Accelerating Change Programmes

Seeking the approaches that enable faster change in the complex world of health and social care

How to spoil a good Crisis

We often hear the phrase ‘Never waste a good Crisis’,  yet it seems that in health and social care we regularly waste the opportunity a crisis presents.

The perception of a crisis varies, however my experience of responses to a crisis is that there is a strong tendency to seek increased control through:

  • tighter processes e.g. adding more project/programme management,
  • drawing decision making and solution generation closer to organisation senior management,
  • prompting the appointment of yet more senior people,
  • increased focus on achieving timescales/milestones,
  • requiring more frequent and detailed reporting.

This is a great way to spoil any crisis and slow any change down.

The result of these responses is that people become less concerned with outcomes, are less likely to engage with frontline staff or take risks. This leads to slowing change down and either the crisis deepens or is fudged.

Many times, I have seen or heard about Monitor, TDA, Local Authorities or NHS England applying control to services, organisations or systems in crisis, however it rarely seems to result in real change or a resolution. Crisis in the sector can be brought about by quality, performance or financial problems, but the solutions always seem to drive a short term and narrow focus and rarely address the underlying cause. This all serves to slow down change.

Occasionally, for small scale crisis, additional control is effective, and this may serve to encourage intelligent and capable people to use this approach for all crisis.

The military understands this issue, making sure that unit leaders have devolved responsibility to meet a clear objective or outcome. When crisis occurs, they have full authority to do what’s required to achieve this. Imagine what would happen if when a unit came under attack, they had to contact HQ to ask for solution, await for someone senior to be appointed to the crisis and generate a response, and then stop to report progress on a regular basis. We know this wouldn’t work, however this is how organisations often behave.

My own research shows that in cases of perceived crisis, doing all the right things will enable accelerated change, however without all the conditions being in place, rapid progress is only sustained for a short period. Whenever someone referred to a crisis event, some of the right things often happened, but not all. I see these as being attempts to setup the right conditions for accelerated change, but ultimately they failed to generate real change and the crisis appeared elsewhere or reoccurred.

So what are the ‘right things’? The things that allow you to accelerate change when you have a crisis and then ‘never waste it’. These are the enablers of acceleration that sit at the core of this blog:

  • devolved decisions making with clear roles and responsibilities
  • strong operational relationships
  • strong operational vision
  • clear programme outcomes
  • sufficient resources with a balance between local operational and
    programme management
  • co-ordination role focused on vision and outcomes rather than
  • flexible plan with key milestones.

My view is that crisis is an opportunity that is often spoiled, but by putting the right things in place, these events can be used positively to accelerate change.

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