Helen Bevan - long-time leader of change inside the UK's NHS.
Jen Frahm:
Hello everybody. It is absolutely fabulous to be back with you in this Conversations of Change with Dr Jen Frahm. Today I have an extraordinary privilege. I'm bringing to you a change chat with none other than Dr Helen Bevan, the Chief Transformation Officer of the NHS. I have been a fangirl for quite some time of Helen because, seriously, in terms of longevity in the system, ability to influence - and I was thinking about how I would introduce Helen, and I was thinking, well look, yes she is a thought leader but she's a thought doer, she actually does the work, which she has so many extraordinary examples of having done brilliant work. She leads the Horizons Team of the NHS, has been responsible for really remarkable stuff, the NHS change has won awards from the Harvard Business Review, McKinsey and just consistently builds and builds on the community. Helen welcome to Conversations of Change.
Helen Bevan: Thank you, Jen, and really looking forward to our conversation.
Jen Frahm: Yes, super. Now, Helen, the listenership of this podcast is beyond the UK. Can I just get you to introduce or tell us a little bit about your role and the NHS so we can set some context for the stuff that you've done?
Helen Bevan: Absolutely Jen. So I work as part of the National Health System or National Health Service in England and it's the biggest public health system in the world or the biggest publicly funded health system in the world. And we have about 1.3 million staff and we provide care for 54 million people. So just to kind of get a sense for the scale of it, every 24 hours the National Health Service in England provides care to a million people.I'm an Internal Change Agent in a very big and busy healthcare system. I work in a team inside the National Health Service in England which is called the Horizons Team and my job is the Chief Transformation Officer. The role of the Horizons Team is to support large scale change across the health and care system. So we get involved in lots of projects and programs which are about improving the way that health and care gets delivered. Very often we're working on very big projects, with hundreds of staff and hundreds of patients. Just doing change on a very big scale or supporting change on a very big scale.
Starting out in change work
Jen Frahm: That is massive. I'm trying to put it in context, certainly in Australia, and I'm really struggling. It is really massive to get your head around. Helen, can you take me back to that time when you first got an inkling that change was going to be your thing. What was happening?
Helen Bevan: Well, Jen, I've never done any other job apart from being a Change Agent. So sometimes people who have careers in the National Health Service in England, they started as a clinician or they started as a manager. I started as a Change Agent. My first degree was in Social Science and always had an interest in people and systems and what makes things tick. Also, I had a real sense of wanting to contribute to making things better. Having a sense of health as a right and healthcare as a right. Very driven by my own values and wanting to do roles where I could contribute. I guess lots of people say that. I've always worked in public service. I started in local government, I've worked in education and I've worked in healthcare now for nearly 30 years.
Jen Frahm: Again, I'm curious, you came in as a Change Agent. What was the job description? Were they advertising for a change agent? How were you characterized?
Helen Bevan: My first job, after graduating, was working in the Housing Department at Sheffield City Council in England and it was a kind of administrative organizational role. But within about three or four months I've been seconded from that job to work as a full-time Change Agent. With one or two exceptions, that's what I've always done. Even once or twice early in my career, when I was in mainstream jobs, very quickly I got moved into jobs of being a Change Agent.It's interesting, so when I joined the National Health Service it was on a scheme for people who were senior leaders in other sectors. The idea was that I would be on a fast-tracked scheme to become a Chief Executive in the NHS, but I never became a Chief Executive because as soon as I got in the role where I was working in quality improvement and change, I never left the job. That's what I've done the whole time since. And if you look at my career it is utterly consistent in terms of the kinds of things I've done and the ways that I've done it.
Jen Frahm: I find that really interesting from the perspective of a lot of people ask “How do I get him to change work? How do I get into this?” And I say, “Look, just be the change.” You don't need a formal role. Just being the change and people seek you out. They see that and you know, the roles open up. So it's a brilliant example of that. So thank you for that.The power of one, the power of manyNow, it's been 10 years since you co-authored The power of one, the power of many. I'll put a link to that in the post notes that follow up with this. I'm curious, what do you know now that you didn't know then with respect to leading transformation?
Helen Bevan: Can I say a few things, Jen, about The Power of One, The Power of Many, first?
Jen Frahm: Yes!
