Service re-design, innovation and the need to make change are very common themes in the NHS right now. Yet while it is easy to say the word, making change presents some real challenges for leaders in healthcare. So what are some of the common mistakes that leaders make when it comes to making change?
Mistake #1: Not Engaging Stakeholders
It can be really tempting to get stuck in and start doing things. At the same time we all know that unless you have the engagement of stakeholders it is always going to be difficult to make significant progress. Start on the right foot and focus first on getting key stakeholders engaged.
Mistake #2: Not Involving The Right People
Those in leadership, management and functional roles clearly have a huge role to play in change, service re-design and improvement. On the other hand they can only do so much. Making significant progress requires the involvement of the right people, with the right skills, the right knowledge and the right attributes.
Mistake #3: Over Reliance On Tools and Techniques
Yes tools like process mapping, lean and six sigma are all valuable but they are essentially enablers. Often it is as much about culture change as it is about what you do.
Mistake #4: Paying Too Much Attention To Outliers
In any change situation where change is needed there are going to be a small minority who embrace it, a small minority who resist it and the critical mass who will or won’t get on board depending how well you do at positively influencing. The danger is that you spend too much time on the outliers and lose sight of the importance of the critical mass.
Mistake #5: Trying To Eat The Elephant
Yes you might want to get a result fast. At the same time you need to be realistic. While you might want to get from start to the end point in one step, you know that this is not going to happen. Most organisations can only ever hope to tackle a few significant things at any one point.
Mistake #6: Relying On The Wrong Type Of Influencers
Every stakeholder group has very specific interests. They look at things in terms of what it means for them. As a result you need to adapt your influencing style to meet those different needs. A one size fits all rarely works.
Mistake #7: Trying To Bulldoze Through What You Want
Sometimes we see situations where people come in with a big reputation and try to bulldoze their way to success. This rarely works long term and often just results in people being even more defensive.
The Bottom Line: Every leader makes mistakes, even the very best. At the same time often paying attention to some of the basics can make a real difference to the results you achieve.
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I couldn’t agree more with the first 3 points… and I don’t even work IN or FOR the NHS!… although my husband does. ‘Solutions’ are often imposed from on-high without understanding the medical necessity behind some of the practices.
e.g. “don’t cancel this patient ‘cos they’ve been cancelled before” (we cancelled them because there wasn’t a bed in the High Dependency Unit, and patient safety comes first), or “you need to work evenings and weekends to keep the lists down (no matter that you’re on-call to provide an emergency service too)”, “You need to come to a meeting next week, (even though you have 18 patients booked in clinic, & we can’t cancel them)” , “We’re making this clinic run on 10 minute slots (even though the examinations require 20)” and “you have one piece of equipment, so share it. We can’t afford another (even though we’re a multi-sited hospital)”
These are just issues that have occurred in the last 3 weeks. Senior Doctors’ time is highly scheduled, most of it 6 weeks in advance, most of it patient facing and most of it driven by ‘the system’. Unfortunately, these are among the key stakeholders that need to be involved with agreeing change. I’m certainly not saying change isn’t needed, but its all a bit chicken and egg – you can’t involve doctors until they have free time, and they won’t have any free time until they help shape the change.
Many thanks for taking the time to provide such an indepth post with your observations.
No one would say any of this is easy. At the same time some simple changes can really have a big impact.
Duncan Brodie