The proposed overwhelming changes in the NHS continue to focus the minds of those of us employed in the NHS.  Anyone who has read anything about the American pioneers who set off across their continent on the Oregon Trail will know about the feelings of loss, leaving behind the familiar and loved, and of helplessness in dealing with the unknown as they encountered unimaginable challenges.


Talking to managers and staff there are two themes.


First there is the overwhelming sense of being “done to”.  How many staff can say that they were at the table when decisions were made to reshape the NHS?  And the outcome is resentment, resistance, and denial.  Research tells us that if people feel part of the decision they are more likely to be engaged, but that is not the scenario we are dealing with now.


Second there is the uncertain map of the future.  There are not many people who can say with any certainty (particularly if your current employer is a PCT, SHA or similar) what the future holds.  Are you here for the transition, or do you hope for a place in the new structure? Whatever you prefer, you may not have a choice. If your role is considered business critical, then RETs (Retention and Exit Terms) may offer a package that will keep you until the end of the transition period but if your role is not considered business critical then that is not an option. 


If you are hoping for a place in the new structure the mist has not yet cleared – though some with crystal balls may have a view about what they see in the future. The rumour mill is alive and well and in the absence of facts, people are creating their own pictures of the future.


Looking at a typical Change Cycle, people need to move through feelings of loss,  fear, then curiosity and finally acceptance.


This story started in July 2010 and now, 8 months later, people still don’t know what the future holds.  If people are to be able to move through the fear and onto curiosity, then they need answers and clarity about their future careers.


The conspiracy theorists are convinced that there are people somewhere who know exactly what is going to happen, and have all the answers.  Most people just want to know what is going to happen to them – good or bad, job or redundancy.


Going back to the Oregon Trail, as the pioneers crossed the Rocky Mountains they faced the loss of their familiar identities. Emerging new structures will mean people have to let go of organisations that are familiar, that they have invested in, and accept that new organisations may have different cultures and values.   

Read "The challenge of change in organisations" by Nancy J Barger and Linda K Kirby.