Transforming healthcare means rewriting the rules of change. This was the message Dr Helen Bevan, Chief Transformational Officer at NHS Improving Quality, had for APAC 2014 delegates.
The ways we go about making change in healthcare often don’t deliver the change we want, or don’t go far enough. The small, incremental changes that were appropriate in the past don’t work anymore. To make change happen in our organisations, to deliver better care for our patients and our communities, we need to go further, faster, with large scale disruptive innovation.
Change leaders in different sectors all over the world agree that the single biggest thing happening in the world right now that impacts our ability to deliver is the rate of change. Change is getting faster and becoming more disruptive.
Digital connectivity feeds this trend. We can connect with virtually anyone in the developed world at any time. Boundaries between our personal and professional lives blur and traditional approaches and assumptions are challenged by new ideas in this interconnected environment. And world is only going to get more connected in the future. Facebook, Twitter, cloud computing, apps and Skype have become an integral part of our lives, but only ten years ago they didn’t even exist. How, then, will the world look ten years from now?
The effects of digital connectivity have created a global phenomenon of increasing complexity in our work. We work across networks much more than we used to. It’s often no longer possible, for example, to contain the management of a patient to a single clinician, unit or organisation. Patients are empowered by digital connections with other patients and access to information. Complexity has a specific consequence: the erosion of traditional hierarchical power. As individual organisations become less important in the way work gets done, the power structures that traditionally held people to account become less effective.
Interconnectedness is moving change processes to the edge of organisations. Globally, the research and development or innovation teams of big corporations are no longer in the centre of the organisation, but maintain a network of external links.
As a result of these trends, the improvement methods and models used ten years ago were designed for a different mindset and set of circumstances. They’re designed for a static and stable world that can be readily controlled. We’re operating with 20th century change practices in a 21st century world.
In the approach to change that currently dominates transformation efforts:
- power is embedded in a hierarchy
- the mission and vision of an organisation is important in dialogue around change
- understanding and motivation come through rational argument, data and planning
- innovation is leadership-driven and comes from the top down
- change is based on tried and tested experience
- the underpinning focus is transactional – performance management and holding staff to account.
However, a new direction for change is emerging that reflects the mindset and circumstances of the modern world. In the emerging direction:
- power comes through networks, connections and influence
- a common understanding of shared purpose among organisations, communities and other partners is more important than the mission and vision of a single organisation
- understanding and motivation come through emotional connection – people engage in change because they want to, not because they have to
- innovation is driven by the front line of care
- change is based on open approaches – sharing ideas and data, connecting, co-creation
- the underpinning focus is the commitment that comes from relationships.
This emerging direction will become more important as the world changes. Nonetheless, the current dominant approach is likely to remain strong for years to come. As leaders of change and improvement, we need to learn to live on the line between these two approaches.
Dr Bevan’s presentation at APAC 2014 was based on ideas in her July 2014 white paper, The new era of thinking and practice in change and transformation: A call to action for leaders of health and care. The full paper can be downloaded here.
Watch Dr Bevan’s presentation: