hsj change challenge_2015

Overcoming the top ten barriers to

bottom-up change in the NHS

Change challenge

@HSJNews hsj.co.uk/LinkedIn hsj.co.uk

We launched the ‘Challenge Top-Down

Change’ campaign to our network to

find out if the power of the crowd could

help NHS organisations change better.


We turned to 3,595 NHS staff and

service users in 45 countries to identify:


The

barriers

to change…


…the building

blocks to

overcome

them…


…and the

solutions that

can be adopted

by your

organisation.


You identified ten barriers to change in NHS organisations…

CO

NFU

SIN

G S

TR

ATEG

IES

OVER CONTROLLING LEADERSHIP

ON

E-W

AY

CO

MM

UN

ICA

TIO

N

POOR WORKFORCE PLANNING

STIFLING INNOVATION

PLAYING IT SAFE

POOR PROJECT MANAGEMENT

UNDERVALUING STAFF

INH

IBIT

ING

EN

VIR

ON

MEN

T

PER

VER

SE

INC

ENT

IVES


Confusing strategies

Our organisational strategies hold us back,

they fail to provide a clear ‘call to action’

to change things from the bottom-up.

They reinforce our inflexibility in business

structures and controlling leadership.

Often there are so many priorities, it isn’t

clear what we should do. This leaves us

fearful of stepping up without the autonomy

to deliver change effectively.


Over controlling leadership

Despite some efforts we still rely on

command and control leadership rather than

coaching and nurturing.

We perceive we do not have the freedom or

trust to create change from the bottom-up.

It’s not that our leaders are bad – they just

do not have the rights skills.

This leaves many staff feeling afraid to

speak up, which restricts bottom-up change.


One-way communication

Often our leaders communicate at us, rather

than with us. We are not open and

transparent with each other.

We also do not have enough formal and

informal ways of connecting creative

people.

Part of this is because there is a lack of both

soft skills training and technical systems to

support communication.


Poor workforce planning

It feels like we lack either enough people or

enough time to get involved in driving change

from the bottom-up.

We often don’t have the right mix of skills in our

teams because we are failing to nurture our

people and organise the right mix of talent.

Having the right people with the right skills

requires us to work in partnership with

organisations outside our own, something we are

not very good at.


Stifling innovation

There is no shortage of ideas among health and

care staff.

The challenge is a shortage of processes to

capture ideas and a lack of leaders who truly

empathise with the needs that we see. Senior

leaders are trapped in inflexible processes.

We fail to embrace ways of taking part in low

cost, low risk experiments to test ideas. We

must utilise the diverse experiences of

stakeholders including our patients.


Playing it safe

Our hierarchical centralised structures either

make it too difficult to access funding and

support for ideas or we end up funding too

many projects with not enough resources.

It seems that a lack of clarity on what’s

needed from leaders, plus a fear of doing

something new from the bottom-up, leaves us

supporting low risk ideas, involving the usual

suspects.


Poor project management

When developing and implementing projects we

tend to value inputs and action rather than value

and outcomes.

We’re kept busy with no room for effective

bottom-up change. We underestimate the

complexity in which we are working and blame

inflexible processes and lack of resources.

How change is led from the top, and how we’re

trained to manage and implement projects,

ultimately undermines bottom-up change too.


Undervaluing staff

We must treat each other with compassion, as

much as we would our patients.

Alas we don’t always do this. All too often we

do not feel connected to our organisation’s

purpose and do not feel we have a real stake

in its future.

Being a ‘cog in the engine’ makes us feel

undervalued, disengaged and even ill. So why

would we proactively get involved in change?


Inhibiting environment

Our physical environment can stop us meeting

people and connecting ideas.

The closure of sites has put a burden on the

remaining organisations.

And, as we all know, our IT systems do not help

us access knowledge and share information.


Perverse incentives

The incentive system and

performance management regime

creates disincentives

to support bright ideas, which

might create better outcomes for

patients but will lose the

organisation income.

It creates incentives that leave us

stuck habitually supporting self-

serving projects.


