Seeking the approaches that enable faster change in the complex world of health and social care
From my perspective, I only change when I really want to.
Why do I still munch on too many cakes? Because my enjoyment of cakes is stronger than my desire to lose weight. I could do with losing a few pounds, but fundamentally I don’t want to change. If however, I started to develop symptoms of poor health, the need to stop eating cake would increase, but even then, change would only happen if I wanted it to. My desire for any particular change will be driven by my values and the things that motivate me.
We all know this, however our approach to organisation change often doesn’t reflect this. The strategic planning process used in health and social care in the UK is very good at describing the need to change and I’d find it difficult to argue with most of the strategies this process produces. The problems really appear when implementation begins. The common approach is to build project or programme structures that use senior managers or professionals to define what needs to be changed and then engage front line staff, specifying what they need to do. Sometimes, this produces change, but my uneasiness with the approach is that it often doesn’t. It often leads to quite tense situations with frontline staff, delays, partial implementation of changes and situations where changes aren’t sustained or workarounds appear. The approach is similar to my GP specifying that I shouldn’t eat too many cakes, I know this already, but unless I really want to change, I won’t. It’s not a consistently successful approach, nor is it cost effective.
In health and social care, if I look at service change from the typical GP, hospital nurse, community physio or social worker perspective. Why would they want to make savings, reduce inequalities or improve 4 hour wait performance in A and E, just because there is a strategic need to do this? They will be interested in how the proposals impact on them and use this to work out if these are important benefits to them. Like me and my cake, they will only really change when it is something they want to do. An approach that suggests that these professionals will fall into line with strategic needs is not only flawed, but, in my view, disrespectful.
From experience, whenever I’ve been able to genuinely hand over responsibility to frontline staff, real change often begins to happen. Investigating the nature of acceleration across 5 programmes, I saw a number of consistent enablers of acceleration and a number of these speak specifically to handing over responsibility to frontline staff. Specifically, the following enablers of acceleration;
These enablers really support frontline staff take responsibility for defining and driving change and they all appear to be required in order to accelerate change. Central to these enablers seems to be a large operational delivery group, taking responsibility for the vision, relationships and outcomes from change. In my next few posts I’ll expand upon these enablers of accelerated change and large operational delivery groups, inviting comments and experiences of others.
Taking account of these enablers, will not only significantly increase the chances of changes happening, but will make them happen faster. One of the key challenges being how to do this, in a world dominated by strategic planning.
It would be wrong for me not to acknowledge that the basis of this post is to persuade people to join me in exploring and changing their approach to change. I’d like to ask you to join me (by commenting on this blog) and we can explore our cake eating habits together!
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