Author: Mark

Organizational Change Reflection on the NHS at 70

Introduction

The NHS at 70, is a time to celebrate 70 years of the NHS and reflect upon a 2014 paper on change in the NHS which is due to be revised. I have enjoyed the recent culturally important celebrations of the NHS, both for those who provide this service and those who use this service. I had a routine appointment with a rheumatologist recently and he asked if it was OK for a school student who was thinking of a career in healthcare to observe.

I was very happy for her to observe and I played back to him how the biologic medicine he prescribed had been life-changing for myself. He knew, but my words were for the student’s ears. I was impressed that he wanted to enthuse the next generation of rheumatologists and equally that she was interested in healthcare. This is at a time when in the UK healthcare appears to be underfunded and undervalued by the government, yet simultaneously highly valuable to business consultants, leadership developers, and large corporations.

The new era of thinking and practice in change and transformation: A call to action for leaders of health and care

I was recently alerted (tweet) to a paper The new era of thinking and practice in change and transformation: A call to action for leaders of health and care. Change and transformation have the potential to make a positive difference in people’s lives in a manner similar to healthcare. However, equally inappropriate prescriptions may harm individuals and organizations. I welcome notions of a new era, as sadly change leadership orthodoxy and the leading change fetish look very similar to how they looked twenty years ago. I never understood why the NHS Leadership Academy placed such emphasis on Kotter’s eight steps to lead change nonsense?

Elements in the paper really chimed, such as notions of disruptors and radicals particularly giving them legitimacy in a very large and complex institution was encouraging. In leading and managing change workshops, I encourage a DIY approach informed by relevant theories, models, and concepts. I radically encourage participants to build their own models based upon their own unique context. These notions of localized actions rippled through the paper and importantly sharing and celebrating what worked through storytelling and case studies.

Also, I really liked their notion of curating, rather than creating knowledge. We need more curators, what I regard as scholars, people who critically interpret existing knowledge. The other theme I enjoyed was collaborative working and shared leadership with an emphasis on bottom-up approaches to change and transformation, rather than top-down mandated change. JDI – Just Do It invariably fails to engage, explain or motivate with regards to change.

Less convincing was the business as usual emphasis on leaders, leadership and leading change in the NHS, the aims even refer to ‘… develop change leaders who can accelerate change and achieve their goals.’ This emphasis upon developing NHS change leaders sounds very much like the rhetoric espoused for far too many years by the Leadership Academy, rather than real engagement with a new era of thinking and practice for the NHS.

I counted the references to the stem ‘leader’ in the paper 166 references, in mitigation, this included ‘leader’ in the paper title at the head of each page. The authors attempted to temper their passion for leaders and leadership by claiming everyone was to be regarded as a leader, but by definition, if everyone is a leader no one is a leader. My own unease with the current leadership fetish is that it privileges leaders over followers and leaders over managers. If we regard leadership as relational there is a requirement for followers and by definition, these followers become subordinates in status, but also subordinates in processes of changing. I was deeply troubled to see John Kotter and Gary Hamel being celebrated as part of this new era. If you take the time to trace the NHS change leadership fetish to its origins it goes back to eighties and nineties corporate America when businesses turned against managers and turned toward leaders and change leadership. Writings in business practitioner magazines such as Harvard Business Review then gave legitimacy to the shift.

If the curators of knowledge as proposed in the paper had been at work twenty years ago, collecting, filtering, evaluating, contextualizing and sharing knowledge from multiple sources, the migration of American change leadership businesses practices into the NHS would have been far less likely. There is a surprising lack of empirical evidence that combining organizational change and leadership results in a successful change (filtering/evaluating). Kotter et al observed, wrote about and wrote for American corporations, he was writing about a very different country and a very different sector (contextualizing).

Reflecting Upon NHS Changes

The hospital I recently visited in London, is an exemplar of best practice, externally acknowledged and confirmed through my lived experience based on having been treated there since 2010. Visionary leadership is apparent every time I visit as the physical structure of the hospital evolves. I benefit from the latest advances in treatment, changes informed by research projects within the hospital’s own research centres. As a patient, you have a sense of a hospital having to change and benefitting from effective change leadership.

