’re the places where the leaders understand that we’ve got to make the time and space for connecting, and communicating, and learning, and sharing together. I don’t think there’s only one magic answer, but I do think the answers are there in our people, as they’ve always been.
Helen it’s been absolutely wonderful talking to you. Thank you very much indeed.
Dr Helen Bevan, OBE
Dr Helen Bevan, OBE, is Chief Transformation Officer with the Horizons team, a group of internal change agents within the English National Health Service. Helen has been a leader of large scale change, improvement activist, thought leader and innovator within the NHS for more than 30 years. She has led and facilitated many nationwide initiatives to improve care, including in cancer services, urgent and emergency care and services for people living with dementia, involving many thousands of NHS people and people who use services. She acts as an advisor and teacher to leaders of health and healthcare in many other countries.
Helen has an ability to connect directly with thousands of frontline staff and patient leaders. She is one of the top social influencers in healthcare globally, reaching more than a million people each month through her social media connections, virtual presentations, commentaries, and blogs. She has thirty year’s practitioner experience as an internal change agent in the NHS and has worked on initiatives involving hundreds of thousands of patients and people who work for the NHS. She advises leaders of change in healthcare systems across the globe. Her team won the global HBR/McKinsey award for creating “Leaders Everywhere”. This was for their NHS Change Day initiative, that created hundreds of thousands of pledges for change in the NHS. The award was organised by Gary Hamel and the Management Lab. Helen is featured as a case study in Gary’s latest book with Michele Zanini, Humanocracy. Helen was the subject of an interview in HBR in 2018 on “making process changes stick”: https://hbr.org/2018/11/making-process-improvements-stick . Her work as a change practitioner using social movement change methods inside a large organisation was featured as a case study in New Power by Jeremy Heimans and Henry Timms in 2019.
Helen leads The School for Change Agents, an online programme on “how to rock the boat and stay in it”. This is currently offered as a MOOC on the FutureLearn platform. Nearly 100,000 people have taken part in the school since 2014. Helen is on the Thinkers50 radar class of 2020. She is one of the most socially influential people in healthcare globally (@HelenBevanTweets) reaching over a million people a month with her tweets, blogs, and commentaries.
Professor Domhnall MacAuley
Domhnall MacAuley currently serves on the International Editorial Board for BMJ Leader.
Declaration of interests
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.