Taking The Opportunity To Build Back And Transform

Laura Churchill is the Director of the London NHS Sustainability & Transformation Partnership Network. Previously, she was Executive Director of NEL Healthcare Consulting. Most recently she has led the London Improvement and Transformation Architecture programme, which aimed to redesign how improvement and transformation activities are delivered in the capital.

Last year I wrote a blog about resistance to change and the steps we can take to make transformation less painful.

I was unapologetic about the scale of ambition behind the programme I was leading, recognising that the whole health and care landscape is shifting in order to create integrated care systems across the country. As a result, it was unfathomable that any organisation that considered itself to be part of those systems could stay static and still be relevant. I reflected that traditional industries everywhere are experiencing change, driven by progress in digital technology.

Constant change was about the only thing that could be expected. Economists call it VUCA: Volatile, Uncertain, Complex, Ambiguous.

Nothing, however, could have prepared me for the impact of the COVID-19 pandemic. If we thought we were navigating a VUCA world a year ago, we were, and continue to be, pushed to new heights now.

My role sits within the NHS in London. I work for the five Integrated Care Systems / Sustainability Transformation Partnerships on regional priorities that they choose to drive forward together. I look around me and very few of my colleagues are doing the same jobs as they were just four short months ago. I’ve had some colleagues approach me in despair and dismay, and others in exhilaration and excitement. Many of us are wrestling with the impact of COVID-19 not just on our professional lives, but on our personal lives too.

We have oscillated between a deep-rooted sense of pride in the system we serve, and the uncertainty of what means for our own, personal place within a system that is unrecognisable from the one we knew.

I found myself wondering if the suggestions I made last summer, about making change less painful, could still be applied in this new world. Here are my musings.

1. Transformation is not crisis management.

Crisis management is what happens when we wait too long to do something about an issue or where we need short term fixes.

Throughout the COVID-19 crisis response I have observed, and felt, the energy of a crisis. I admit that it was exhilarating and even rewarding at times. However, over an extended period, it is exhausting and stressful. I’m now witnessing the slump of the shoulders, and blood-shot eyes that are looking at the long road ahead to restart services whilst considering the prospect of a second wave and localised outbreaks.

We are tired. After months of long-hours, little or no time off, and the constant rush of fear and adrenaline, there is little left in the tank. As we recover, we need true transformation, not crisis management. We must be driven by strategy and longevity. We need to enact our recovery with calmness and consideration, albeit at pace.

2. We cannot transform something with the sole purpose of hitting a target.

In an integrated environment, targets relating to single parts of the system (geographies, organisations or sectors) will only create barriers and channel programmes into work that is siloed and divisive.

The COVID-19 crisis has brought into sharp focus how dependent we are on each other across the health and care system. Never have we ever had such stark examples of the connections between hospitals and the community, or between health and social care.

This week, we are starting to see headlines again about reintroducing performance management across NHS trusts. I understand the reasons, but grounding our recovery from COVID-19 in hitting targets will serve only to undo the partnerships we have forged over the last four months. Instead, the transformation required must be about creating resilience and preparing our system, the whole system, to succeed in the long term. COVID-19 gave us a clarity of purpose that we have never seen before.

Regardless of where you worked we had one, shared, clear goal to save as many lives as possible as COVID-19 swept through our communities. Whilst “business as usual” has more facets and subtleties than this, we need to continue to inspire change through purpose and common ground, rooting our transformation in better outcomes for our patients and citizens.

3. Transformation, by its very nature, creates conflict, and we should embrace and harness the energy and focus this brings.

If you’re transforming something and no-one cares enough to voice a different view, you’re either not really transforming anything, or you’re not engaging, in which case your change won’t stick. Throughout the crisis, we let things go, keeping comments to ourselves where previously we would have wanted discussion and debate. It will not be like this as we transform through recovery. Money will be firmly back on the table, politicians will rightly expect appropriate consultation with the public before major reconfiguration is enacted, and we will, once again, have competing agendas, targets and masters.

In order to not lose the connections we have forged, or the appreciation we have gained for those outside of our immediate teams and organisations, we must embrace this opportunity to engage in heated conversation. This conflict will fuel innovation because it forces the consideration of divergent viewpoints and will drive improvement. It should, of course, be managed with respect, appreciation and an open mind, but it mustn’t be avoided.

The COVID-19 pandemic has been, for many of us, one the most challenging of times of our lives. We have seen devastating loss.

But the actions we have taken in collaboration and partnership across our system, the incredible dedication of our staff and the commitment from Londoners themselves in following advice, meant that our capital was not overwhelmed. We have a great deal to be proud of, and the relationships we have forged and the learning we have had over the last four months are great gifts.

We owe it to our system, and to our communities, not to revert to our old ways of working, but to build back, to transform, into something better than before.