Helen Bevan: So, I got my first big national job in the NHS in England in 1998 actually 20 years ago. My first big job nationally was about leading and supporting big programs of change to reduce waiting times that the patients. Over the course of quite a few years, a big focus of my work was around big national programs, big national programs to reduce waiting times, big national programs to improve care for people who need cancer services, big programs for people with heart disease and so on. And what I learned over a period of time and what I kind of understood was, whereas at one point I thought big nationwide programs were the answer, coordinating change in very programatic ways across the whole country. What I know over a period of time was where the real magic was, was when people often at the front line of care, where clinicians work with patients. Actually, if we started to support and organize and give power to people at the point of care, that was where the real magic happened. So, what happened to him very early on, was I was able to collaborate with people who could see the potential of bringing social movement thinking into health and healthcare improvements. I thought at that point in time, when you thought about change management or program management and you thought about social movement thinking they were two very distinct approaches. They came from different academic traditions. They operated in very different camps and people who worked in big programmatic change would never think about social movement thinking and people that use social movement thinking and were activists would never think about programmatic management.And I think what we've seen over a period of time is actually the bringing of different ideas and different traditions together. So in terms of the power of one, the power of many, when that was produced, it was about bringing social movement ideas to help with health care improvement, which was pretty revolutionary at the time. And I think what I've learned since is that that those kind of ideas are really some of the ways that we need to be thinking. I think one of the key things that I've learned over a period of time it's not one or the other. We have to work in ways that are about dealing with tensions and complexities and two different ideas often at the same time.And I think we need programmatic approaches because if we don't have programmatic approaches, then how can we make change happen at a very big scale and for a lot of people.? And at the same time that we need programmatic approaches we need emergent approaches that start in very frontline ways that start on the fringe, and start with the activists. And I think one of the kind of key things that I've learned is that it isn't one or the other. Actually we need to work with with both at the same time. And I think understanding how we work in ways, particularly with large scale change that are about complexity and contradiction and paradox and polarity and an understanding that very often there isn't one right answer, but there's multiple answers. I think. Yeah, that’s some of the key things I've learned.
Jen Frahm: Yeah. Look and it resonates so strongly for me because I think as you'd be aware, I am very, very comfortable with the social movement concepts in change. I find that I get caught in this space of people who are really pro-social movement and community focused, snarling “Change management is dead, project management is, is... this”. It's really derogatory, the conversations that come out of that field and yet they're also bemoaning “Why am I not making traction? Why can't I get anybody to listen to me?” And then you have this equivalent bemusement from the other side around these people who seem to be full of ideas but don't actually do anything. And I'm like, “Look, the answer is the two.” You've got to bring the two together. You can't, it's not that you can't, it's just so much more power in using change management and program management with your community focus.
Helen Bevan: That's absolutely right. I mean you mentioned the word power and again, when I think about all the frameworks and models and approaches that I use in my practice I think that one of the ones I find most helpful is, if you like, the tension or the paradox between what is called old power and new power which is a model from-Jen Frahm: Heimans and Timms. Yeah.
Helen Bevan: Jeremy Heimans and Henry Tims, yeah. I think that's incredibly helpful. And particularly in the Health and Care system. We work in a system, very often that is driven by old power, which is about formal authority. It's very often top-down or change-cascaded through our system. And very often we're commanded to do things. And it's very transactional. Often it’s about projects and programs, it's about systems and structures. It's about governance, it's about holding people to account.And increasingly we see a world of new power, which is about people come together with a common purpose. It's open, it shared. And the thing is that we have to work with both. I don't think that old power will be going away, certainly not any time soon. But you see this layer of new power coming on the top, which creates all kinds of opportunities. We have to work with both. And I mean, I see so many new power activists. I see community leaders, clinical entrepreneurs who come up with amazing ideas, but because they don't know how to navigate the old power system their ideas don't get very far. I also see lots of leaders, or former leads in our system, who are trying to make very big change happen and by driving things through in old power ways and that doesn't work either.We have to work with both. And I would say that most of my practice now as a change agent is as about operating in that very difficult space between old power and new power, part of a big formal system, but trying to work in ways that are very flexible and agile. One of the projects I'm working with now is it's a project called #projectA. And it's a project with frontline ambulance staff and we're working with 13 ambulance services across the whole of the UK and it's about getting ideas and learning from the experience of frontline ambulance colleagues, and trying to make those ideas work across the whole system. And it's been pretty amazing with this project, we had an idea's channel with lots of tweet chats.We had 31,000 interactions with our change process and we've got down now to five key areas that we're working with across the country. And more than 10% of all the ambulance staff in the country have now contributed directly and have been part of ProjectA.But at the heart of it isn't just about new power and isn't just about working with front line staff. It's also about working with the formal leaders who have the authority and getting their support and their leadership and their backing to this. I think when we set up project time, we were asked to work on it. A lot of people thought this is the new power movement is just about front line staff and getting their ideas. But we couldn't make the changes that we're making, taking the brilliant ideas from so many of our front line colleagues, if we didn't also have the backing of the leaders in the formal system, we have to work with both.