However, I also witness a hospital being effectively managed. Kotter et al disparaged managers and management to privilege leaders and leadership, but it was never about an either/or dualism which they encouraged. I mentioned earlier 166 references to the stem ‘leader’, yet in the New Era … paper there were only 2 to the stem ‘manager’, very much in line with NHS orthodoxy, but not really a new era or radical disruption of thinking. During my hospital visits, I value the mundane aspects of how the hospital is managed, such as effective appointment management, a clean ward, effective layout, working lifts they all oddly matter to NHS patients.

I was pleased to read yesterday that the paper is being updated and I look forward to reading the updated version, both as somebody interested in organizational change, but as an NHS patient. I have witnessed positive changes at this hospital in parallel to important continuities in how the hospital continues to operate effectively, I am still under the wonderful care of the same rheumatologist I met in 2010. We know in studying organizational change that dualisms such as either change or continuity are problematic, there will always be a mix of change and continuities, even if at times it feels like everything is changing. A new era of thinking and practice for me would be when we start to remember that both leadership and management have a crucial role to play in effectively delivering healthcare, rather than privileging leadership over management. In the NHS there have been changes and there are significant changes to come, but there will also be continuities, celebrating 70 years should also really be a celebration of the continuities with regards to what is good in the NHS.

Further Reading

Bevan, H. and Fairman, S. (2014) The new era of thinking and practice in change and transformation: A call to action for leaders in health and care. White Paper, Horizons Group of NHS Improving Quality. Accessed at https://aace.org.uk/wp-content/uploads/2014/08/nhsiq_white_paper.pdf

Hughes, M. (2016). Leading changes: Why transformation explanations fail. Leadership, 12(4): 449-469.
Organizational Change Reflection on the NHS at 70

August 9, 2018
Whatever Happened to Sustaining Organizational Change?
Post in 54 words

Managers/leaders initiate organizational changes such as service delivery improvements in the expectation that such service improvements will be sustained. But what do we know about sustaining organizational change? A debate sparked just over a decade ago spoke to this question, but for various reasons, this debate was never sustained.

Fashion and sustaining organizational change

Effectively overcoming resistance to change and communicating change have been recurrent themes in discussions amongst organizational change practitioners and amongst academics. Today, they may be perceived as old chestnuts, yet they appear to have been sustained over time, possibly even after their shelf-life has been exceeded. My own lived experience confirmed a tendency towards the influence of management fashion.

The implication was that the organizational change everyone was talking about today, nobody might be talking about in six months and vice versa. Whilst such management fashions go far beyond organizational change they have significant implications for organizational change. Imagine quality circles being in vogue as a participative means of managing quality you invest human and financial resources in developing these quality circles and in developing the skills to make them effective.

Then the world moves on, quality circles are no longer in vogue and the debate has moved on to a different means of managing quality, yet you are left with your infrastructure of quality circles.

Sustaining organizational change after the launch party

My concern is not with the transitory or fashion orientated nature of organizational life, but with what happens to an organizational change after the launch party is a distant memory. I draw on my lived experience inside organizations again. These changes for a time appear to capture the imagination of individuals and organizations. Discussions about these changes are very prominent in written and spoken communications, it can be as dramatic as if you are not discussing the particular change you are not ‘on message’. Ideally, the new way of working becomes the norm, the ‘normal’ if you like. I can think of many examples of this happening.

Some changes stick whilst others drift away

I used to assess paper-based student assignments, rocking away merrily in my rocking chair. Then everything went digital and students submitted their work digitally online, I assessed it online via an intranet site. I do not envisage us returning to paper-based assignments, it was an outcome of a process of change which was sustained.

Alternatively, our university departments used to be clustered into Faculties, a change initiative was initiated in which departments would be clustered into Colleges rather than Faculties and there would be fewer of these new clusters. In this instance, the College organizational structure didn’t really work and after a few years, the Colleges and their supporting infrastructure were abandoned. In reflecting on both these examples the organizational change I experienced may be ‘stepping stones’ to further organizational change with changes along the way embedded or abandoned.

