Can we please stop pretending? – Insight from Tammy Watchorn

Article By Tammy Watchorn, Author of the Change Ninja book series and the 4 Day Ninja Challenge

I was this years old when I realised something about transformation. More importantly why we might be getting it wrong. A few conversations that I’ve had recently were ‘aha’ moments.

But first:

Imagine a bridge that is crumbling…. you can spend money trying to fix it over and over or you could spend just enough money to keep it safe while you build a better and newer bridge. What do you do?

Now imagine you are stuck in a traffic jam. You rant and rave, getting impatient to get where you are going. You shout what is causing this horrendous traffic. How often do you stop and think, ‘oh, it’s me, I’m part of the problem’?

I worked, and work with the UK’s National Health Service (NHS) a lot. I still believe in the purpose of an NHS – universal healthcare free at the point of use.  A health care system for all, from cradle to grave.

But I don’t believe that the system it is run by is working anymore. It hasn’t for a while. It’s an 80 year old system designed for a very different world. It’s an old crumbling bridge.

But it’s transforming, apparently. There is a lot of change, much of it technology driven and it’s being called transformation. People believe the changes underway will be transformative and it just now needs a shift in leadership and culture and it will all be fine. 

I have recently presented this challenge to senior NHS leaders who do believe the NHS is transforming.

I suggested the changes happening are ‘bolt on’ technology being labelled as transformative. Bolt on that are rarely joined up and trying to fix the existing system (not change it). It’s like putting scaffolding on that old crumbling bridge. 

I suggested the changes are trying to fix a system designed to ‘just’ treat people who are ill but where the current requirements are much wider, like providing preventative and lifestyle change services. That perhaps a new bridge is needed, or something that isn’t even a bridge, as we know it. 

I suggested the much needed culture and leadership change are too huge to do properly from a top down perspective, the NHS is too big and made up of too many modules. 

I suggested everyone thinks it’s someone else’s job to do which is like being stuck in a traffic jam and not realising you are part of the problem.

I suggested learned helplessness is rife.

I suggested focus needs to be on changing the ‘HOW’. How you get from the new a to the new b rather than keep fixing the old bridge. And how do you keep the old bridge in place until the new one is ready with minimal spend to keep the users safe.

The first response I got to this was culture. “No one is empowered to change things or make decisions” they said. I call bulls**t on this. If a person on £60-90k in the NHS can’t decide for themselves that they will make changes then they shouldn’t be in the job. If not you then who?

I then asked: “What services do we still do the same way today that we did 80 years ago?”

The answer: “Banking”

This left me open mouthed. Banking is probably one of the most transformed services we have. As a customer banks still do the same thing – keep our money safe and give it us when we need it (mostly). But the entire system, process, infrastructure and staff base is different to the ‘It’s a wonderful life’ banking days. Even if we go into a nearly extinct branch they just do what we would do at home – internet banking. They are more likely to employ IT bods, and overseas call centres than customer friendly bank managers. It might look the same on the outside as a core service but it’s entirely different on the inside.

And that for me was a ‘aha’ moment.

Everyone thinks the NHS is transforming because all it does is change. 

Very few realise they are patching up a crumbling bridge because they can’t see that a transformed service, like banking, is run entirely differently to how it was run in the past. The banks didn’t patch up. They swapped friendly managers in branches with tech geeks and apps. The entire back end has changed. 

If no one really understands the basics of transformation they will keep thinking they’re doing it when all they’re really doing is propping up a dodgy bridge. So nothing will fundamentally change and the money will keep getting spent and keep being wasted.

But if everyone stopped pretending that improvement programmes are transformative.

And if everyone stopped thinking they needed permission to make decisions like deciding what meetings to not go to or what valueless tasks not to do.

And if everyone everywhere stopped saying things like ‘it needs culture change’ when those in it are the culture and they are the ones who need to change it themselves rather than waiting for someone to come and tell them to change. 

Then perhaps, perhaps, things might start to change. There might be enough people calling out the bulls**t to allow someone to be brave enough to at least suggest some thought might be given to what the new bridge/tunnel/giant hover board could look like.

Tell me why I’m wrong.

And tell me why this isn’t just an NHS thing.