Jen Frahm: Just... I'm struck by 31,000 pieces of data scientists on your team. So are you processing that much contribution?
Helen Bevan: In my team, in the horizons team, we don't have any form of formal data analysts, but what we all do is data analytics as part of our job. So the first thing I’d say is that, in terms of social media, there are so many great analytics packages that we worked with that, give us brilliant data. We also work with a number of crowdsourcing platforms that, again, give us great data. So we didn't have to do a lot of analysis ourselves and we worked with platforms and systems that give us the analytics.
You beat a machine with a movement
Jen Frahm: Brilliant. I think, building on the conversation around new power and old power -- here in Australia, we've just had the Netflix release, Knock down the House detailing Alejandro Cortez sent to the White House. Now in it, she says “You beat a machine with a movement”. And I kind of feel like you've been talking about movement for a very long time. I'm curious around what that quote means to you personally.
Helen Bevan: How do I feel? I absolutely get where she's coming from, and I really get the idea about movement. And honestly Jen, I think that the people in the future who will succeed are the people that can mobilize. But also I'd say, “Do we need to beat the machine?” because, in our system in health and care, we need things to be very organized. You know, if we want to provide high quality, safe-care for every single patient, then in a sense, you know, we need systems that work really well. We need cohesion.We want to make sure we don't have unwarranted variation. We want every patient, wherever they are in the country, to be able to get the right level of care so we need to be really well organized. And at the same time we need the diversity. We need the dissent, you know, we need dissention. And again, it comes back to this issue around balance. In my system, do I think that the movement will beat the machine, taking it literally? No. But I think that the movement can make a massive difference in terms of how the machine operates. So again, I think we need both.
Self-care and the change agent
Jen Frahm: Yeah. Nice. I'm thinking about how long you've spent in the sector and in that type of role. Longevity in change work has really started to emerge as a bit of a pain point, I guess, in the profession. So I'm thinking about when I have change practitioners, at particularly the risk of being a bit ageist, those of us who've had 20 years plus in the sector. There's a lot of talk around burnout and fatigue and what comes next and disillusionment. I'm curious about... you've been rocking the boat for a long time and I think I've seen the quote “ou rock the boat but not fallen out”. What's the secret sauce? What's your thoughts on self-care of an internal change agent?
Helen Bevan: This is a really important topic, Jen. I think it's very hard to be a change agent for a longer time, particularly when you are in a very big system. All the time as a change agent when you're challenging the status quo, you're wanting things to be different. I think it's very easy to feel ostracized, to feel that you're in a difficult position. And I think the whole thing around resilience and self-care is so important. So the first thing I'd say is that very often with change agents, certainly in the world I'm in, I think that it's not so much an issue around burnout. It's an issue of moral stress because we find ourselves in situations where the things that we believe passionately in, we’re asked to work in ways or to do things that actually we find distressing.With regard to our values and the things that we really believe in. And I think there's a whole load of things that we have to do. You know, one of the things I say is the number one rule of being a change agent is that you can't be a change agent on your own. You know, however clever or creative or how good your ideas are. I just think there's this whole kind of process of normalisation in organizations that encourages us to conform, to comply, to not rock the boat. And I think when I look back around my career, in a lot of my career I've been really lucky because I have had line managers who have really supported and championed me and given me the air cover and space to do things I want to do and make the contribution I want to make.
But that hasn't always been the case. And not everybody gets a great line manager all the time. So I think that key to this, the key to the longevity of an internal change agent is around togetherness and linking up with other people who see the world in the same way. But I think there's multiple reasons for this. So some of it is, again, goes back to what you were saying, Jen, about social movements. And finding like-minded people who have got the same values and want to make the same changes. And then I think the other aspect of it is just having people to support us and to keep us safe when we're doing this very difficult work.
