Purpose - The purpose of this paper is to review the change process that is required to support CANDO, a business improvement technique primarily associated with the manufacturing sector. It reviews the transferability of CANDO to a health setting and examines the effectiveness of this tool through the eyes of the change agents and implementers. The study draws on an ongoing empirical research study in the NHS. Design/methodology/approach - The methodology is a case study, combining semi-structured interviews, observations and reflexive accounts. Findings - The results show that this improvement tool is an appropriate mechanism as a foundation for developing change agents and for creating change in health care. The capability and competence of the change agent is critical to the success of a change programme. Specific skills include developing people outside of their normal functional boundaries, redefining values and norms, motivating and energising others, translating terminology, setting the initiative within the wider agenda for change, and designing and communicating solutions and new systems as a result of CANDO activities. Research limitations/implications - As the research focuses on one NHS Trust within the UK this limits the generalisibility of the results. However, the results provide an important insight into developing change agents, their role while identifying enablers and inhibitors to the change process. Originality/value - This paper records the early stages of what is a large-scale and long-term improvement programme from the perspective of the change agent. This is an important perspective that is often overlooked when examining change programmes.