Posted on Thursday 7th July 2016
We are told we’ve never seen the like in a generation…we’ll never see such change again say the media. All the talk is of how the world will never be the same again. So what changes have we seen over early summer…well I call it summer…we have had below average temperatures, above average rainfalls and fewer sunshine hours than normal…apart from that it’s been lovely. Anyway I digress. Change – that’s what is in the air. Just think what changes we’ve seen in recent days:
Oh and bakers in Tonga are now banned from selling bread on Sundays.
Question: is any of this really ‘change’?
They may be ‘events’ or loudly expressed opinions but what defines ‘change’?
I ask because the world keeps turning, we go about our daily business; we broadly will do tomorrow what we did today. But what about the ‘EU Brexit vote’ you cry. Well if you go along with my cynical view of the world where I suggest the overarching establishment always wins and deals are done (however spun in the media) over time I suspect we will still have significant labour movement and trade tariffs will not be one way and we will still have to pay somehow into a pot somewhere to enable ‘free trade’ to happen. The world tends to work for the benefit of the richest club members be it inside or outside the EU or USA or the Far East emerging markets. I suspect deals are always done that maximise those benefits for those that control the agenda. Of course I may be wrong and the trading world may collapse, markets may seize up and investment may be put on hold…although cyclical events mean just that…markets do bounce back and new opportunities are found. Much of what is happening now is due to uncertainty and a political leadership vacuum…not because we’ve actually changed anything.
If I’m wrong however then real change for the NHS could mean for example that 50% of supplies already imported from outside the UK will no longer be available as the first choice of users adding potentially an extra £900m bill to NHS costs (HSJ 04/07/2016). It might mean our 50,000 NHS staff who joined from the EU choosing (or being forced) to return home and it will probably mean EITHER a sizeable cash injection for the NHS (say Brexit) or significant further pressures on costs (say Remain) reflecting the uncertainty of our economic future outside the EU.
In the event I doubt any of these extreme outcomes will happen and the most likely assumption is that things will stay broadly the same even if there is a general election, new PM, EU exit clause triggered and goodness knows what else.
Why am I so cynical? Because real change is about finding new ways of doing things, transforming behaviours and introducing aspects of innovative behaviour that make us stop and gasp and say “well – I never thought that would happen”. It’s not about saying ‘no’ or ‘yes’ and then simply changing the captain or manager or structure.
Definitions of change include:
So when I qualified my Google search to include ‘NHS change’ and found over 21 million different results…this suggests lots of NHS change going on then. And yet there isn’t – not really.
There are undoubtedly new clinical techniques, new procedures, new safety standards, new skill sets, new approaches to treatment all of which mean we can care for more people with better outcomes than ever before. I get that. But is it fundamental change in the way we deliver care at a time of challenge, increased demand, austerity and our selfish behaviour as patients? I don’t think so. Because real change transforms our life..look at the Internet, mobile and digital technology and social media. Real change is sustainable and delivers outcomes and behavioural impact ideally for the better. In my view real change is also enabled by looking at what others do, seeking partners where skill and resource gaps exist and trying to say ‘what can I do’ not ‘ I can’t do it because..’
We have ‘change models’, ‘change management’, ‘change transitioning’, ‘sustainable change’, ‘transformative change’, ‘accelerating change’, ‘analytical change’…and many, many change managers… but there are also barriers to change as highlighted in The Health Foundation report ‘Constructive Comfort: accelerating change in the NHS’:
And therein lies the problem for the NHS and others. Because we can have committed leadership, data that supports the need for change, resources set aside for change, problem solving skills and even an enabling environment for change…but if there isn’t an acceptance of the absolute requirement to change…that burning platform …then changes won’t happen. We know almost 75% of change initiatives fail to achieve their intentions…so says Helen Bevan who is Director of Service Transformation at the NHS Institute for Innovation and Improvement. She says the more things change the more they stay the same and has based her assessment on peer reviews of over 1000 healthcare initiatives.
So when we talk in the NHS about hospital chains, integrated care, accountable care organisations, single oversight frameworks, sustainability and transformation plans and forward views are we really talking about absolute and fundamental change… or just new words for repackaging care delivery, estates and cost changes and care planning in new boxes? Change means being fundamentally different and we aren’t… we are doing the same things differently, in a different order, in a different system with new names…but the outcomes are the same. I get frustrated by that set of parameters but I do try and understand all the pressures and governance challenges that limit change, limit risk taking, limit imagination and initiative and try in our partnerships to share those risks and promote innovation. And I know that working at the sharp end of care is difficult; working in a hugely public and political environment under the media spotlight is terribly hard but is the solution really more Government led structural change and name juggling? Or is it time to look at other countries, other models of care, other local solutions capable of extrapolation and see what real change might look like?
Because old chestnut although it is, there is much to recognise in the words attributed (perhaps falsely) to Gaius Petronius in AD65:
“We trained hard… but it seemed that every time we were beginning to form up in teams we would be reorganised. I was to learn later in life that we tend to meet any new situation by reorganising; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralisation.”
Stephen Collinson, Managing Director