Building blocks identified…

INSPIRING AND SUPPORTING LEADERSHIP

CO

LLA

BO

RA

TIV

E W

OR

KIN

G

FLEXIBILITY & ADAPTABILITY

SMART USE OF RESOURCES

AU

TO

NO

MY

A

ND

TR

US

T

CHALLENGING THE STATUS QUO

A CALL TO ACTION FOSTERING AN OPEN CULTURE

NURTURING OUR PEOPLE

LONG TERM THINKING

THOUGHT

DIVERSITY


Provide inspiring and

supportive leadership Leaders need to inspire and support their

people. This means:

1. Taking forward ideas to improve their

organisations based upon their quality

rather than their author

2. Less hierarchical structure where people

have a greater understanding of each

other’s roles

3. ‘Distributed leadership’ where people are

trusted and talent is nurtured


Work collaboratively

Collaboration between peers within and

between organisations leads to operational and

personal benefits.

Change programmes are more effective,

allowing us to improve the outcomes for people

and populations.

Collaboration also builds supportive working

relationships, essential to improving wellbeing,

nurturing a positive mindset and the

connections needed to drive bottom-up change.


Increase flexibility &

adaptability To deliver bottom-up change we need

flexibility within the system – both in terms

of the formal organisational structure and

day to day processes.

This will allow organisations, teams and

individuals to more successfully adapt to the

changing environment in which they are

operating.


Be smarter with resources

We must do more with the resources we have.

The world’s most successful organisations are

more resourceful than their competitors.

By adopting a resourceful mindset and

providing suitable staffing and skill-mix, we

can try to deliver change within our means.

We should aim for smarter project selection –

doing the right projects well, rather than

trying to do too much with not enough

resource.


Build autonomy and trust

Increasing people’s sense of trust empowers

them to deliver change. This capitalises on the

knowledge and passion of people working in

health and care. We need to:

1. Work within acceptable clinical parameters

2. Remove the fear associated with failure

3. Foster a no-blame culture of reflection and

learning on what does and doesn’t work.


Challenge the status quo

Everyone is able to create and identify great

ideas.

Organisations need to nurture and embrace

the creativity of all their staff to challenge

the status quo and deliver real change.

A large part of this requires health and care

organisations to experiment more and share

their learning, for the benefit of all.


Give a call to action

We must consistently give a clear call to

action for everyone who works in health and

care. To do this we need to articulate the

purpose and meaning of our organisations.

This will ensure alignment within organisations

and across boundaries and inspire

contributions to the mission from the bottom-

up in a way that ensures every person is

moving towards the same common goals.


Foster an open culture

A commitment to transparency and openness

creates a more positive environment.

Openness both allows learning to be shared

across boundaries and means we have

integrity to the people we serve and our

colleagues.

The most open organisations are the most

innovative.


Nurture our people

We need to prioritise the training and

development of health and care staff.

However, we cannot be stuck in traditional

mindsets.

Developing the right mix of skills in the right

places will support and nurture our people to

take local leadership of the changes that are

needed.


Think long term

Teams and individuals need to be

given the space and freedom to

make long-term improvement

plans.

Large changes cannot happen

overnight, and we will only be able

to dramatically improve the health

of populations by successfully

planning for the future.


Value thought diversity

Organisations that value dissenting

opinions as much as coherence and

conformance are more effective at

creating change.

Thought diversity allows the creativity

of our people to flourish and good ideas

to be discovered.


Solutions you can adopt now…

We invited contributors to

identify and further develop

solutions to the problems.

The final 15 - which apply to

more than one barrier or

building block – can be adopted

quickly by any organisation.

If you’ve identified one

or more of these

change barriers

in your organisation, get

the solutions today…

If your organisation is

subscribed to HSJ, visit

hsj.co.uk/change-challenge to read more

Or visit

info.hsj.co.uk/corporate to enquire about access for

your team

hsj change challenge_2015

Documents

nhs change challenge

change campaign

driving change

nhs staff

right skills

right people

controlling leadership

lack of leaders