To say that the health service is drastically changing is like pointing out that the sun is warm.

And this change is not limited to structures and hierarchies. Lines of accountability are becoming more clearly defined in general and the entire landscape around the NHS is transforming.

The weight of expectation grows heavier every day, with an increasing demand for transparency, clarity and better communication with stakeholders. The pace and volume of change is reaching unprecedented intensity.

So what does it all mean? Potentially, it spells big trouble for the middle and senior leaders in the NHS. They are likely to grow increasingly frustrated because all this constant change means they are not being listened to. Their peers, bosses and subordinates may have so much to handle already that these managers’ voices get lost in the clamour.

This is dangerous. When leaders’ voices are not being heard, it can lead to disaffection and a loss of engagement, not to mention how the organisation suffers from the lack of internal debate to drive it forwards and come up with new ideas.

For an entity such as the health service, already accused by many of being too hidebound and bureaucratic, this is the last thing it needs.

In the face of all this confusion, most leaders are forced to adopt a fight or flight mentality. Some choose to rebel against the changes, which leads to conflict - and which can often be positive - while others hide away in their bunkers and do things the same way they have always done them. After all, they think, my goal is enhancing healthcare provision, why should it matter how I do it?

But if leaders want to lead and be listened to, they need more than a fight or flight response. There are two main ways in which they can find a receptive ear: look for a mentoring programme or hold regular team discussions.

Whether internal or external, a mentoring or coaching initiative will provide managers with a sounding board for their ideas, offering guidance on which ones to make a fuss about and which ones to discard.

By ensuring regular, open team discussions on what they are doing and why, leaders will find a receptive audience to their ideas and can also demonstrate whether those leaders are themselves guilty of not listening to others. A collaborative approach to team discussions is vital, because successful debate requires honesty from the participants.

But these only work if they are ongoing processes, not one-off meetings. The main reason is, of course, because of all the change. Even when managers are listened to and their ideas implemented, the goalposts can shift and they might have to go back to the beginning. A continuous system means that even if the environment transforms out of all recognition, the opportunity for forging new ideas does not.

NHS leaders want to provide better services and many have good ideas for how to make it happen. The key is to ensure that those voices are heard.