Manage change, but first lead it…
The NHS structural changes announced earlier this week are resulting in much discussion and speculation - will they ultimately deliver better care to patients within the reality of tight resource constraint? The jury is out, but what is certain is that once again the Health Service is going to have work through a period of major change. This change will need to be efficiently managed to avoid the chaos that could ensue as Primary Care Trust (PCT) commissioning migrates to GP consortia. However, before the change project plans are developed and implemented there is a need to consider not how these transitions will be managed, but rather how they will be led. The distinction is that change management is about efficiency and control, but change leadership is about direction and inspiration. Isn’t the main risk right now that the impending changes in the NHS will lack coherent and clear direction and that staff will not be motivated to deliver them, rather than the logistics of how the new processes will function?
Providing direction for the NHS may prove easier, though still challenging, than inspiring its workforce to deliver the new arrangements. How do you inspire a busy GP to spend a significant amount of time working out how to commission secondary care through consortia arrangements that don’t yet exist? How do you inspire PCT managers who have spent the last few years developing world class commissioning systems to embrace probable redundancy while engaging constructively in the transition to GP commissioning? Designing and implementing efficient change processes will be important but probably not enough to win hearts and minds.
As with all major change it will require leadership that creates a compelling vision and creates a believable story of how the vision can be attained, as well as listening to those closest to the action along the way. The Health Service in the UK is underpinned by values and principles that need to be kept to the fore; a dialogue with those that deliver care at all levels should be initiated and on-going. Let’s not make the classic mistake of creating new systems and processes that should work but don’t, because those asked to operate them have not been engaged and are demotivated with a weakened sense of purpose. When we see the inevitable change management plans for the NHS let’s check that they are underpinned by leadership that is capable of releasing the effort that will be required from all staff, if they are to result in a better reality for patients and ultimately the health of the nation.
First of all, these proposals apply to England only – Health is devolved to Wales, Scotland and Northern Ireland.
Secondly, it seems to me that the best managers in the NHS will be snapped up by the GP consortia, leaving the second rate managers to facilitate the handover, which does not bode well for its success.