10 years an NHS change agent: what I have learned

Ian Railton

Ian Railton

Ian Railton is leaving the NHS after 10 years as a change agent. Ian was a fellow of the NHS Institute’s Improvement Faculty and was a member and strong advocate of the Academy for Large Scale Change. He was formerly Head of the North East Transformation System and has spent the last 5 years as Programme Director (Transformation) within a large mental health and learning disability Trust. In the first of this blog series he gives an overview of his key learning as an NHS Change Agent.

In 2003 I was serving with the Army in Iraq, the end of a near 20 year career as an Army officer. There is nothing like experiencing conflict to convince oneself the world could be a better place. It’s from this backdrop I proclaimed the NHS my first undertaking – what better place to start!

My key learning points follow but first an announcement: the military is not a top-down, command and control-obsessed, supra-hierarchical beast – the NHS is! If it’s to transform, the NHS needs more change agents than it has bureaucrats – start recruiting now, in large numbers.

Learning #1 – Success is possible

  • It’s not whether it’s possible, it’s whether we’re capable
  • Most change efforts fail yet people keep doing the same thing
  • Do something different
  • Learn and apply: Kotter, Large Scale Change, social movement, lean
  • Make this the ‘way you think’ – the ‘way you do’
  • Let go, be passionate, put away self-doubt

Learning #2 – Purpose

  • Truly believe in what you’re doing
  • Imagine the future and articulate this to others
  • Sell the why and nurture those for whom the why is deeply felt
  • Pick the right people: values, commitment, cause, influence, connection
  • Allow people to talk about why in a way they understand
  • Embrace everything trying to achieve the same why
  • Stop, weaken or distract things working against the why. Do so carefully – be Sun Tzu
  • Be ready to talk what and how but de-emphasise until why is established

Learning #3 – Urgency and pace

  • To achieve urgency and pace, act with urgency and pace
  • Don’t get stuck in the short term – lift yourself out of it, others will follow
  • Separate ‘daily business’ from ‘longer term business’ and align resources. The military do this, it works
  • If the future you paint is not sufficiently desirable to generate urgency, paint the unpalatability of the current or predicted future
  • Avoid detours and distractions. If you’re on one, jump off or move quickly

Learning #4 – Leading and leadership

  • Leading by example influences in all directions
  • Don’t wait for permission or perfect leadership from above… you are a leader!
  • Give allegiance and loyalty to those who seek change. Be polite to those that don’t
  • Influence and support leaders to lead in the right way
  • Empower others to lead and you’ll gain, not lose
  • Sometimes, the best way of influencing people is to influence the person next to them – use your network!
  • Identify and help future leaders – they may not be stuck in the present
  • Never accept poor behaviour… if it’s yours, correct and apologise immediately.

Learning #5 – Structure, processes, systems and culture

  • Think of all of these and how they align
  • Re-connect people with why and culture will start to shift
  • Breakthrough ‘existing ways of doing things’
  • Create solutions for what saps energy
  • Experiment – show change can be good
  • Use the Thinking Differently toolkit
  • Develop a need to innovate and people will be creative
  • Break silly rules – be a rebel!
  • Always have a story and data – together they’re compelling
  • Remember function before form
  • Value stream maps help show people change is necessary and possible

Learning #6 – Personal resilience

  • Find a cause you really believe in
  • Show courage and passion – stand up, even if you face standing alone
  • Never stray from the truth
  • Find friends and connections. Find one near the top and make this your golden alliance – nurture it
  • Help people fix their problems – they will look after you
  • Break up your journey – reach the foothill before contemplating the mountain
  • Don’t waste time fighting unnecessary fights

Learning #7 – Methodology

  • Understand the business: How can you improve what you don’t understand? – Too few do, which makes you an asset
  • Understand and measure: demand and supply; work and resources; process and time; flow
  • Map the wider system
  • If you’re not good at maths – find someone who is. You need the numbers!
  • There are better methods for solving problems than: meetings; policy reviews; task and finish…
  • Use proven methodologies – generate capacity and capability in them
  • Teach others ‘your way’ – let it become ‘our way’
  • Ensure method does not become the why

Over the course of the coming months, Ian will blog in more detail about each of these key learning areas. Follow Ian’s series and subscribe to receive NHS IQ blog posts direct to your inbox, by following this blog. You can connect to Ian on LinkedIn or on Twitter @verandernltd.


4 thoughts on “10 years an NHS change agent: what I have learned

  1. Pingback: 10 years an NHS change agent: what I have learned | Leading change in the real world

  2. Pingback: 10 years an NHS change agent: Learning #1 – Success is possible | NHS Improving Quality

  3. Pingback: 10 years an NHS change agent: Learning #2 – Purpose and the importance of Why? | NHS Improving Quality

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