Abstract
Embracing eternal change: Life on the edge in the NHS
Change, change, change; a word akin to healthcare provision at any moment in time. Dealing with change is something that seemingly comes as second nature to us. The NHS and our work environment is never free from change. Since I qualified as a junior house officer 16 years ago I have tried to embrace a state of constant transformation. This not only relates to personal experiences of surfing around different hospitals as part of training, but also the change in our day-to-day work in providing effective and safe healthcare. The environments I have worked in have also tried to embrace a world of continuous change. New guidelines, new medicines, new quality and outcomes framework domains, new locally commissioned services, new procedures and policies are just a few of the entities that constantly change around us. Change creates challenge and challenge, in turn, creates risk. The risk of being out-of-date can be substantial and potentially fatal. So how can we embrace this never-ending revolution without rebellion or uprising? An optimist will say that change should be seen as an opportunity rather than hindrance. A philosophy of accepting change with open arms should lead to safe practice and, above all, a happy ecosystem that is better equipped to defeat the disease of burnout.
So how do we accomplish the art of loving change? Human instinct can lead us to resist it, yet we must identify and overcome this. Albert Einstein famously said ‘If you always do what you’ve always done, you will always get what you’ve always got’. You can choose to love change or fear it. How would you feel if you were told in 10 years’ time you had not changed?
The Chinese proverb ‘When the winds of change blow, some people build walls and others build windmills’. cleverly depicts the embracer from the pessimist. Which one are you? And why? Barriers to change are all too great and the enablers not always easy to find.
To begin to embrace and manage change effectively, one must first learn to overcome fear, doubt and uncertainty. If you think the answer to this mystery is in this article you will be wrong. This is a personal journey where reflection will aid. This is a useful topic for your study group, where you can share experiences and wisdom that may lend itself to a learning log entry. What are your personal barriers to change? And what organisational barriers have you witnessed with consequences to patient care?
Organisational and transformational change across the health and social care landscape has been phenomenal in the recent past and continues. Sustainability and transformation plans are driving big scale reorganisation that may have a huge impact at the coalface. Are we equipped for the challenge?
What differentiates a leader from a manager in any organisation such as a GP surgery is the ability to not only facilitate change, but to initiate it. Top leaders will inspire change and a culture that looks for it. We are now mandated to undertake practice improvement projects to initiate and take ownership of change to improve care. Keeping up-to-date with change in medical advances is crucial to safe and effective clinical practice and evidence is required to demonstrate this for appraisal and revalidation.
Socrates said ‘The secret of change is to focus all of your energy, not on fighting the old, but on building the new’. Understanding the barriers to change is crucial in this journey. ‘Regret’ and ‘error’ are concepts we aspire to use as infrequently as possible.
The National Institute for Health and Care Excellence (NICE) has produced guidance to help understand, identify and overcome barriers to change (NICE, 2007) which is freely available online. A worthy read for an aspiring leader.