A sea change is happening in the way we approach large-scale change in the health service.

The new mindset is in its early stages, yet is surprisingly widespread, from primary care trusts thinking about how to achieve their health inequality goals, to strategic health authorities considering how to implement their next stage review clinical visions, to NHS providers redefining their success strategies.

Somehow, these perspectives are coming together to create a new era of systemic change thinking and practice. I've labelled it "the age of energising", since its success depends primarily on the ability of leaders and advocates to mobilise people around big goals for change. I predict that within three years it will be the norm in health service leadership rather than the exception.

How do the new ideas differ from previous thinking? Well, the focus is as strongly on "how" to make change happen as on "what" to change. Leaders seek to unleash the creativity and vitality of staff, users, partner organisations and communities to solve common problems and create a future everyone wants to buy into. This requires massive engagement in the change process by many different groups, bottom-up emergence of ideas and more flexible approaches to planning and change design.

Leaders make a compelling case, by helping people to feel the issue (connect it with their emotions and values) and see it (through evidence and data). Leaders view the change process as a system of mutually reinforcing actions and strategies that connect up and complement each other, and are more willing to address beliefs, values and behaviours.

So, what advice would I give to health service leaders in this new era? First, create your own theory. In my experience, working with an explicit theory of large-scale change helps leaders to be more reflective, capable and confident. What is your hypothesis about what you need to do at what level in the system/organisation/community to create your desired outcomes? How will the different aspects reinforce each other? What are the small number of themes with which you will mobilise people? How will this work in practice?

Understand the symbiotic nature of top-down and bottom-up. Wholesale engagement does not mean less top-down leadership; it means more, but of a different kind. It is about articulating a compelling direction, constancy of purpose, making sense and profound engagement with the people and change processes involved.

Once you embrace this mindset, you cannot go back. The reality of large-scale change is messy and complex. It is impossible to know what the full consequences or quantified results will be. Things may get worse before they get better. Leading in the age of energising requires sophisticated improvement methods and programme management skills. It also requires faith, perception, instinct and proceeding with plans even though evidence is incomplete.