And I think it's hard to be a change agent. When we choose to do these roles, we don't choose an easy life. We'll never get the same promotional opportunities as people that do more mainstream roles and never get the same gratitude, we’ll never get recognized in the same kind of way, and it's part of what you choose to do. But I think we have to find places for ourselves in organizations that give us the support that we need. And the second thing I think is that we have to deliver, we have to be able to show that the kinds of things that we're doing collectively with other people are making a difference because why would we be funded and supported if it weren't able to to do that? So I think there's a lot of pressure around “you can't just talk the talk or go round and tell people what to do and be an expert.”I think, in my kind of system, to thrive and survive as a change agent you've got to be out there as a practitioner working with other people at delivering and showing outcomes from what you do.
Jen Frahm: Yeah. That ability to actually deliver. And I think sometimes that means we really need to scale back what we want to deliver. I think, I don't know if you found it, but I find that sometimes having that mindset means we want to see big change and large change and it's really expensive. But that's at odds with delivery.
Helen Bevan: You know, one thing that I learned, early on, was the first ever really big change job I got on the National Health Service, was working in a hospital in Leicester, in the East Midlands of England. And it was the biggest change project that had ever been done inside a hospital and it was called the Leicester Royal Infirmary. And at the time the approach was re-engineering. So the idea for this was, in a very short period of time, we're going to re-engineer this whole hospital. It was really big scaled change project that I was the change leader for. And at any one time we had up to 50 staff seconded on this project working as part of the Leicester Royal Infirmary Engineering Program. And we have a hundred change projects happening simultaneously. What was interesting was that people didn't judge this change initiative on the fact that there were a hundred change projects happening simultaneously. People couldn't grasp the breadth of it. What people took notice of and what people judged us on were one or two really iconic projects. So we had a couple of projects that were really small scale but they were revolutionary. And so one of these projects, for instance, was how we did patient testing and did it very immediately, which was very different to anything that has happened before. And people took that idea and it spread all over Europe and it was impactful over the world. And even though we got a hundred projects. People judged us on just the one or two iconic projects and that's kind of really stayed with me throughout my career. So what are one or two things that we can do that will make a really big difference.And again, I talked to you about the ambulance project, the ProjectA, where we're at with that is doing a very small number of things, wanting to do them really well and it can still be large scale. Because... so we've got a project around how ambulance staff responded to patients who fall. So it's got a narrow focus but, in a sense, we're working with every ambulance service in the whole country and up to 20% of all calls to the ambulance service are people that fall. So it's a narrow focus. But we have the opportunity to make a difference to people across the whole country.
Jen Frahm: Really high impact, really.
Helen Bevan: I hope so.
On psychological safety and diversity
Jen Frahm: Yeah. Brilliant. On a different tangent. One of the things that's been bugging me at the moment is this emphasis or this industry around the concept of psychological safety. And I'm kind of pondering how did this become such a thing? Something that is a fundamental thing that we should have in organizations that we feel comfortable to voice and it's become a thing. It's a real thing, like with a capital T. And I'm curious as to what you’re finding, or what your thoughts are as to how have we become this industry, which now has people telling leaders how to create psychological safety. Why? What's going on?
Helen Bevan: Yeah, I think it's an interesting one again. I'm a big fan of psychological safety. What I would say is that if we want to make really big change happen in our organizations and systems, then we need diversity. We need people with different backgrounds and people who have different experiences who can come together and see the world in very different ways and challenge each other. We can only really value the difference that we need if we can create the kind of psychological safety, the ability for people to work together, to respect difference, to feel supported by each other. So I'd say that in terms of my change practice, how we create psychological safety, how we create spaces where different people can come together and enable change together.I think this is really important. I think we can talk about psychological safety in lots of different contexts. I think there's the psychological safety in a team and there's psychological safety in a change project. And I think the two are related but slightly different.
Jen Frahm: So tell me more about that.
