How to be an NHS change leader

Budget reductions and structural changes mean the NHS is facing probably the greatest challenges since its creation. Successful implementation change will be critical to meeting future patient needs, but there is increasing evidence that rational decision-making alone is not enough to bring about change.  

Change initiatives can no longer take years to implement, lack clarity and focus and never quite deliver the predicted benefits. They are a risk to an organisation, but a risk that must be taken to deliver the best patient care. The longer it takes to change, the greater the risk of failure, wasted resources and diverted effort.

To be successful, chief executives must launch change initiatives as high impact, engagement exercises and implementation must be rapid, focused and deliver measurable benefits.

Critical factors

The Boston Consulting Group’s DICE system has been validated in over 1,000 major change initiatives. It indicates four factors critical to successful change:

• Review frequency - every six to eight weeks on simple and two weeks on complex change.
• Project team capability - the team must be the best people for the task.
• Management and staff commitment - those who have to change must be committed to do so.
• Additional effort support- those delivering change must have time to do their “day” job as well.

These review factors give a measure of likely success and potential risks. In the January/February issue of the Harvard Business Review, Robert Miles looks at why change fails.

Failure factors include the avoidance of reality, lack of management commitment, too many initiatives, disengaged staff, loss of inertia, and doing change or day-to-day business but not both. These factors mirror the DICE success factors and vice versa.

Change is not just a rational exercise. Recent Corporate Leadership Council research on building engagement and getting high performance suggests that up to 47 per cent of an employee’s commitment is emotional - much higher than many assume.

So to get high commitment to change there has to be emotional as well as rational buy-in, something often forgotten. Neither is sufficient to ensure success. Emotional buy-in alone will not deliver high commitment unless supported by rational buy-in. There needs to be a clear case for both in presenting change to staff. 

Together, they give us powerful principles to increase the chance of successful change in the new challenging world. Other tips are:

• Launch with a bang and have everyone engaged and ready to implement change within three to four months. Keep the momentum up.     
• Confront reality. Management and staff must accept the need for change and what needs to be done.
• Emotional and rational case for change - both are needed.
• Commitment for change- everyone must commit to that change.
• Use your best leaders to lead change. Those delivering and leading change must be the best people for the task, not the people who have time on their hands.
• Keep it simple and focused. Have one clear overarching initiative that everyone can focus on and which can be simply communicated.
• Frequent progress reviews. Check you are making real progress and identifying risk every few weeks.
• Combine change with business as usual - help staff to be able to do the day job and make change happen at the same time.

The chief executive is key in any strategic change. They must make the case for change, build engagement for it, use the best people to make it happen and then drive it personally through line managers supported by HR. Any passing responsibility for leading change to HR or the workforce will cause it to lose credibility.

Partnership working between all key stakeholders is vital for success. Within only a few weeks senior management and senior clinicians can ensure change is a either a success or doom it to failure by their actions.

Never forget, bad change is actually worse than no change.

Multiple, ineffective, confusing and distracting change initiatives are viewed by many junior leaders and employees as a depressing reality of organisational life that saps their enthusiasm and commitment.

Change should be a challenging and inspiring journey to a new, better world undertaken willingly by your people.

Using the ideas above will help your future change initiatives build inspiration, not desperation.