The key to a successful Large Scale Change? start small

By 19th April 2019Uncategorised

15s30m: two years on

Its almost exactly two years since we sat in a sunny office together for what we call a “big pen, big paper” session. The sort of brain space we rarely afford ourselves to release the ideas we have and play around with them.

What we came up with, unwittingly, was a type of large scale change platform, the type of which many have stated is the only option for the NHS to get from where we are now to where we need to be.

So, on a sunny bank holiday weekend, we’d thought we’d share why a social movement like 15s30m can be so successful in its approach.


Effective change is less to do with hierarchical power or positional authority and more to do with ability to influence through a network. 15s30m remains staunchly outside the departmental and division structures of an organisation – it’s a change platform, not a change programme. 15s30m seeks to find key influencers in each area – those who are most likely to have the power to lead change – this is not necessarily a manager or team leader, but someone whose approach to patient care is respected.

15s30m builds agency – “ the capacity of individuals to make their own choices and take action”. The self-appointed 15s30m Heroes show, through their actions, how life at work CAN be.


Traditional models for change rely upon intellectual energy – knowing the theory and building plans. 15s30m relies upon spiritual, social and psychological energy – people undertake change because there is a clear line of benefit, because they want to reduce frustration and be part of something exciting.

There is no standard to which participants must work; no threshold to pass to take part. 15s30m change is not driven by planning, data, spreadsheets – instead we appeal to the emotional currency, their personal convictions and values. Passion creativity and initiative are the driving forces for change. 15s30m workshops being by using a simple exercise to connect with staff’s motivations and values – why do they work here? What is a good day? How do you know when you’ve made a difference – and tap into these emotions to develop a desire to change, to do things differently

Staff undertake change because they WANT to , not HAVE to.


15s30m offers a solution to bridge the gap between leadership and workforce. In large organisations there is an inevitable disconnect between senior leaders and the majority of staff. However in 15s30m it is the frontline workforce who are driving the change.

It is spread through informal or virtual networks and social relationships. 15s30m heroes are an example of distributed leadership – of staff embedded within work teams to “show not tell” how to improve frustrations at work. The projects themselves are small and pose little risk. They don’t need to be sustained to be effective, just inspire others to act.


15s30m draws upon a wide group of expertise – none of whom have formal QI expertise, but expertise rather in how to best do the job, how to reduce frustrations. If we offer an opportunity to share that knowledge, to attribute value to it, then the self belief to effect change follows quickly behind.

15s30m offers an unprecedented amount of flexibility in a Quality Improvement programme – we can truly “ go where the energy is” and build momentum.


A Guide to Leading Large Scale Change states that

“large diverse groups of non experts consistently outperform small groups of experts”.

15s30m offers a scattergun approach – it is collecting hundreds of ideas from diverse backgrounds and roles – rather than converging around a single inflexible plan to which everyone must sign up.

15s30m is an incremental transformational change tool. Each person has a small, seemingly disparate set of objectives which together link to improve the functioning of an organisation. The big picture however – to reduce frustration, increase joy and improve patient care – the focus on a benevolent cycle and how each action of each staff member contributes to the delivery of excellent patient care – remains the same for everyone



15s30m avoids the mechanistic model of change – it is not a small team of experts plotting a detailed plan to roll out top-down. Instead we call upon every member of staff to come up with their own plan, supporting them to draw upon the detailed knowledge they have of their specific work area, and show us how to do it best.

15s30m seeks out lone wolves – people who are individually making changes, but doing it privately, without sharing or demonstrating their ideas. Whether you are using 15s30m as a fundamental building block of your preceptorship programme, or have stumbled across us by accident on twitter and have secretly launched your own mission – the barriers to participation are almost non-existent. By linking people together via a virtual network, we provide support and encouragement to keep going – along with the all important praise and recognition which is the only reward which truly motivates.

15s30m is strong on story telling – rather than analysing data, process mapping and gap analysis, it relies upon getting attention of staff, stimulating desire to change, be part of something exciting, to reduce frustration, increase joy and then reinforce with reason.


The change in approach that 15s30m encourages – to do small acts to benefit someone else – can become embedded in everyday work; it has the potential to be used to examine every process a staff member undertakes, be that a phone call, filling-in a form, creating an appointment or interacting with a patient. In this way the principles of 15s30m will become sustainable.

Over time staff no longer consider these actions a 15s30m Mission, they simply become part of how you are at work, knowing that this approach will make the job more rewarding, create joy and reduce frustration. We are all about transforming mind sets, not processes. Then wherever the member of staff goes in the organisation, they carry the ethos with them.




Want to know more about our social movement to reduce frustration and increase joy in work? Quality Improvement for those who think Quality Improvement isn’t for them.


With thanks to @sonia_sparkles for our fabulous pictorials

Rachel Pilling and Dan Wadsworth are the winners of the 2017 NHS Improvement Sir Peter Carr Award. They’d love to hear from you…follow them on twitter @miss_pilling  or @danwods or get in touch using email above.