Seeking the approaches that enable faster change in the complex world of health and social care
Recent national events remind me of the importance of Vision, not just any old vision, but one that people can be motivated by. Much is written by change experts about the value of vision, however in complex people change, it’s the attractiveness of the vision to those that will need to live with the changes, that really counts. Roy Lilley highlights in his recent blog the problems with the current vision of the NHS, which isn’t inspiring people. In his words, ‘if the best you can offer is more regulation, inspection, guidance bullying and tough talk.. you just don’t understand the vision thing’. He is exactly right. If more austerity is required in the NHS, who, of the people that will be impacted by changes, is going to follow those leading this? An increasingly small number, in my view.
My experience is that people become excited by being drawn into solving problems, and improving the world either for themselves or for others, drawing them towards something they want to do. In other words, an attractive vision. The logic behind movement to an attractive vision, is driven by individuals feeling; ‘I don’t like it here’ or ‘I don’t like where we will be in the future’. Many frontline staff in the NHS are articulating these feelings, ‘managing within our means’ has been a big part of the overall vision, however after 7 years of this, staff can see the negative impact on them and the people they serve. Initially, the ‘managing within our means’ vision for the NHS had support, as people understood the value of reducing national spend following the financial crisis.
But, it could be so very different. There are many positive narratives, which could drive change, generate efficiencies or quality improvements that also have beneficial financial outcomes. I’ve studied a couple of change programmes where a very strong vision focused around, the benefits of people avoiding admission to hospital, and/or being treated by an integrated multi disciplinary team, has lead to both strong frontline motivation to make change and also reductions in overall health system costs. More recently, I’ve seen strong engagement into a vision to deliver a more consistent service, focused around teams and patients, improving the quality of care and reducing the inefficiencies, which frustrate everyone everyday. These changes also deliver significant cost reductions, but very few people involved in the change are doing so because they want to reduce costs.
A perfect example of a vision which missed the mark, comes from a few years ago. I was involved in a whole organisation event to introduce everyone to the organisation priorities for the year. The event started with ‘it’s going to be a difficult year, we need to save around £20m’ and focused discussions on how this could be achieved. Talking to people afterwards, their mood was very flat, they’d been hoping for something different. Needless to say, the savings target wasn’t achieved.
As a change professional, I strongly believe it’s crucial to understand your key stakeholders and what resonates with them. To strengthen the vision and motivation further, taking people through the process of understanding the problem, developing a vision and how to achieve it, is very effective. Thinking you know the answer and can generate a vision to bypass some time, then establishing a communications campaign to sell it, suggests misunderstanding of the role of vision within change.
Reflecting on work over the years, many times, I’ve created a vision within a change programme, sometimes to appease my masters and other times to engage those involved in the changes and genuinely tap into their mood and drivers that motivate them. The latter are, and feel very different. They also deliver more change, faster, it’s a no brainer in my view, build an attractive vision by engaging people into the process of developing it.