Transformational change – a call to action

Steve Fairman - photo May 2014Blog post by Steve Fairman, Managing Director of NHS Improving Quality

Today’s NHS is facing almost unprecedented challenges. Demand for services continues to grow while resources are under greater pressure than ever. It is clear that we can only square this circle by changing the way we do things. And that is exactly what NHS Improving Quality’s new White Paper offers.

The new era of thinking and practice in change and transformation: a call to action for leaders of health and care The new era of thinking and practice in change and transformation: a call to action for leaders of health and care was released this month, and is written by Helen Bevan and myself.

It brings together evidence from around the world, tapping into a wide range of sources, to offer practical ways of introducing transformational and sustainable change in the NHS.

One of its principal messages is that we need to change our way of thinking about change. We need to alter our own mindset if we are going to alter that of others.

The truth is that introducing change in the NHS isn’t technically hard. What’s really difficult is making it sustainable.

We can all recall making changes to systems and practices that appear in the early stages to be having a real impact. But six months or a year down the line it is often as though the change never happened – things have reverted to type.

This isn’t that surprising. People in most walks of life tend to be resistant to change that they don’t feel they have been involved in creating or owning. And healthcare is no different.

Our White Paper tries to show how we can turn this around by harnessing people power rather than suppressing or ignoring it. The inspiring thing is that once a change movement has momentum it can become almost unstoppable!

So how does this work in practice? One table in our White Paper juxtaposes the current ‘dominant’ trends in healthcare improvement and change such as working through hierarchies, having a mission or vision, operating in a single organisation and performance based on transactions with ‘emerging’ trends such as working through connections and influence, having a shared purpose across organisations and performance based on relationships and a common cause.

There is growing evidence that these emerging trends often hold the key to real sustained change. However, this isn’t a question of either/or – change leaders will increasingly need to operate in both worlds if they are really going to make a lasting difference.

Our White Paper also lists five key enablers that will help create real change. These involve embracing rather than spurning the mavericks and radicals in your organisation (they have great ideas), leading transformation from the ‘edge’ not the centre (ideas need space to grow into something practical), changing your story (think less about changing behaviours, more about changing mindsets), curating knowledge (manage the internet-spawned ‘information overload’ to your benefit) – and building bridges to connect the disconnected.

This last point is one of the cornerstones for sustainable change. We need to make connections with those people – in the organisation but especially beyond it – who aren’t usually part of the process.

Increasing the number and range of voices involved will not only help to inject new diverse thinking into the process, it will make the resulting change plans more resilient because there is a wider sense of ownership.

For instance, one of our White Paper case studies showcases the Newquay Pathfinder project which brought together 1,000 older people to find out what mattered to them and what support they needed to live well. The results completely altered organisational thinking which had been focused on ‘fixing’ conditions rather than helping people to live their lives. The scheme has enabled older people to reshape their future, widen their social circle and actually reduce care packages. Emergency admissions have also fallen sharply.

So where now? The White Paper includes a ‘call to action’, a list of 15 practical steps that health and social care leaders could begin making right now to start the process of truly transformational change.

NHS leaders will have to work and think differently in the future. They will also have to surrender some control in doing so. This will be uncomfortable for some. But all the evidence suggests that in releasing control you gain power and unleash more fundamental change that will ultimately benefit the patient. In the current environment that surely has to be our goal.

Download the White Paper:


One thought on “Transformational change – a call to action

  1. Pingback: #nhscitizen and local involvement – Birmingham session, some thoughts. « Podnosh

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