It’s Not Me, It’s You. Dynamic vs Directed Change In The NHS

The geolocation of problems is one of the most insidious barriers to change: within many groups you find that the problems are laid elsewhere. There is a sense that change is needed, that we, we fortunate few, understand and are acting upon it, but that over there there is a silent majority of people who neither get it nor believe it. The people who are building the wall that will prevent change happening. I’ve been considering change in the NHS this week and I cannot escape the sense that there are walls all around me: clear views of who is at fault, of where problems lie, of the need for change, but very much a sense that the change needs to be directed and pushed. In fact, what may be needed, is a more dynamic approach to change: cocreated and co-owned, and starting with the realisation that it may be me who built the wall and me who needs to break it down.

The National Health Service operates in a wildly complex environment, subject to multiple dimensions of pressure: political, social, resource, and time. As a massive organisation it has access to enormous manpower, vast amounts of resource, and an incredible amount of goodwill and expertise. And yet despite, or quite possibly because of, these dimensions, it is incredibly hard to change the thing itself, despite a number of widely supported, fully democratised, creative and dedicated communities.

A directed change model would seek to impose order upon change, to set the direction and impose momentum. A Dynamic Change model will seek to create a frame for change and to co-create and co-own that change. The first relies on those in authority believing they have the answers, the second relies on them having the humility to recognise that they may be the problem.

As I work on the final stages of the Dynamic Change Framework, I’m going to look more at the application of the principles of co-created change in giant organisations. Organisations where their very mass and momentum make them almost impossible to change. In these contexts we need magnetic models of change: we have to recognise that to affect change we must relinquish certain control, invest broadly in the future state by listening to a wide variety of views and generate individual agency at breadth to drive the change.

In the case of these gigantic organisations, we may have to admit that the problem is not you, it’s me, and only by investing myself in the change community and being willing to engage with you in that space, to co-create a new meaning that we can both be invested in, to learn the 50% of stuff we need to know to get there, only by doing this can we truly affect change.