HomeMay 2012Change programmes from a car boot

Change programmes from a car boot

Health service manager, “Laurence Nightingale” offers some light-hearted advice to colleagues facing into another wave of reform within the public health services.

At a conference I attended a couple of years ago a manager from the NHS in Wales remarked that most of the colleagues he encountered on a day-to-day basis were either recovering from the latest wave of health sector reform or steeling themselves for the next. Sound familiar?

The structure of the Irish health services has been in an almost perpetual state of reform since the late 1990s. Although not unique to Ireland, our predilection for the building and subsequent dismantling of organisational forms and structures is now an established pattern. If this were synchronised swimming, we’d probably be in with a shot at Olympic gold. That is if we don’t drown in the process.

There is a myriad of literature offering advice on how best to engage people in change programmes and maintain their interest throughout it.

You will likely encounter some or all of the following over the next few weeks:


Identifying ‘change agents’

This is a form of speed-dating for would-be reformers where interested parties are courted for short periods of time to establish their ‘change-readiness’.  Evangelical types thrive in this environment and will likely be invited to form part of a ‘guiding coalition’ or a ‘coalition of the willing’. Recalcitrant types will be ignored or dispatched to a remote outpost (most likely to some regulatory role).

Successful ‘change agents’ will undergo a conditioning process which will render them permanently enthusiastic. They will be marked-out from colleagues by their use of emphatic hand-gestures and their love of templates. They may want to take you to lunch or for a coffee so they can impart their new-found ‘road to Damascus’ wisdom.

Beware of change agents bearing gifts; it will most likely be a template.


This will generally involve being invited to a meeting to give your perspective on a decision that has already been made. You may or may not know if the decision has been made but rest assured it doesn’t matter. The Irish Times will confirm that for you the next morning.

Dissenting perspectives will be noted as ‘valuable contributions’ and assurances will be provided that your ‘really useful’ feedback will be taken on board. This will be filed away in a large bag marked ‘Shredding’.

Stakeholder engagement

Having formulated your plan for world-domination, you must move swiftly to ensure the villagers are behind you. This can take a number of forms. Town hall meetings are now de rigeur in any change programme and involve senior managers sitting in poorly-lit canteens out-of-hours explaining what’s in it for you.

Up and down the public sector, similar change programmes are being unpacked from the boot of someone’s car, ready to hawk to passers-by

Town hall meetings became fashionable in the 18th century when angry young men would gather to exchange heated views on the burning issues of the day. It is worth reminding readers that indiscriminate execution of the ruling elite was equally fashionable in the 18th century.

If you do not have a town hall, than any hall will do; as long as it’s well lit and has tea and coffee making facilities.

Project teams

Project teams are the progeny of ‘change agents’ and senior managers and are used to condense a large scale transformation agenda into bite-sized pieces.

Like any group of children, surveys of project teams reveal a wide variety of capacity, interest and attention-seeking behaviours. Project teams work to a Project Plan. The key to any successful Project Plan is the use of brightly coloured boxes. Exemplary Project Plans will resemble the aftermath of an explosion in a Dulux factory.

Due diligence

This is effectively an exercise in risk-management where the soon-to-be defunct elements of the organisation document critical work-streams and processes which require preservation and attention in the new order. These are voluminous documents which you will forced to do in anticipation of a tribunal or some such event. You will likely find the last one you did at the bottom of a septic tank in Moate.


Most change programmes come with their own set of ‘buzz words’ which will permeate through the line into everyday use. The need for flexibility in ‘thinking outside the box’ whilst visioning the ‘future-state’ will require a dizzying amount of neurological and linguistic gymnastics.   Views expressed from inside the ‘box’ will be considered the work of ‘organisational terrorists’ and will invoke responses last seen in Guantanamo Bay.

As the impetus for the latest wave of reform grows over the next few weeks, some or all of the above may be visited upon you and your staff. The important thing to remember is that you are not alone; up and down the public sector, similar change programmes are being unpacked from the boot of someone’s car, ready to hawk to passers-by. Your main focus should continue to be your team and the patients you serve. Ensuring that they remain the priority will keep any process in its proper context.