Back to story list

Getting a 'fundamental shift' in your NHS Trust

Mon 27th March, 2017
Getting a 'fundamental shift' in your NHS Trust

Listening into Action (LiA) has evolved in response to system-wide challenges facing the NHS, which have grown and evolved over the past 20 years or so.

The national system is overly politicised, overly regulated, overly bureaucratic, overly fragmented and overly reactive. In an increasingly complex health and social care context, the NHS’s ability to react and respond to the needs of a rapidly changing societal demographic is being challenged like never before. And on top of this, the system-wide response to affording services which are free at the point of need has resulted in a growing shift in NHS leadership away from medics and clinicians, and towards managers and non-clinical business 'experts'.

The impact on frontline staff has been profound.

Happy staff, happy patients

It was David Nicholson under Patricia Hewitt as Secretary of State for Health, who recognised the need to re-engage our NHS medics, clinicians and other health professionals if the system was to succeed in its next round of wholescale change. Frontline staff who have felt ‘done-to’ over the past few decades have slowly withdrawn from leading positive change to the Service for themselves, their colleagues, their patients and the public at large.

This challenge gets no easier 10 years on with over £3.3bn spent on plugging workforce gaps in 2016 due to staff shortages. The 2017 figure will be over £4bn, despite NHSI’s Agency caps for all Trusts over the past 12 months.

Many NHS Trusts have staff turnovers of 10-17% annually, vacancies of around 5-15% of their workforce, and sickness levels of 3-7%.

Fundamentally, none of these statistics allow for a stable, secure service where continuity of care and a focus on improvements to the quality and safety of that care is the number one priority for all. Short-term expediency and fire-fighting the most recent system calamity will always win out over doing the right thing.

For anyone in any doubt, check out what the system measures, and the job tenure and security of its local leaders. As one anonymous CEO told us: "There are 150 reasons I can lose my job, and the extent to which I engage and empower my staff is not one of them!". What a missed opportunity and what an indictment of the system!

One might venture – as many commentators, academics and experts do – that quite the reverse is the case in fact! There is a very strong correlation between the extent to which an organisation and its leaders engage and empower its staff, and their success. In the NHS, this is most commonly expressed in the ‘happy staff, happy patients’ mantra, and we have seen nothing or no-one of any substance who would dispute this statement.

Finding time for the important over the urgent

And so the challenge for a local leader – and their national colleagues too – is how to stop doing what isn’t working to make time to do what will? How does a CEO and their Executive Team find the time, resources and effort - and the courage - to stop measuring what’s not working and start changing what needs to be done to improve the service?

What’s needed is a fundamental shift in how we work together locally and nationally. There are way too many layers, silos, structures, divisions (in all senses!), organisations and committees to make sense of what DOES need to happen: doctors working with teams, working with managers and support staff, to deliver improvements to patient care. That’s all that’s needed. What other way is there?

Changing the way we do change - once and for all

LiA gives local CEOs who get this – and feel sufficiently emboldened and secure to try – the opportunity to lead a fundamental shift in how the NHS works. It’s about giving control back to the people who know healthcare best. It’s about letting medics and clinicians lead improvements for all, supported by – and this is a cultural and operational challenge – the very same managerial colleagues who today may well be their direct supervisors or bosses. Collectively, they will come up with better, longer-lasting improvements to care than the current structures and processes that prevail nationally and locally.

But this change takes time. Changing a culture take as long as the culture took to emerge. Ask the academics and change experts. In some cases this can be a 5 to 10 year journey. It’s impossible to turn this ship around in a year. So, if you are adopting LiA to tackle the challenges and opportunities facing your organisation or local health economy, it will pay to recognise that it’s not a 12-month initiative. LiA is predicated on the NHS and its staff learning to do this for themselves, and embedding it as 'the way we do things around here'.

There is zero chance of lasting, sustainable change when it is done TO YOU by outside agencies and consultants. The 'graveyard of change' is full to bursting with the remnants of failed Transformation Programmes, Turnaround Strategies and the much loved Programme Management Office. Change only sticks when the people within an organisation decide to lead it for themselves.

It is also far more cost-effective and far more rewarding. The sooner an adopting LiA Trust can continue under its own steam, the better. But that doesn’t mean you can get complacent after an initial 12 months of learning the ropes. A year of learning and evidence is just the beginning - it's time to push the boundaries, up the pace, keep it fresh and multiply the impact. Culture change means altering the DNA of the organisation, and this requires a simple, consistent approach to change, a common language, and staying on course.

So the key messages are:

  • You need to stop doing what’s not working to make time to start doing what will
  • Courageous leaders give control and authority away. Poor leaders take more back to the centre
  • LiA leaders are courageous people who are prepared to lead by example and challenge convention to deliver different - and improved - results, often in short term conflict with immediate systems priorities
  • LiA is about a fundamental shift in how an organisation leads and works – if in doubt, LiA Pulse Check your staff who will tell you this is a necessity to their return to advocacy for their organisation
  • LiA is not a project, programme or initiative that you try for 12 months then stop. If this is the intent, you will wish you hadn’t started
  • It’s easy to do LiA, but it’s very hard to do it very well, and the results you get will reflect what you put into it
  • If not LiA, then what?

If you would like to discuss any aspect of this article please contact Gordon Forbes on 07734 812311 or email

 Add a comment

All comments are moderated

NEW Case Study from RDaSH

Mon 16th January, 2017

Entrepreneur of the Year Award 2016

Wed 23rd November, 2016
Back to story list