Leading improvement in chaos


Latest improvement blog from Haelo’s Chief Executive, Professor Maxine Power, on leading change in chaotic environments.

Sitting here at the North West Ambulance Service leadership conference I am reminded of the constancy of change and improvement in the NHS and Social care. One speaker after another has reinforced one indisputable fact: there is really only one constant and that is that there is almost always ‘chaos’. Despite a commitment to no top down re-organisation the coalition government instigated a series of NHS reforms which have had a dramatic impact on the way services are delivered. This is now being made even more complex by the strategic changes demanded by the Five Year Forward View. Our system is paralysed by and waiting for stability. Our reality though is that this is unlikely to come, not in our lifetime as leaders. I’m left thinking how we can navigate through the chaos. Here are five tips for leading change in a time of chaos:

  • Simplify: The easiest thing for us to do as leaders is to mirror the complexity we see around us. There are such a plethora of plans, schematics, logos, motos and frameworks, the temptation to create a new one is almost irresistible. My advice would be – don’t try to. The work of leaders is to simplify complexity and to make it easy for others to follow. A simple and clear aim, road map and measures can create light and help people to see how they can make a contribution. There is no shortage of will, but there is fear of ‘doing the wrong thing’. If we can help then we can harness the talent in our teams and move forward.
  • Focus: The enormity of our challenge to ‘make improvement’ and to meet the demands on our care system often overwhelms us. It can make us feel that the contribution we can make will be meaningless and grossly underpowered, a bit like trying to sail around the world in a dinghy. In fact, the exact opposite is true. Improvement science shows us that a clear understanding of the contribution that each and every individual can make is what makes the difference in an improving and learning system. We know that in the right context, the small incremental improvements we make to systems CAN make a big difference. Our biggest challenge is to stick with it, believe in our changes, learn fast, celebrate success and learn from failure. In Haelo we use the Model for Improvement to help with this, it’s a great tool.
  • Act alone and together: Our training as the ‘workforce’ within the health and care system helps us to acquire the skills required to excel technically. We use the skills acquired both to become technically competent and to lead. Often this results in us ‘taking charge’ of the situation and this initial action requires courageous and honest leadership. It is a central tenant of change but it is insufficient to take change to scale. To change at scale, we need an understanding of how we can mobilise others to come along with us and how we act together as a team, reaching beyond the boundaries of our organisations and structures to create the right teams to solve the problem. I am known for saying ‘improvement is more like rugby than badminton’ in other words, it is a contact sport where passing the ball and knowing where your fellow team members are are as important as scoring a try.
  • Tap passion: In today’s health and care system the chances are that improvement will be something which requires effort, often over and above the day job. Not quite the north pole, but it sometimes feels like it! The currency we are using ‘leadership’ can easily get distracted – report writing and other ‘busy work’. Tapping into our own passions and the passion of others helps us to re-fuel and to draw the energy required. The energy to move forward and to re-calibrate.
  • Celebrate: The currency of change is positivity of mind and a celebration of the small changes which collectively make a difference. The health and care system of today is focused on planning and defects. We often forget that small breakthroughs are happening every day and pass them off as ‘small things’. Success breads success and learning breeds greater success. We need to celebrate every success, no matter how small, a thank you, a quiet word, a mention in the team meeting, all give us the energy to go on and do ‘one more test’ and that could be the test which makes all the difference.

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The Haelo team hosts a number of improvement training workshops throughout year. If you work in a system you want to improve, invest in your development and attend:

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