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The headlines are divided and the commentaries are flying as to whether the White Paper launched this week will drive the NHS forwards or lead to a derailment. Stepping back from the headlines, here is a major change management challenge and although over 15 years old, the work by Kotter (1995) on why change fails points to some interesting strengths and weaknesses as the change journey for the NHS begins (again).
Establishing a sense of urgency
Lansley has ticked the box on this one and gives a very clear message that he has done his homework, formed his thinking and has set the stage for change. He sees that the business-as –usual is not acceptable in the NHS and in some respects is” making the status quo more dangerous than launching into the unknown”
Forming a powerful guiding coalition
The new ministerial team are in place and roles agreed but to be successful, the ministerial team has a pivotal role in growing the same drive and commitment from a wider pool of leaders and stakeholders to ensure that there is a sustained critical mass of supporters and followers. This has yet to be tested during the journey.
Creating and communicating a vision
Clear elements of the vision are there in the White Paper and the strap line “no decision about me without me” sets the tone for the future. The picture is painted of a patient-centred NHS, more choice, more frontline control, more focus on clinical outcomes, a more market driven healthcare system. The destination is clear with some unchartered waters to get there.
Getting rid of obstacles to change
This is where the debate around policies, the levers in the system, current organisational forms and incentives becomes very interesting. The reality is that there will never be alignment with financial, performance or delivery mechanisms in the system before the change starts but the key is to know which ones to change and when. Has the structure button been pressed too soon or is it really the main obstacle to achieving change?
Creating short-wins and declaring victory too soon
At the moment this is the area where it is hard to see any signs for success. It is hard to see any productivity or performance gains or increases in patient satisfaction over the next 12 months. The short win of reducing management costs might be judged as a success for an external audience but to those working inside the NHS or for patients the benefits may be difficult to see or feel. There has to be some short term wins to be used to build credibility for the bigger, more challenging issues ahead.
Anchoring the changes in the culture
It might possibly be a first if the NHS is really given the one direction of travel and the time to get there. If patients and their families, staff and politicians really do see and feel new behaviours rooted in social norms that support freedom, fairness and responsibility then the White paper will have been a success. The urge to take short cuts or change route makes this seem like never-neverland.
Liz Howarth, assistant director, iMPOWER
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