The King’s Fund report this morning is just the latest – if one of the most visible – reminders of how difficult it is to change complex organisations, and the law of unintended consequences.
The challenges facing health and care providers are well-rehearsed: multiple partners; fragmented financing; complex, highly technical services delivered at high-volume; low tolerance for error; political interference; mission creep.
It would be wrong to suggest that there are no answers, or that those leading the system are not making real progress. For those of us working to support the system, the fundamentals remain the same:
- The importance of clear, shared purpose, accountability and authority.
As the King’s Fund points out , for the NHS in London, this is spread across five STPs, includes 36 trusts and foundation trusts, 32 clinical commissioning groups, 33 borough councils, the Mayor and Greater London Authority, 33 health and wellbeing boards, three academic health science networks, the London Health Board, London Strategic Partnership Board and Healthy London Partnership, and the regional outposts of several national bodies.
Wow! So what do you need to address this?
- Good relationships and shared understanding of “the plan”.
- Focus on technology and innovation – you can’t transform an organisation just by doing the same things but a little more energetically.
- Buy-in by customers and ownership by front-line professional staff.
The challenge will be to avoid overlaying yet another structural solution (more top-down reorganisations, anyone?), and look at the system from the bottom up to answer the question: What is the problem we are trying to solve?
Our experience suggests we can get traction and bring people along successfully as partners in transformational change – but we need to look at things from a different perspective.
If you are managing a complex transformation or change, Verve can help. We have supported sustainability and transformation partnerships across the UK including working with clinicians and leaders across ten organisations to communicate a powerful vision for health and care.