The slide deck that Helen Bevan presented at the virtual workshop on "breaking down hierarchical barriers" at #LeadersHealth20 on 18th November 2020

1. NHS England and NHS Improvement
S
@HelenBevan
#LeadersHealth20
hierarchical
barriers
Source of image: breaking down barriers film festival

2. 2 |
A disclaimer: my views on hierarchy on a page
With some content borrowed from How to Create Positive Team and Organisational Hierarchies by Lindy Greer, 2020
1. As much as we might
want to abolish them,
hierarchies serve a
purpose at work
2. When we see bad
leadership, we blame the
hierarchy—structures where
certain people have more
power or influence than
others, forcing us into
dominance and aggression
and conflict
3. The basic function of
a hierarchy is to allow us
to make sense of the
world, simplify
information, and make
decisions
4. I don’t know of a
any organisation
anywhere that
doesn’t have some
form of hierarchy
5. Hierarchy can:
• slow down decision-making
• create inconsistencies in
management that impede work
• delay communication
6. Hierarchy is less
powerful now than it
used to be but it’s not
going away any time
soon

3. We still organise the health and care system
like the Tabulating Machine Co. of 1917
Source of image: @corp_rebels

4. Jeremy Heimens, Henry Timms New Power: How it’s changing the 21st Century and why you need to know (2018)
new power
Current
Made by many
Pulled in
Shared
Open
Relationship
old power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
@HelenBevan #LeadersHealth20

5. 5 |
Covid-19 metaphors and power
Sources:
Ella Saltmarshe: https://medium.com/@ellasaltmarshe/8-tips-for-framing-covid-19-f3c897c1ffa6
Public Interest Research Centre: https://publicinterest.org.uk/part-4-metaphors/
The Workshop: https://mcusercontent.com/b0185015163b8400982fe50f3/files/5b54ba18-e698-4ee5-8c68-
9d950d81b6db/The_Workshop_Covid19_Digital.01.pdf?mc_cid=620d8519d0&mc_eid=f7b8a6dd7c
• The war, the fight, the
battle against Covid-19
• Crime: “lockdown”;
“curfew”; #covidiots
“transgressors”
• Doctors and nurses as
“superheroes”, “troops in
battle”, “frontline”
• “Battening down”
• Needs command &
control, top down
leadership
• A journey with challenges and a hopeful
destination
• Positive human actions based on shared
purpose: “Building”, “forging”
“reconstruction”
• Many people working together, each playing
their part - interdependence
• Creating resilient, connected communities

6. 6 |
What is the predominant
approach in your setting?
Mostly new
power
Mostly
old power

7. The Network Secrets of Great
Change Agents
Julie Battilana &Tiziana Casciaro
As a change agent, my centrality in the
informal network is more important than
my position in the formal hierarchy

8. The power,
individually and
collectively, to make
a positive difference
@HelenBevan #LeadersHealth20

9. Find the 3% “super-connectors”!
Source: Organisational Network Analysis by Innovisor
Just 3% of
people in the
organisation or
system typically
influence 85% of
the other people
.Influencers

10. Why superconnectors?
A major cause of change failure is poor dialogue with
the informal organisation
The 3% informal influencers:
• 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 often unknown to formal leaders
Source: Innovisor
Source of graphic:
The Strategy Group
Even more important at a time of ambiguity and uncertainty
@HelenBevan #LeadersHealth20

11. The 3% rule also appears true for social
media
Source: research by Graham MacKenzie using NodeXL
In health and
healthcare globally,
tweets by 3.3% of
tweeters accounted
for 85% of retweets
@HelenBevan #LeadersHealth20

12. Don’t underestimate the power of social as a
source of information to drive change
@HelenBevan #LeadersHealth20

13. The superconnectors become even more important at
times of ambiguity and uncertainty
@davemorgan_NEAS
@trishgreenhalgh
@doctor_oxford
@HelenBevan #LeadersHealth20

14. Innovisor Evidence-based change
McKinsey Tapping the power of hidden influencers
Mike Klein Internal influencers: actionable and no longer optional
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 resect?

15. What does this mean for me?
- Build your connections
and relationships
- Be a model of trust and
positive behaviours
- Always, always follow up
Be a
superconnector
Source of graphic:
The Strategy Group
@HelenBevan #LeadersHealth20

16. What does this mean for me?
- Build your connections
and relationships
- Be a model of trust and
positive behaviours
- Always, always follow up
Be a
superconnector
- Get their insights
- Engage them in
change
- Stay connected for the
long haul
Find your
superconnectors
@HelenBevan #LeadersHealth20

17. 17 |
The predominant approach in recent years has been
STRUCTURE but the Covid 19 response means a big shift
towards AGENCY
The design dilemma at the heart of change
Structures and
systems
Performance goals
Compliance
Regulation
Competition
Programme
Management
Incentive systems
Activation
Ability to make choices
Collective action
Leaders everywhere
Social action
Solidarity
Social movements

19. The power of connection
Evaluation of five NHS hospital systems that undertook
comparable improvement initiatives and achieved vastly
different outcomes.
The most significant difference between the five
organisations? The level of social connections between
those working to deliver improvement
Source: Nicola Burgess, Warwick Business School, evaluation
of the partnership between the NHS and Virginia Mason Institute

20. From the study: an “outstanding”
organisation

21. From the study: an organisation that went
into “special measures”

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

23. The leaders who succeed in the future will be those
who develop the ability to operate in new power ways
Individual capacity
Designing change
Information flows
Building agency
Leadership
Modified from Donella Meadows adaptation of leverage points in
OECD ‘A brief history of systems approaches’ 23

24. Source: @NHSChangeDay
24
@HelenBevan #LeadersHealth20

25. 25 |
Confronting people with
their freedom may be the
ultimate act of love
Peter Block
@HelenBevan #LeadersHealth20

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