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  • Writer's pictureCarl Davies

No change is better than poorly managed change

Updated: Apr 10, 2018

Around 70% of change management projects fail to deliver the benefits they orignally set out to achieve. The reasons that they fail are quite consistent; Scope creep, lack of planning, poor resourcing, poor risk and issue management, no clear roles and responsibility and a lack of clear project structure.

Change is complex. It is even more complex in a public health system such as the NHS, due to the various political and operational challenges it faces.  That's why it is is essential that we have leaders who understand how to manage change and build a culture of continuous improvement to manage transformation.

Change management requires a particular set of skills to be successful.  Unfortunately, when those skills are not present, some organisations expect that operational leaders (often excellent at day-to-day operational management) deliver change on the ground.  As a result, we are seeing a shift towards extreme 'cost-cutting' measures, which actually put patients at significant risk and decreases quality. We see a shift towards a situation where we have decreased cost (a win for those who hold the purse strings), but a reduced quality of service for the patient and a pressured situation for the staff (a win-loss-loss scenario). Staff become demotivated, exhausted and it results in the total opposite of the 'culture of continuous improvement' we strive for.

This is not a criticism, it's a reflection of the current situation. Many managers in the NHS are fire-fighting, and have learned how to 'survive' in a very challenging environment. The pressures of performance management are focused on symptoms of the problem rather than root cause, and even those people who do see the solution and have the skills can find it difficult to get their organisational leaders to think differently.

When running a service I immediately do two things, I identify what works well and what doesn't work well.  After doing this, I look at how we can rapidly tackle the things that do not work well, and then help facilitate a collaborative long-term vision for a transformed 'system'.  I 'never' just go in there and see if I can maintain the status quo, because even in the best performing services there is always something that can be improved.

Managers who simply maintain the status quo often believe that to do so is a success under 'current pressures' but I try and look at things differently.    Innovative managers try to challenge a workplace sentiment that change has been 'forced' upon them. Act or be acted upon. Leaders try to encourage the art of the possible, and try to inspire others to identify ways to bring about improvements.  There can be stark differences between managers who look to 'survive' and leaders that aim to 'thrive'.


Leader:  Savings target £100,000.  Takes system thinking approach to redesign and looks to build connectivity between system components.  Looks to identify waste (in form of duplicate appointments, unnecessary appointments, long waits, poor preparedness, etc etc) and for ways to improve the efficiency of the service.  Seeks to provide more time for clinicians to work together, understanding that an improved system and a focus on quality improves productivity.  In doing so, this type of manager identifies that they can provide a high quality service with 1.5 less staff, reduce number of contacts required and achieve a considerable reduction in consumables, whilst also maintaining high patient satisfaction.  Achieves savings target and has improved quality.

Manager:  Savings target £100,000. Understands that staff costs are the biggest costs for the service, so starts with targeting a reduction in these.  Encourages staff to work harder, targeting improved 'productivity' and expects more patients to be seen within a standard session.   Focus on achieving more form the 'current system' and looks to reduce any time spent in non-patient facing activities.  Very little attempt is made to transform the 'system', which leads to poor staff motivation and reduced patient outcomes, but does manage to achieve a reduction of 2 whole-time equivalent staff members.  Achieves savings target, but at the expense of quality.

Both leader and manager will believe they have sought to improve 'productivity' and both have achieved the savings target, but only one has really delivered a true benefit to the local healthcare economy.  Short-term focus are false-economies and ultimately cost more than they save.  One of the challenges in the NHS is, that whilst there are many excellent leaders, there are also far too many 'Manager' types that are taking short-term decisions to cut cost due to 'current pressures'.  Many are are attempting to transform a system without the skills to do it and are actually adding to the cost, whilst negatively effecting patient outcomes.  

As leaders it is vital we consider the unintended consequences of our decisions. In many instances, having the insight to know when to say STOP on a project is a sadly neglected skill. There is nothing wrong with failing, we learn important lessons, just fail fast. What is worse than failing, is continued failure, as that is what can 'bring down the house'....

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