Follow the tides of change to achieve new models of care

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Pilot the changing variables and behaviours, instead of swimming against the tide, to effect sustainable and consensual change, says Jonathan Pearson

My father in law is in his sixth decade of sailing, and he is adept at reading and riding the wind and tide. He harnesses and adapts to the constantly changing squalls and waves to get to where he wants to go.

Jonathan Pearson

And so it is with leading and delivering change: one needs to pilot ever changing variables and behaviours in a complex environment to patiently reach an objective.

In his review Sir David Dalton sets out a compelling case for the benefits of scale that can be achieved through hospital chains. The story of Axel Paeger and the AMEOS Group shows that with tenacity and adaptability these benefits of scale can be delivered.

Many NHS providers are struggling to maintain clinical and financial sustainability within their inherited care models. Dr Paeger illustrates that healthcare leaders can make a difference and can change their models of care.

‘How can patients benefit from the improved care quality that can be provided through a hospital chain?’

So, NHS leaders could ask themselves how further benefits of scale can be achieved, given where they are now and their organisation’s existing business model.

How can patients benefit from the improved care quality that can be provided through a hospital chain? Do the same arguments apply to other providers, including our fragmented system of general practice?

Community roots

One issue for a hospital chain will be how it ensures each of its hospitals remains rooted in its local community, and that a live relationship and dialogue continues between the community and the hospital.

Formal governance arrangements, as well as a wide range of engagement approaches, can be used to do this.

The success of AMEOS seems not to be in the brilliance of its strategy, but rather in the execution of its plans. The primary challenge for delivering the benefits of a hospital chain in the NHS is not one of strategy, but one of execution.

The way not to approach this is with a 2,000 line Gantt chart that assumes change in healthcare is a predictable and stable project, like building a submarine, and is simply a logistical problem.

Change programmes in healthcare are notoriously unpredictable and unstable, and require goal orientated project management.

‘Change programmes in healthcare are notoriously unpredictable and unstable’

Where leaders agree the goal for their project, they plan how to get to that goal democratically with their team and are then left alone to deliver it. They are, however, held accountable for delivering their goals and have authority within clear boundaries to do what is required.

Oil rigs were consistently delivered to the sea bed on time within the weather window required in the North Sea, where the technique was pioneered. To deliver the benefits of hospital chains, leaders and their teams need to harness and adapt to the “winds and tides” of their environment, to reach their agreed goals, like my father in law, who adapts to the changing gusts and currents to sail around a buoy, and then another buoy, in pursuit of a chosen course.