What I learnt this week: Whose ‘change’ is it anyway? #WILTW

This is the 42nd WILTW

The main dangers in this life are the people who want to change everything… or nothing.


In late summer 2012 a small group of junior doctors, nurses and graduate management trainees met to discuss a methodology of engaging other health care professionals in innovation and improvement. Follows is a quote from my call to action:

But like others in the NHS I have a sense of belonging, anyone who has been on a department night out will note the sense of commoradie amongst us. Despite this sense of belonging the NHS, much like a steam roller, is a machine that does not move quickly. It eventually gets to its destination and achieves its goals but the journey is slow and often painful for those at the bottom.

I was a junior doctor at the time and was really excited to be part of a project which I believed may help others make changes, however small, to their practice. Our aim, born out of a few hours discussion, was to model the Earth Hour social movement and create a day in which any health care professional would be asked to pledge a health care action. It wouldn’t be defined or mandated but could be shared and copied. In the room at the time were no government representatives, regional strategic directors, presidents of Royal Colleges or BMA representatives. There was a group of (relatively) young people connected by various leadership and improvement networks and brought toghether by Helen Bevan, then of the NHS Institute for innovation and improvement. At that meeting we set the day for early March 2013. I make this point because on the 6 February 2013 the Francis report was released. The date of release had fluxuated for some time but even given my health service naivety I was unprepared for how this would affect our project. Let me be clear first. The Francis report was a defining point in the history of the NHS. The underlying issues affecting not only Mid Staffs but other hospitals are clearly fundamental problems that need to change.


However NHS Change Day was not a response to the Francis report. It has been, and still is, very difficult to convince people of this. The timing too ‘co-incidental‘, the concept clearly ‘from government‘, the ethos ‘reactionary rather than visionary‘. I will accept much criticism of change day (I am not an evangelist and continue to ponder whether we got the name right) but I do get upset, and I’ll be honest angry, when this particular charge is laid at my door.

From then on I have become very aware of the differences in the way people value what is important and right to do. Motivations to change (either yourself, organisation or system) are in part dependant on the values that you hold. I would have thought that many people would have had a shared vision of what change day was trying to achieve. But that in itself is a false and arrogant premise. It is not for me to decide what other peoples values are. So while thousands of people join a pledge on smiling at work, others lambast this as weak and something that should already occur. While we aim to bring discussions together on various social media channels, others see this as talk rather than action.

And no one is ‘right’. The Change Day team have aimed to move from pledge to actions, remove the emphasis on ‘totals and targets’, increasingly get involved at a local level, facilitate discussion with more patients and create more space to engage with all those interested. But we are always going to rub someone up the wrong way. We are also not homogenous in our own values. I personally can not promise that enthusiasm and passion haven’t over-run. I apologise to those who believe they are excluded and am honestly very upset to hear stories of where people have felt affronted during conversations.

But in return when I have been contacted with concerns about these events I find it increasingly difficult to arbitrate. The rapid nature of conversations that take place on social media does no-one any favours (believe me I know the Daily Mail have taken hold of an ill-phrased tweet of mine). When you combine limited characters with a topic such as ‘change’, in an organisation as emotional as the NHS, friction is likely. A simple question is perceived as antoginism resulting in an overly defensive response and there begins a spiral in which both sides feel aggrieved.

And there we have it: ‘sides’. An outcome that was never intended or desired but the ‘change’ those of us at the outset wished to take place is not the change others wish to see. It’s a shame it’s developed into ‘sides’ especially as I am sure my ‘change’, and I use this term of any methodology I might use to improve myself or others,  is no better than anyone else’s ‘change’. In fact I agree there are some fundamental issues in the NHS that are going to need a lot more than NHS Change Day to alter. And these changes are certainly not going to happen through change processes I use…

It’s my change though and I am passionate about it. My action, is neither evidence based or groundbreaking. But it’s something different, outside of my comfort zone and it creates a conversation which previously didn’t exist.

If you have something you would like to act on or join, please do and if not, I certainly think no less of you. And if I am not offering the change that you would like to see, I’m sorry, but I’m sure or hope someone else is!

Whose change is it anyway? #WILTW

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