NHS Quest CEO Breakfast Session: Becky Margiotta – The Billions Institute


On Tuesday 22 November 2022, we were joined by Becky Margiotta, co-founder and owner of the Billions Institute, working with organisations to design and lead large-scale initiatives tackling problems within their own workplaces.

Based in Los Angeles, Becky has worked closely with not-for-profit organisations in the UK – introducing the ‘Spread and Scale’ programme to hundreds of leaders within the NHS. The programme encourages participants to upscale their innovative ideas, identifying what is working well and spreading and scaling the work within organisations and beyond.

How can we encourage staff within our organisations to innovate, and effectively scale their innovations?

Firstly decide, what will you spread and scale?

Instead of falling in love with your solution, fall in love with your problem.

Dr. Christine Ortiz Guzman

Becky shared her experiences of working with the NHS, and that we often try and provide solutions before we really understand the problem and its root causes. Once we understand the problem, we are better equipped to come up with even better solutions.

How do I fall in love with my problem?

  • Eliminate all problematic narratives when describing the problem
  • Fully understand your relationship with the people experiencing the problem
  • Be confident your solution solves the problem

Next decide, how much and by when?

Setting the aims of a solution is vital to determining its success. Becky showed us how she guides participants to move away from jargon and reframe their aim with a people or system focus.

She encourages participants to set an aim that elicits an emotional connection, and this leaves staff feeling empowered to produce ambitious aims.

Then consider, how will you get leverage?

Once you have your aims, what do you then need to do to achieve them? Becky presented three simple ideas to work around:

  • Build awareness – make as many people aware of your solution as possible
  • Build will – create acceptance of trying something new
  • Transfer skill – pass on your skills so the work can be done without you

Before starting a piece of work, does your team need to detox first?

Becky explained that for us to know our teams can perform a solution to the best of their ability, we need to understand what holds us back from meeting our aims.

Tight on aims, loose on everything else

Dennis Wagner

We can then think about how to tackle these issues.

Are you likely to subconsciously sabotage the effort?

Becky then moved on to say how important it is that we know ourselves before we can lead on a large-scale project:

You can’t take ownership of what’s out there if you don’t take ownership of what’s in here

Becky Margiotta

She said it is vital to be prepared to make hard decisions and accept the criticism that comes with those decisions.

How did our Quest members react?

Becky’s presentation sparked a variety of conversations between the Chief Executives in attendance. 

We considered: how we can help create a courageous environment where people feel safe to be ambitious and take risks; how we can better understand the psychology of change to unleash potential in our teams; the importance of using just the right amount of data; and how using a simple phrase can help to reframe a complex problem.

Becky then went on to invite any Quest members to come along and see the Spread and Scale work she is doing with the NHS in London, Cardiff and Yorkshire. If you would be interested in this, please get in touch.