5th April 2016

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Before someone does it to you
News and Comment from Roy Lilley
There is a word.  It's following me around.  Read anything about the NHS and there it is, leaping off the page.
Six letters beginning with 'C'.  Got it?  The definition:
'Make or become different'
'Take or use another instead'.
Yup, it's 'change'.
No PowerPoint is complete without it.  No article finished without the word liberally sprinkled throughout.
Just what is it people want to 'change' about the NHS?  Probably the most admired healthcare system in the world; free at the point of use, young or old, rich or poor, drug addict or yer granny... we'll pick you up, get you back on your feet and help you get on with your life as best as you are able.
What do you want to 'change'... 'use another',  or 'make or become different'?
If you must use the word (when I think you mean the NHS must be more nimble, innovative and agile). Let's give it a meaning in a context that is useful.
C - Culture.  Everyone says we must change the culture of the NHS.  Will that be the compassionate bit, the caring, sympathetic, non-judgemental bit, or the bullying, intimidating, threatening bit?  Maybe the slow to move, glacial bit?
I suspect... the latter two.  In which case, culture is the last thing you should try and alter.  Culture is entrenched, engrained and embedded.
Management theory is based on human behaviour.  Peter Drucker called it a liberal art.  How we arrange our collective efforts to adapt, improve and survive.
If you want to change how the NHS thinks and moves, try changing the 'climate'.  Climate dictates culture.  Climate is what we bring to work.  

We are each our own eco-structure, our own climate.  We can each decide to say, 'I'm sorry we didn't get this right, how can we do it better next time?'
Each of us can decide to say 'we' and 'us', instead of 'you' and 'I'.  We can change the 'climate' by asking the people we work with; 'what three things do you think should be the top of my to-do-list today'? 

 'Please. Tell me what I need to know'.
H - How.  If you want people to change something give them the 'how' as well as the 'when'.  Show people what good looks like and they will get on and do it... better.
A - Adapt; if you are on a change programme (and I'd rather you called it a Good, Better, Best campaign), be ready for things to go wrong, to slow up, lose direction, go off at a tangent.
Inflexibility is the enemy of doing things differently.  Be prepared to adapt your plans, acclimatise to changes outside your control and adjust. Be nimble.
N - No.  Knowing when to say 'no' takes courage.  When changes aren't working, be prepared to pull the plug and reach for Plan B.  Saying 'no' when plans are not delivering is much more sensible than ploughing on, hoping something will come right.  

Look what happened to the Lansley Reforms and 7-day working...
G - Gather.  You are not the font of all knowledge.  Before you embark on a 'good better best campaign', look around you.  In this country, on the Academy web site, overseas, think tanks and find out what has worked elsewhere.  

All healthcare systems are facing funding and demand problems; there is a lot going on and you may not have to re-invent the wheel.
E - Exciting.  Let's face it, no one likes 'change' done-to-them but we do like change if we feel part of it, if we feel we are in charge. 
'We are going to change discharge arrangements' 


'We are going to see if we can find a way of getting people home quicker and safely.  Tell us what your ideas are...' 
I know which works for me.  Get it right and 'Change' is exciting, exhilarating, inclusive and stimulating.
'Change' it is a dangerous word.  Be careful what you wish for.  We can't change the seasons or the wind, but we can change what we wear.
Change the NHS?  I don't think so.  Make it work better, why not.  To not 'change' is to be stuck in the past and then we risk missing the future.
Change is not delivered on the back of a truck; change is delivered by the people driving the truck.  

Be a driver and travel the road of your choice.  If something has to 'change', be sure you are part of it... before someone does it to you.  
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