Helen Bevan: So psychological safety in a team is about wanting to create a team of people where everybody covers everybody else's back. Where people feel able in that team to say the things they need to say, knowing that they're not going to be ridiculed or criticized by other people. And I think about teams that I've operated in and been part of actually having teams that feel like that I think is really important having the kind of leaders that creates psychological safety in their teams.So leaders who operate in ways that are very authentic and very respectful and wanting to develop and support everybody, valuing difference I think is really important. And then in the context of change initiatives, because we are very often thrown together, you know, very different groups of people contribute to change. So in my world, I think one of the biggest and best things that's happened is we're focusing so much more on co-production, co-creation. So how we work with patients and families and frontline staff to redesign power is really important. How we create psychological safety in that context is a little bit different.I think, if we're doing some co-design or co-production where we're designing a new pathway of care and we're doing that with patients and families and frontline staff as well as experts and leaders, how do we create very safe environment where people who feel that they've got less formal power or less expertise, but actually have got lived experience and a different kind of contribution? How we as change leaders and facilitators can create the conditions where everybody feels safe. I'd say that the first step in that is that we talk about three words, which is Our Shared Purpose. So starting off with the “our”, which is people who will be impacted by the change, people that need to contribute to the change, but really understanding who are “our people” as a first question.And then we think about the “shared”, which is … there are many things about us that are different, but what are the things that unite us collectively? And then we have the “purpose”. Like, what's this really all about? What are we really trying to achieve here at a level that connects with our values and things that really matter to us in world? And what strikes me is that any kind of change that we're trying to do, particularly with a broad community of people, we have to start with our shared purpose and actually creating a safe space for doing that. I'm really strong on psychological safety and in doing that creating that as a change facilitator is very, very important.
Jen Frahm: Nice. And I think what that gives people, I think what you've articulated there, so there's two things that I pull out of that, is we've let go of a focus on diversity and that's created an environment that has not made it safe for others who are different. But, two, our avenue into how to build that is those three words and really focusing on that. Which is really quite elegant. And I do like that.
Helen Bevan: Well Jen, what I’d also say about that is what I look back at in my change practice and how it's different now. I think one of the absolute key things that is different now is that focus on starting with shared purpose and a lot of effort and energy into doing that. Previously because my training and my background is in classic kind of improvement methodology and improvement science, we start with an improvement aim and an improvement aim is really important. But actually we have to go upstream of that because if we don't bring in our community or our collective of people together who are going to be impacted by the change and create a really strong sense of shared purpose, then we don't create the conditions for large content.
Change starts with me
Jen Frahm: Fantastic. One of the things that I've found in working with leaders around change leadership, is that change has to happen within before we can look to changing outside in the organization. So, it’s this really interesting crossover space between personal and professional development. What's your take on that? What are you seeing in your space?
Helen Bevan: So one of the big shifts that I'm seeing in my factor and the world I’m operating in is a shift from what I would call independent leadership to interdependent. Until recently if we're thinking about change in health and care, we'll be talking about say, an individual hospital or hospital system or a mental health service and about independent leaders who made their organization the best that it could be. So it was independent in a sense that “I'm a leader of this organization, my role or my mission is to make this organisation as good as it could be”. One of the very big shifts that we're seeing is to work interdependently. So it's no longer enough to have a very good hospital or a very good primary health care centre or a very good mental health facility.You know, actually if we start from our patients and people and families or communities and what they need, they don't just need a hospital, they don’t just need a mental health facility. Actually, it's about a joined-up connected health care system that gives people the things that they need when they need it across sectors. So the very big shifts, and we're seeing this around the world in the world of health and care, is what we call an integrated care. So we've had primary health care sector and the hospital sector and the mental health sector. And what's happening more and more now is that they're coming together in an integrative ways. So it basically means that our senior leaders have to work interdependently. And when we talk about interdependence, we mean “I've still got to achieve my own goals for my organization, but we need to be system leaders and we need to be working with other senior leaders.”And then there can't be winners and losers. Actually, when we think about our population and our health system, we have to create ways for us to be winners together. So the kind of leadership that we need in an interdependent system. I think it is much more mature than the kind of leadership that we need in an independent leader. And it's about the kind of leaders that can work collectively with others, for bigger goals, that are comfortable working with paradox and complexity, but are trying to create win-win all the time rather than winners and losers. So, in a sense, I think it's the difference between being ... the Arbinger institute talk about the difference between an outward mindset, an inward mindset. And an inward mindset means “I've got to protect the interests of my organization and my system and, even though I'm collaborating with the people, I start from that place.” Whereas an outward mindset means “Actually, I'm understanding that I have to stand in the shoes of other people and have to understand where they are coming from. And I have to find ways that we can collaborate and work together.” And I think it's having this outward mindset, certainly in my world, it's where we're going as leaders. And it's about me and how I operate in the world. And it's about relationships. It's about trust, it's about authenticity. And so I think change does have to start with me.
