The chances of achieving all change objectives were pretty poor and the key question for leaders was to see what they could do to achieve the fraction of change which was possible, Dr. Helen Bevan, OBE, Chief of Service Transformation, NHS Institute for Innovation & Improvement, told the 9th National Health Summit in Dublin. Maureen Browne reports.
The chances of achieving all change objectives were pretty poor and the key question for leaders was to see what they could do to achieve the fraction of change which was possible, Dr. Helen Bevan, OBE, Chief of Service Transformation, NHS Institute for Innovation & Improvement, told the Conference.
Dr. Bevan, whose job is to help and enable reform processes to happen, said that if she were to take a bet it would be that the chances of achieving all our change objectives were pretty poor. McKinsey had said that most large scale change failed to achieve its objective and the McKinsey transformation survey showed that only about 25 per cent of change objectives got anywhere. The key question was what did we need to do to ensure that we achieved that 25 per cent.
She said that she would like to contrast the anatomical approach to change versus the physiological approach.
“I would say that in England about 80 – 90 per cent of effort is the anatomical approach – how the system is organised, structured, how we deliver care and how it fits together.
There is no evidence of a health care system that has delivered and sustained change through compliance.
“From a leadership point of view when we are thinking anatomically we are thinking about how we can improve delivery of care and eliminate waste and unwarranted clinical variation. Anatomical change is very important and we need to be doing it and doing more of it, but it is not enough. We also need to be thinking in a very significant way about the physiology of change which is quite different.
“Physiology enables people in the system to grow and develop and change, so our focus as leaders is how to build energy for change. It is how we create a higher purpose and commitment to change across the workforce, in patients and citizens. It is about creating a sense of hope and optimism about the future. It is an approach to change based on commitment rather than compliance”
Dr. Bevan said that there had been remarkable improvements in the UK where now people did not wait more than 18 weeks from referral to treatment and about 96 per cent of people spent less than four hours from arriving at the A&Es to discharge, treatment or admission. This had been largely done through compliance, which was the minimum performance standard which everybody had to achieve.
The last era of management was about how much performance we could extract from people, the next is about how much humanity we can inspire.
“If we look at the history of work, there is no evidence of a health care system that has delivered and sustained change through compliance. We have to think about commitment, which states a collective goal to which everybody can aspire. It is based on shared goals, values and sense of purpose. A commitment to a common purpose creates energy for delivery. We will not have high quality, safe care without compliance, but we need commitment also and we need to be able to hold them in tension with each other.
“Dov Seidman said the last era of management was about how much performance we could extract from people, the next is about how much humanity we can inspire.
