Change…. Didn’t we do that program already? by Neil Kelly

“The Only Thing That Is Constant Is Change -”
― Heraclitus

How often have we now heard that the challenges we face can only be resolved through transformational change?  It seems we are in a constant state of flux with management structure changes, team developments, policy statements and strategy.  So does it feel as though these changes are transformational? Although we have this feeling of constant reorganisation I suspect we are all still inherently conservative and hope that if everyone else changes then we can keep our own ‘show on the road’.  Our natural anxiety of change being disruptive helps us to keep our heads down and hope that the process will pass us by and things will settle down as they so often have in the past. This defence mechanism has served us well in until now but is about to be found wanting. In Primary Care (as in the whole of the public sector care giving service) we face the ‘perfect storm’ of even increasing demand, a dependence culture generated by our desire to ‘do good’, a crisis of man power with unfilled posts for GPs other clinical staff and especially carers and significant financial pressures which continue having already ‘trimmed all the fat’ over the last 4 years.

It trying to deal with the’ impending dooms day scenario’ we have been doing multiple tests of change, PDSA cycles and participating in all the latest Scottish Government and Health Board initiatives in an attempt to reshape what we do.  We have gathered a lot of information about how good some of these initiatives have proved to be.  However now we seem stuck.  How do we convert all this ‘learning’ into the transformational change we all desire? Certainly our approaches until now do not seem to have delivered for us.

At the core of what we do as a service are the people who are toiling every day to provide the care demanded and recognising the pressures trying to work harder, faster and smarter.  We are literally ‘sweating our assets’. The eternal busy-ness has resulted in silo working and fragmentation of teams.  So we now need to pick up our bits of learning, coordinate our approach to care, re-establish our community based teams and begin a very different sort of relationship with the communities we serve. In Annandale and Eskdale we will establish in the first instance 4 community groupings of health and social care staff with third sector and independent service providers. These groups will work closely with public health teams to better understand the needs, prioritise and plan services more in tune to those needs and negotiate amongst themselves how this can best be achieved.  In other words everyone involved will take a bit more responsibility for what they do.  The users of the service will be encouraged and enabled to care more for themselves, family members will take a bigger role and everyone involved will be geared to working towards those aims.

So how do we make this happen?  We need to invest in and support collective leadership and ownership, allow much more autonomous decision making and allow the team to monitor its own success. This is a change in approach which is just beginning and will be challenging and uncomfortable at times.  It may feel like just another ‘dip in the change water’ but this time it really needs to transform what we do.  This is applicable to everyone and this time there will be nowhere to hide.

“No man ever steps in the same river twice, for it’s not the same river and he’s not the same man.”
Kelly 1― Heraclitus

Dr Neil Kelly is a GP in Annan.

3 thoughts on “Change…. Didn’t we do that program already? by Neil Kelly

  1. Well said Neil!

    I firmly believe the majority of the ‘coal face’ staff are with you on this. However, in my opinion it is at governance/leadership level that there needs to be the biggest change. There appears to be growing concern from my colleagues (across the sectors) about not only the growing number of roles at the centre but also in clarity over what they do to support the actual delivery of transformational change…

  2. Thanks Liz – we went to an interesting session looking at the Buurtzorg model of community nursing and there were similar sentiments about the pull of the institutional magnet which retards the ability to change.

  3. Change as stated is inevitable due to the “perfect storm” described, however the only way in which change can succeed proactive engagement . Leo Tolstoy stated “Everyone thinks of changing the world, but no one thinks of changing himself.” If everyone was to be presented with the accurate and timely knowledge of the challenges we face and challenges ahead in an open, honest and timely approach inevitable encourage better engagement. This is a stark contrast to the somewhat true headline that the press spin feeding low confidence within the NHS as a whole and frankly scaremongering readers to engage in their very questionable “good story’s”. As Ms. Forsyth rightly said the individuals at the centre should give more clarity in their role in supporting the actual delivery of transformational change, and perhaps part their role should be to engage and educate everyone on the challenges ahead. In doing so the hope would be each individual would see change in a less fearful light and more as an opportunity to improve, actively exploring ways they can step up to make professional steps to support the changes ahead.

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