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NHS - Change needs to change!

Relax everyone, it’s not the end of the world.  According to the latest polls. (Have I Got News for You)

And so, as we digest the United States election results, the polls have been trumped again (my apologies for the horrendous pun, but it had to be done you understand).

Once again, the polls have got it wrong: from the Scottish vote for Independence, to the General Election that voted David Cameron Prime Minister with a majority, to Brexit and now to the United States Presidential election. 

There was much hand wringing and commentary in the press and in the media in the wake of the US Presidential election results about how the pollsters are increasingly wide of the mark in predicting the outcome of voting.  To the point where one commentator suggested that when people are being polled they are deliberately misleading those asking the question by not giving an answer that reflects their true view.  Furthermore, it was also suggested that pollsters are not targeting the opinion of enough of certain ethnic and demographic groups, and then making incorrect assumptions about their views as a result.

In a nutshell, the world of polling has changed.  The rules of what once worked in polling and would accurately reflect the outcome and views of the populous have now changed.  It did work.  It doesn’t now.  The commentator reflected that a different way of collecting opinion was needed, so that the outcome of major elections and referenda didn’t come as a complete surprise, the complete opposite of what was expected, as it has done so often recently, with the shock reverberating around the media and social media.  But yet the answer hasn’t been found.  In the meantime, I suspect they’ll carry on regardless until someone comes up with a new approach that gives the right answer and not the wrong one.

And so it is in the NHS.  It needs to change and adapt in order to survive and continue to be free at the point of access.  It knows that large-scale change, not tinkering around the edges, is needed in order to bring it back from the brink.  Yet it continues to use out-moded and out-dated change methods, which once did work but now don’t work.  We know they don’t work because nothing changes.  The people who are required to implement and deliver change at the coal face know that, and have grown cynical about it; they know that service developments and changes have been pre-determined by the chosen few, and they are asked for their views at the end to rubber stamp it, but it’s badged as involvement, engagement and consultation.  The upshot is that change is often overtly resisted, even if the ideas are good.

Like the current methods of polling, people have changed in how they respond to the change process.  And so they either start playing the destructive game, or just disengage; they actively seek to pervert the outcome because they perceive it to be an unfair or undemocratic process where lip service is paid to their views.  And even when they do input their views, little, if anything, actually changes; why should they put their energy and enthusiasm into a process with such an outcome?

I’ve said it before, and I’ll say it again: change needs to change.  There is a way to ensure that we effect proper, meaningful change, which delivers the outcomes that those who deliver care and those who are receiving care need.  This involves some difficult conversations and for leaders to ensure there is meaningful engagement right through the system, with all stakeholders, both within and outwith, not least patients.

Like the pollsters, we cannot afford to keep getting it wrong.  Time now to change our approach and accept whether you have 9, 90, 900 or 9000 stakeholders to engage, you need to give them all a voice, let them self-select to become engaged and let them fully develop the ideas. It can be done, indeed, it has been done with remarkable results. It doesn’t take months of subcommittees and terms of reference, what it takes is three one day workshops and a small number of mini sessions to allow those who could not make the main workshop still input.

In a nutshell, the leadership agree the principles and let the stakeholders fully engage in the debate on how the change required is best achieved. It becomes about winning hearts and minds before empowering the group to develop the changes required and the implementation plan before the deliver the change.

Once again I encourage you to avoid top down reorganisation and instead engage every stakeholder from the start. If you give them a voice and engage them in leading the change, your change project will deliver.  It’s not easy, but it gets real change happening in a positive and constructive way, and also ensures resilience for future challenges.

If you are thinking of developing an at scale provider organisation, or about delivering any form of change, and are looking for a model to engage every stakeholder in that change, and would like more information on how BW Medical Accountants can support you, or to arrange to speak to one of our experts please contact  or call 0191 653 1022.

Additionally, if you should have questions for us please email  and we will do our best to answer these within the blog.

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