The Challenge of Change

Has Change Changed?

Has Change Day Changed?

Or has Change Day changed change?

At a recent strategy day for the 2015 event table ‘3’ contemplated questions that might be asked of the Change Day team in 5 years time. This simple sequence of questions raised a laugh at the time but has a serious point to make as to the challenge faced to continue the movement in a relevant way to health and social care in 2015. Change Day was envisaged as a social movement, not a solitary intervention, with a view to reaching out to staff in a way that would engage and inspire not direct and dictate. But because of this its very success became almost its worst enemy. Those who decided to pledge did so for reasons intrinsic to them and therefore the pledges were, by definition, very different. The sheer volume of pledges highlighted the fact that, while some pledges had obvious face value and clear outcomes, others did not. Quite rightly the dissonance between what, why and how pledges were being undertaken concerned those who felt uncomfortable without any tangibility in purpose.

“To the organisers of Change Day, you need a bit of cautious optimism. Don’t let the event be hijacked by people jumping on the bandwagon with pledges that raise questions along the lines of: “What have you been doing so long?” From Dr. Partha Kar: A note of caution about Change Day ” Health Service Journal March 2014

I’ll be honest – some of the pledges caused me conflict. I am a ‘quantitative’ personality.  My PhD research in medical education created measurable frameworks to bring together often qualitative attributes. Pledges such as “I will provide great care” weren’t quite what I had in mind when I first meet Stuart Sutton and Helen Bevan to discuss how Change Day would work.

But I have moved on from this state of mind. In large part due to Kate Granger  who reminded me that even the simplest thing in health and social care can be done badly. #hellomynameis a perfect of example of what some might see as a ‘quid pro quo’ in communication and yet it clearly isn’t. My own reflections on when I forgot to introduce myself made me realise it is not for me to say what others can and can’t pledge. It is their pledge. The purpose of change day was to engage in a non-hierarchical fashion. The very notion of telling people their pledges are worthless simply destroys that approach.

But what of ‘change’ itself. The term change is becoming increasingly poisonous. One delegate hit the nail on the head at an RCPCH event to assist educators in promoting and delivering change.

So a NHS Improvement Day? I feel that may well have created a similar backlash. So we decided on Change Day. But I acknowledge change is a challenging concept. Change itself is undergoing somewhat of a revolution at the moment. NHS IQ have released a white paper on the subject. It is worth a read. Some will find its ideas off putting – its use of the term ‘radical’ uncomfortable. Recent discussions on twitter and other fora have identified an important engagement principle at stake here. It is not a black and white case of bad vs good. There is a danger that camps may start: radical vs non-radical, insiders vs outsiders. George Julian recently raising the issue of Courageous Challenge versus Conformist Control. A vital theme is explored here and one we must all heed: perceptions and motivations of change are different. Health and Social care is not a homogenous beast but a vibrant mix of personalities and approaches. And this is why I see see Change Day not being the same thing to all people. We are not a small group of individuals telling people what to do but a large network of professionals and patients wanting to make a difference in their own localities. The hubbies are a fantastic example of how a shared value can bring people together – student nurses, managers, patient advocates, junior doctors – working in a capacity that wouldn’t have been plausible a decade ago. But some of those same people are enthusiastic about change in a way that is very different from others. In fact within the ‘change’ community I see grumblings about the importance, or not, of wearing public passion on your sleeve. Twitter, in particular, has enabled some people to be very openly proud about their values. Their followers applaud this public display of strength and candour and affirm it. Others can’t stand the pomposity of it all and ignore or deconstructively challenge. And some where in between a group of people who share similar passions often find themselves arguing against each other. The fast paced nature of the world we live in creating conversations and dialogues in formats not always suited to appreciate both sides of the debate. Having recognised my own passive aggression on twitter I really think we could all benefit from a look at our own approaches to the change debate and this is something the Change Day team must be very cogniscent of. We are running the risk of creating radicals within radicals if we are not careful.

Change Day Triangle

As well as determining a common language of change we are also challenged with looking at what change day has actually achieved. I was very deliberate at the start of the piece. Change Day is a social movement – it is not a medical intervention. That does not mean it is not being evaluated but it does mean that it is not a simple case of saying; “This went in and this came out”. I use the following tweet to explain the complexity of the challenge:

A learning package was created on the basis of Change Day which resulted in one doctor changing their practice for the benefit of a patient. This is a very difficult thing to record (and if I had not seen the tweet I would have missed it). But it is a very real difference for the persons involved. My own pledges have been around patient experience. Can I truly say I have changed anything. On paper – no. But around the department many know of the unpleasant nature of flucloxacillin and I’ve seen staff speed up the extraction of children from spinal boards as they have heard of my experiences. Please don’t get me wrong. I am not making excuses for why (to some) we have little definitive to show (we do have a developing, long term evaluation strategy which involves a PhD on our work). We must acknowledge this is not a Beta-Blocker trial but an ongoing complex intervention spanning years.

I think an important lesson for us all is to be  respectful of others ‘change’ journeys as everyone moves at very different speeds. The emotions and passions surrounding the NHS sometimes make it easy to forget we are all part of this great institution whether you are a health and social care professional, patient or member of the public. I personally welcome the challenge of change and hope I, and others, respond in a way that is considerate and constructive regardless of the medium used.



This blog is my personal opinion and has has not been reviewed or endorsed by other Change Day Team members. I welcome comments, critical or otherwise, from anyone with questions about Change Day. 


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