As a service transformation specialist, I spend a lot of time seeking out transformation strategies in other industries and systems, attempting to apply the approaches and lessons to the NHS. So I feel reasonably qualified to comment on the emerging national plan for world class commissioning which aims to transform the role and impact of NHS commissioning.
The world class commissioning strategy demonstrates many transformational characteristics. It provides a fundamental reframing of the commissioning role; a clear vision and aspirations for change. The process to develop the national strategy has involved multiple stakeholders; there are many hearts and minds behind the plans.
The real test comes as we move to the next stage. There is a danger of 'voltage drop' as the strategy is rolled out. The different thinking that characterised the conceptualisation of world class commissioning might not be followed through in its implementation. The biggest risk is that the transformational aspirations of tomorrow get hijacked by the thinking of today.
Cognitive science tells us that to some extent this is inevitable. As we learn the language of the world we live and work in, our minds tend to hold concepts that flow together in our thinking. Our thinking is highly constrained by our existing experiences and world views. Our existing mindsets or mental models create the greatest barriers to change.
When we think about commissioning, its practical application, how we performance manage it, and so on, it is really hard to envisage it in any way other than the way we know it already.
Innovation experts tell us we must stop before we start. Instead of rushing ahead to generate ideas about local implementation, pause to consider how you might reframe the issues to think differently. I was in a group recently looking at development aspects of world class commissioning. Someone suggested a 'pig' metaphor: what were we trying to do - weigh a pig or make a pig fatter? It sounds ridiculous but it helped us consider the issues in a different light. Particularly, as we begin the implementation process, we need to do more divergent thinking - looking at the issue from a variety of directions and expanding the list of possibilities - rather than diving straight in with convergent thinking - focusing on specific proposals. The NHS Institute has published a useful free guide, Thinking differently, on the topic.
Paradoxically, evidence suggests that transformational ideas are much more likely to be widely accepted if they start from the organisational legacy and what people are used to. So in framing world class commissioning, we need a clever balance between transformational proposals and building on current reality.
Thinking differently - prerequisite to doing differently - is the bridge to get us where we want to be. It has to come from within. As Tolstoy put it, 'everyone thinks of changing the world, but no-one thinks of changing himself'. How much each of us is willing to think differently determines how great a difference we can make.