David Buchanan and the National Health Service (NHS)

I want to introduce the writings of David Buchanan and his colleagues which were particularly grounded in experiences of change in the NHS. Anyone interested in reading more about sustaining organizational change should check out Buchanan et al’s (2005) review of this literature. They offered reasons why this area of study received only limited attention, which may today explain why the debate was not sustained.
- Organizational change theories in emphasizing adaptation and constant change, negate the need to sustain organizational change outcomes.
- Next, implementation can be studied over a short time horizon, whereas sustainability requires a longer time horizon.
- Researching change may be more appealing than researching stability and sustainability which may be regarded as a condition to be achieved, not as a problem to be solved.
Modernizing the organizational change lexicon

Buchanan et al (2007) based on their research into the Modernization Agency implementation of the NHS Plan introduced four useful and informative terms into the organizational change lexicon.

Sustainability – The process through which new working methods, performance enhancements, and continuous improvements are maintained for a period appropriate to a given context.

Do we want to ensure the enhancements of this change initiative are maintained?

Decay – The opposite of sustainability, where change is not maintained and benefits are lost.

Is it best if what we were seeking in this instance is not maintained and allowed to decay?

Spread – The process through which new working methods developed in one setting are adopted, perhaps with appropriate modifications, in other contexts.

Do we want these new working methods to be adopted elsewhere?

Containment – The opposite of spread, where changes at one site are not adapted and adopted by others.

Do we want to actively avoid rolling out what we attempted here elsewhere?

This lexicon appears to me to be useful in discussing organizational change within a single organization and between organizations. In studying or practically engaging with an organizational change it raises questions which I have couched in practical terms in italics beneath each term.

Returning to my earlier reflections, the shift from paper-based marking to online marking spread through my university, it is a change that has been sustained. The shift to Colleges decayed, it was not sustained. However, we now have a flatter organization structure without either Faculties or Colleges, in this sense Colleges may have provided a stepping stone towards a new organization structure, only time will tell if this structure is sustained.

References

Buchanan, D., L. Fitzgerald., D. Ketley., R. Gollop., J.L. Jones., S.S. Lamont., A. Neath., and E. Whitby. (2005) No Going Back: A Review of the Literature on Sustaining Organizational Change. International Journal of Management Reviews 7 (3):189-205.

Buchanan, D.A., L. Fitzgerald and D. Ketley. (Eds). (2007). The Sustainability and Spread of Organizational Change: Modernizing Healthcare. London: Routledge.

Hughes, M. (2019) Sustaining Organizational Change. In Hughes, M. (2019) Managing and Leading Organizational Change. London: Routledge.
Whatever happened to sustaining organizational change
August 6, 2018
Post-truth Leadership
Introduction

What if leading organizational change and transformation truths business schools disseminate were largely appeals to emotion and personal belief with little grounding in objective facts? Wouldn’t post-truth leadership offer us a critical moment to question the current orthodoxy of leading change and transformation in favour of thinking critically about how leadership could change?

12″ Inch Sleeve – Behave! by Chumbawamba

Enough is enough

In my youth Chumbawamba used to challenge racism and fascism through songs such as Enough is Enough, urging listeners to open their eyes, urging us to realize it is time to wake up!

They challenged homophobia through the wonderful song ‘Behave’. More recently women have robustly and very publicly challenged sexual harassment by men. For myself change in terms of race, sexuality, and gender are never encouraged through orthodoxy, which by definition seeks to maintain the existing status quo. Societal and organizational changes are far more likely to be counter-cultural and radical, in seeking to question accepted beliefs and assumptions.

Business as usual: 35 years of writing about the leadership of organizational change

In reviewing the leadership of organizational change literature (Hughes, 2016) I was shocked and saddened by how leadership orthodoxy resisted any form of meaningful change, aided by conscious or unconscious collusion of businesses and business school academics.

In each decade, I would encounter writers questioning the emphasis on heroic leaders and the disparaging of so-called ‘followers’, yet nothing really changed. The most cunning deception of leadership orthodoxy was to maintain leadership business as usual, whilst espousing for ‘followers’ the importance of change and transformation and when these ‘followers’ resisted change to disparage them, simultaneously encouraging more and stronger leadership.

A huge and apparently never-ending income stream

Leadership research, education, and development is a huge income stream for universities in this country and globally. Disruptive notions of post-truth leadership would have profound financial implications for the so-called ‘fat cat’ leaders of such institutions. The self-serving actions of these leaders have been repeatedly challenged by their staff, their students, and even Conservative government ministers. However, any challenge to the current orthodoxy of leadership truths would have implications for the identities of these leaders, how they lead change and transformation, and the income streams funding their enhanced remuneration packages.

