Seeking the approaches that enable faster change in the complex world of health and social care
Initiating the right changes in organisations needs leaders to stand up and make difficult decisions and take responsibility for achieving these, significant leadership effort is required to do this. Once these changes have been initiated the role of senior leaders can be difficult, as success depends upon them being able to change their approach. In the complex world of health and social care, these fundamental changes will be unpredictable, and very dependent and sensitive to the environment within which they are happening.
Many times, I have seen a belief from senior leaders that once a change is defined and there is a plan, that change will happen based on the plan and the benefits will emerge as predicted. The leadership style that supports this belief, sits well with the command and control type of environment that Project and Programme Management methodologies are designed for. In this situation, the Leadership role would be one of driving the change top down, removing blockers or making the key difficult decisions to enable the change, i.e. interfering. The big question is does this approach work when the change environment gets as complex as health and social care, I would argue that it often doesn’t.
An example of this, often well meaning, style, would be one when a senior leader, frustrated by a lack of progress, initiated a decision to include an additional, but very capable organisation, into a complex change. This didn’t resonate with the changes being made at the time, created additional complexity and uncertainty and took many months of leadership time to resolve, resulting in damaged relationships, trust and significant delays. In the top down view of change, this interference, should have brought more capacity and capability to an ailing project and helped rectify the problems, but it didn’t.
In the real world of change in a complex environment, it is very unlikely that either a detailed plan or modeled benefits would survive more than a couple of weeks without the need to review. My experience of planning and modeling in the sector would be that abilities to predict the future would need to be well beyond those of Nostradamus in order to define a plan and benefits model at the beginning of a strategic change. While I have worked with some impressive people over the years, none even come close to this kind of insight into the future. Thus, in a world dominated by people and perceptions, where the need to enable people to be committed to change, there is a need to adapt and review plans and benefits.
Accepting the need to adapt and engage people in order to accelerate change in the sector, what’s the role of the Leader in this. Command and control styles would clearly struggle in this environment, however a style that nurtures, listens, empowers them take action, and adapt solutions, processes, plans and outcomes should be a lot more successful. To support this the Leadership role is one of steering and is very successful when done well. For example, a few months ago, I spoke to the SRO of one of the most accelerated fundamental changes I have seen. His approach was very different to other leaders I have met, his view of the SRO role was one of being there to support and encourage those involved in the change. In governance terms, he saw himself reporting to the delivery group and that his job was to manage into the organisation to ensure that the team were able to deliver the changes they had defined. He made two decisions during the whole programme, the initiate decision and then the decision, developed by the team, to restructure the workforce.
So my experiences in health and social care leads me to the conclusion that accelerating change in the sector requires an ‘initiate and steer’ approach to leadership and that we need to start challenging the ‘interfere’ style of leadership that is prevalent within our culture.
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