Seeking the approaches that enable faster change in the complex world of health and social care
For a long time I’ve known that managing change in health and social care is really challenging. It is only recently that I’ve analysed this and began to understand the complex nature of this environment. I now firmly believe it is the most complex environment within which to deliver change. I would be happy to be challenged on this, however the following are the reasons why I feel confident in my analysis:
The nature of health – the health of individuals is driven by a combination of genetics, lifestyle choices and environment, a complex set of variables producing a even wider set of conditions, symptoms and behaviours. How much do we really know about health? I have seen quoted that knowledge in medicine has a half life of around 45 years. This means that 50% of all the things we think we know about medicine will have changed within 45 years. If the career of a health professional is 35-40 years, then almost half of their knowledge will change over their career! So what we might have assumed was a world of black and white is, in fact, a sea of grey.
The nature of social care – social care is also inherently complex, with many services and range of practitioners that would assess and define care needs in different ways, most of these differences, all being reasonable. Additionally, personal budgets, mean that people requiring care are able to make genuine choices about how their care needs are met, adding further complexity.
Delivered by people – all these services are delivered by people, in a wide range of professional groups, all trained in different ways, all with a variety of different, but reasonable views on how symptoms, conditions, needs and behaviours are managed, supported, treated and cured.
Change means people changing – all change in this environment means that people, both professionals and patients, need to change their processes, behaviours and sometimes values. All these people have feelings, relationships and past experiences that mean that they will react in very different ways to this change.
Many organisations – strategic change in the sector is very likely to include many organisations, large and small, all with different politics, objectives and cultures. In some cases these changes will be undertaken in partnership, without any organisation being ‘in charge’, thus driving a more collaborative approach to leadership, but adding to complexity.
For those involved in change in this environment, this is why you’re finding it challenging. However, this shouldn’t be an excuse, but you will need to adapt and ensure people are central to the changes. The likelihood is, as I have done, you have already started to change your approaches to match your environment.
So why is this important?
In the UK, the expected approach to implementing strategic change in the sector is programme and project management. These approaches were developed by professionals experienced in capital projects and technology implementations, and as a result are very process focused, logical and linear. These environments are significantly less complex than health and social care. The big question is, are these approaches still fit for purpose in health and social care service change? I would argue that they aren’t, and that to work in a complex environment they would need to support a more iterative approach to change, ensure co-creation, focus more on people and relationships and be much more agile in their processes.
So what does work?
This is really difficult to answer, but there are some emerging themes and examples of successful approaches. More of this, in future blogs.