There is much discussion in healthcare circles about “strategies for radical change”. The same kinds of conversations are taking place all over the world.
In my specific context of the English NHS, I hear it from leaders of clinical commissioning groups who aspire to transform local services, from NHS providers with ambitions to accelerate improvements in patient outcomes, safety and experience in the face of financial challenge, from leaders of embryonic academic health science networks and health and wellbeing boards, building strategic alliances to tackle health inequalities.
More recently, the talk has been about “strategies to transform NHS culture” in the aftermath of the publication of the Francis report into Mid Staffordshire Hospitals.
‘It’s helpful to frame strategy as a system of reasoning about how to achieve change’
What do we mean by “strategy”? I like Greg Satell’s description. He portrays strategy as the logic leaders use to make decisions to drive action and change, in order to achieve the overall mission of the organisation or system; the logic through which leaders allocate resources and implement processes and programmes for change.
It’s helpful to frame strategy as logic; that is, as a system of reasoning we utilise, based on our views and beliefs, about how to achieve change. I collaborated for several years with Paul Bate and Glenn Roberts on efforts to apply social movement principles to healthcare improvement. Paul has a saying that “revolution begins with transformation of consciousness”. What he means is that when we look back in history at scenarios of radical change, we observe a common phenomenon.
Such upheavals are frequently preceded by leaders starting to think in radically different ways (with a different logic) about what needs to change and how to achieve change. This leadership mindset shift is observed in industrial, social and political revolutions and in the efforts of corporate and public sector leaders to transform their organisations.
Change your logic
We should expect the same when it comes to our current agenda of transforming health and healthcare systems. We can’t strategise for large scale change with the logic of the past, where change thinking was often based on hierarchical power, executed through the mechanisms of performance management and compliance with top-down “payment for quality” criteria, where evidence-based improvement methods were “nice to do” not “mission critical”. This strategic logic won’t deliver change quickly enough and on a wide enough basis, on its own in our current era.
As leaders of health and healthcare, we frequently challenge others to change but perhaps now is the time for us to reflect deeply about our own strategic logic for change and consider whether we need to open our minds to additional possibilities.
‘We might learn from a group of leaders with a logic for strategic action that is markedly different from where we normally start in health and healthcare’
I want to suggest that, in probing our mindset for change, we might learn from a group of leaders with a logic for strategic action that is markedly different from where we normally start in health and healthcare. These are leaders of the great social movements; for example, the women’s suffrage movement, the American civil rights movement, the anti-apartheid movement, the climate campaigners of the 1970s and more recent revolutions in Tunisia and Egypt. These movement leaders had few economic resources and little power in a formal sense. Yet they were able to strategise to change their worlds and enable profound change.
Inspired by these leaders, I’ve distilled four principles about strategic logic for radical change that are relevant to health and healthcare:
- The logic of healthcare strategy can be reframed to make it transformational
- Resources for transformation are abundant, even in an era of austerity; strategy is about mobilising these resources
- Strategy is essentially about relationships
- Strategy involves managing duality
Over the next few days I will discuss each of these four principles in turn.
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