Change isn't like something that's happening out there in an external environment. It's about how I as a leader operate in the world, how I connect and build relationships with others. Sometimes we say systems leadership can only happen at the speed of trust. So I think increasingly we're in a world, that’s about connection, that is about relationships. It's about values. It's about taking people with us. Thinking the best of people. So I don't think we talk about large scale, transformational change that we can separate the person and the system. I think that they’re absolutely interconnected.
Jen Frahm: So picking up on that theme, and I love the articulation of what you've bought out there. I'm going to invite you to do a word association. So one word for each word. You're ready?
Helen Bevan: I am.
Jen Frahm: Okay. Courage
Helen Bevan: Constant
Jen Frahm: Empathy.
Helen Bevan: Critical.
Jen Frahm: Vulnerability.
Helen Bevan: Everyday.
Jen Frahm: Curiosity.
Helen Bevan: Creative.
Jen Frahm: Self-compassion.
Helen Bevan: Resilience
I'm most proud of ...
Jen Frahm: Beautiful. They were what I was interested in. Helen getting close to finishing this up and what I'm really taken by is how often you give to the community, how often you talk up other people – how it's your team. And I don't know whether that's a British self-effacing theme or whether that's your personal style. But I'm really keen to hear what you are most proud of personally in your career. What do you want to own?Helen Bevan: I'm proud of lots of things. If I was to pick a particular project that I'm really proud of, it's a project that I worked on that was about people living with dementia and being given antipsychotic drugs that were inappropriate. When you think about people living with dementia, about about 90% of people living with dementia, at various points have got behavioural and psychological issues. And we had a scenario in England, where 180,000 people a year living with dementia were being given really powerful antipsychotic drugs that were absolutely not designed for people with dementia. And of those 180,000, only about 32,000 people should have been on those drugs. And my team we led a nationwide social movement... worked with so many different groups and amazing people around us and we've worked with a community organization called the Dementia Action Alliance. What happened within three years was that we had a 51% reduction in antipsychotic prescribing for people living with dementia, which I thought was pretty amazing. And one of the reasons I feel really proud of that was because my Godmother had vascular dementia, and she was given antipsychotic drugs for about three years.At the time I just thought it's how it is. And when I got involved in work around people living with dementia, and on psychotic drugs and I kind of, the penny dropped for me, I realized what was happening and it made me really angry. So it's a kind of personal thing and this is my Auntie Joyce and I just thought, you know, I feel really proud that my contribution, amongst many, has just stopped so many other people living with dementia who are actually capable of a good quality of life, to have that life instead of sitting like a zombie in a chair, which is what the reality was for my Aunty Joyce. So, yeah, that's what I feel proud of.
Be the community
Jen Frahm: That's wonderful. This has been such a joy to talk with you and you know, I personally have learned from this conversation for which I'm really grateful. I'm incredibly grateful for the work that you do. How can listeners help you going forward? What would you like to ask of the listenership?Helen Bevan: So I would say Jen, “Be in the community.” So how I met you is being part of this wonderful community of change agents who contribute and support each other and learn from each other on social media. So, I say, come and be part of this community. And I love to curate and learn about, like you do actually, new information and new practices, new experiences. So if you're not doing that already, come and be part of that community so that we can help and we can learn from each other and then accelerate change.
Jen Frahm: So in terms of “how”, I interact with you a lot on Twitter, are there other ways that people can be part of that community?
Helen Bevan: So I think one of the key ways is through social media. And I'd say if you're not following me already, I would love you to follow me, which is @HelenBevan. And again, if you want me to follow you, just kind of reach out to me and I'll make sure that I am. And there's lots of other ways through blogs, Linkedin, and through listening to podcasts, like the wonderful Conversations of Change. I'd say just “connect”, be part of the movement.
Jen Frahm: Perfect. Helen Bevan, thank you so much for this change chat. It's been brilliant.
Helen Bevan: Thank you, Jen.
References.The Power of One, The Power of Many. J. Bibby, H. Bevan et al. NHS Institute for Innovation and improvement.New Power. J. Heimans, H. Timms. Random House.