What Gets In The Way Of Change In The NHS?

The NHS is a huge organisation. The work it does is vital. We all will access and make use of services at some time.

Right now the NHS is going through some tough times, financially and operationally. Despite this staff turn up day after day, week after week and do an amazing job.

There is a lot of talk about the need to change. Like all organisations the NHS cannot stand still. At the same time delivering change in the NHS is tough.

I know from my time working in the NHS just how challenging it was to make change. At the same time there are some factors that can get in the way of change in my experience.

So what are some of things that gets in the way of change in the NHS?

Knowledge gaps

There are lots of different professions. The people in each professional groups have real depth of knowledge in their field. At the same time they can often lack insight outside of their own area.

As a result people can sometimes look at things through a narrow lens.

Experience gaps

What people in the NHS are excellent at is safety, processes, making the best use of resources, dealing with large volumes of activity and meeting targets.

Sometimes they are not as experienced in areas like innovation, creative thinking, strategy and long term planning.


The operational (day to day) agenda is huge and can be all consuming. This can result in leadership teams becoming too focused on the here and now rather than the longer term.
Breaking this mode of operating is tough but essential.

Trying to impose change

Top down telling and imposing change might get some progress short term but rarely results in long term change.
Working with, listening to and involving people in change is much more likely to lead to better results.

Over dependency on external experts

Experts or specialists should be brought in where necessary to support making change happen. They should however be seen as partners in the process and in my view should not be taking the lead.

Unrealistic expectations

Change takes time in any sector and this is especially true in a large and complex organisation like the NHS.
You might want to make change tomorrow but in reality any type of meaningful, lasting change is likely to be achieved over a longer period of time.

Personal agendas

Moving into a senior leadership role brings with it certain rewards and benefits. Sometimes as people become more senior their personal agenda and specifically their survival can become a bigger area of focus than what they were brought in to deliver.

Lack of team working

Any change in the NHS is going to require a lot of team working. It is all too easy to forget just how much this matters. Little can be achieved without commitment of different teams in different parts of the organisation or even across health economies.

Duncan Brodie of Goals and Achievements works with the NHS in the areas of leadership, change and improvement.