One of the factors identified in the report that contributed to the poor level of care in Stafford Hospital was the constant upheaval the NHS is in.

The CIPD/simplyhealth 2011 absence management survey (get report from CIPD) gives the average number of days absence for public services as 9.1 days per year.  Although this is a half-day reduction on the previous year, it is significantly higher than the private sector.  A particular challenge identified in the public sector is the sheer amount of major change and restructuring, and it is suggested this could be the root cause for the relatively high level of absence.

In analysing the report, the BBC make the following three observations, that are worth highlighting (BBC insight):

1. The inquiry report said Stafford was “not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated”.
2. To move forward, the report called for a “fundamental change” in culture whereby patients were put first.
3. This would require a commitment from all those working and connected to the health service to make sure they put this at the heart of everything they do.

This poses many real challenges for the various trusts in the NHS, which is where most of the changes need to be made, as the recommendation is that any necessary changes are done within the existing NHS structure.  Should the change be driven bottom-up, from the perspective of the individual patient, who typically wants a local service, within a general, national  framework?  If so, what would be the implications on change management skills within the local trusts?  Also, the need for successful delivery through projects and programmes is fundamental, given the number of reported unsuccessful change implementations in the public sector.

How will the NHS cope, given that successfully changing a culture is arguably the biggest change challenge.  But is there just one culture to change?

Maybe, but one thing is clear, unless there is someone willing to follow there is no leader; not even if one has the title of CEO or executive sponsor.

There are a lot of change management workshops and courses on leadership and creating leaders, but ‘creating’ followers tends to be handled across a number of areas that includes ‘motivation’ and ‘dealing with resistance’.  Are we doing the followers justice?

Derek Sivers uses one of the many music festival videos in discussing leaders and followers.  Be warned, the camerawork is shaky at best!

http://www.ted.com/talks/derek_sivers_how_to_start_a_movement.html

What is your view on ‘creating’ followers?

It can be argued that there has been a paradigm shift in people’s attitude to disability – a moving of hearts and minds – as a consequence of the special circumstances provided by the Paralympics.

Does it always take special circumstances to achieve a paradigm shift?  What is the value of difference?

Watch the video on Sue Austin, an artist who has changed hearts and minds through doing the extraordinary.

http://www.ted.com/talks/sue_austin_deep_sea_diving_in_a_wheelchair.html

What lessons can you identify for managing change, particularly for dealing with resistance in change?

Emergencies, opportunities and externally imposed mandates will, despite strategic intent, all play a role in altering corporate priorities for change and can destabilise the portfolio.  Even worse, this creates the impression of a lack of clarity of purpose and inconsistency in senior management behaviour to the staff who are involved in the changes.  There is little worse for morale and motivation than the perception that an organisation’s leadership is prone to erratic, short-term behaviours – especially when this is not really the case!

The real question, therefore, is how do we deliver strategic change objectives and structure a consistent portfolio, while maintaining the capability to respond to short-term tactical priorities?

Things to consider

Have you discussed and agreed:

1. the relative priority of work within the portfolio and the level of resource commitment that the work requires?
2. the organisation and mechanisms that accept unplanned work into the portfolio and how this will be communicated?
3. the value system that is being used to drive the portfolio?

And are you considering:

1. a ‘practical’ level of planned resource utilisation for the current and foreseeable circumstances?
2. making explicit the rationale for accepting any unplanned work, particularly in terms of the impact on the overall portfolio?