Intellectuals disparage ‘post-truth’

The Oxford Dictionary word of the year in 2016 was ‘post-truth’. In 2017 The Collins Dictionary word of the year was ‘fake news’. We are thrown intellectual baubles to play with like little kittens.

Yet, in the UK today words such as ‘inequality’, ‘austerity’, ‘rough sleepers’ and ‘sexual harassment’ may be closer to what is being debated or we should be debating. Word of the year constructions of reality encourages us to value truth over post-truth and news over the fake news. Certainly, we need to challenge any threat to empirically informed social science truths and vigorously challenge the dishonesty and deceit of fake news. Accounts of inequality, austerity, rough sleepers and sexual harassment are informed through truthful social science research hopefully reported as valid and reliable news. These requirements are not being challenged here, they are integral to a fair and just society. However, beyond the excessively individualistic pre-occupations with certain deceitful political leaders, the concept of post-truth contains the latent potential to profoundly disrupt the current organizational leadership orthodoxy as taught in business schools and espoused by consultants and leadership developers.

Appeals to emotion and personal belief

The Oxford Dictionary (2016) defined post-truth as ‘…circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.’ You would reasonably assume that leading change and transformation currently experienced in many organizations is based on objective facts (truthful leadership), rather than appeals to emotion and beliefs. However, the more I reviewed this literature the less convinced I became.

Post-truth leadership as envisaged here is neither anti-truth nor anti-empiricism. Post-truth leadership is about moving beyond reassuring belief in leading change and transformation influenced by objective facts and recognizing that the current leading change and transformation orthodoxy is a social construction primarily grounded in appeals to emotion and personal belief. I offer a detailed challenge to the leadership of change and transformation orthodoxy in Hughes (2016), although without reference to post-truth which was not as prominent then as it is today.

Post-truth leadership: A critical moment?

At the time of writing this post, I see post-truth leadership as a critical moment inviting us to question the objective facts and truths underpinning the current leadership of change and transformation orthodoxy. Universities are keen to differentiate the leadership truths that they sell and market from post-truth leadership, consequently, they will invest time and money in critiquing post-truth leadership. This is their prerogative, but I see reasons to be cheerful, even to praise post-truth leadership, if only we can see beyond pre-occupations with the very dodgy dealings of political leaders.

Praise for post-truth leadership of change and transformation

My praise for post-truth leadership of change and transformation is organized around a set of closely related themes. I offer them here as introductory points, I hope to elaborate on some of these in future posts, in the interim many of them are elaborated in Hughes (2016).
- Implicit convergence assumptions of truthful leadership studies are questioned as they impede the divergence and dissensus of post-truth leadership.
- Change leaders were socially constructed rather than being an outcome of undertaking social science research.
- Transformational leadership which Burns (1978) originally envisaged was denuded of all radical intent, particularly in terms of the mutual purpose of leaders and followers and his emphasis on moral leadership. Transformational leadership was then misunderstood and misrepresented.
- If post-truth is concerned with objective facts being far less influential in shaping public opinion that appeals to emotion and personal belief (Oxford Dictionary, 2016), then Gouldner (1971) and Davis (1971) were early post-truth pioneers.
- Despite too much being written about leadership studies we rarely read about coercive persuasion and aggression which interested influential leadership writers.
Chumbawamba used to sing – Enough is enough, open your eyes it is time to wake up!

Further Reading

Burns, J.M. (1978) Leadership. New York: Harper Row Publishers.

Davis, M.S. (1971) That’s interesting! Towards a phenomenology of sociology and a sociology of phenomenology. Philosophy of the Social Sciences 1(2): 309-344.

Gouldner, A.W. (1971)The coming crisis of western sociology. London: Heinemann.

Hughes, M. (2016)The leadership of organizational change. London: Routledge.
July 20, 2018
Tools and Techniques of Change Management
The tools and techniques of change management (Hughes, 2007) was a catchy title for a paper, yet revisiting the paper a decade later much of my thinking has subsequently evolved. In the new textbook (Hughes, 2019) I included a chapter on tools and techniques, something which I hadn’t done in previous textbooks.

Textbook proposals go through a scrutiny process in terms of what to include. There was interest from some reviewers in tools and techniques, which I could have resisted, but I wanted to respond to interest in tools and techniques, although probably not in the way reviewers wanted…

Often critical scholars disparage me as merely peddling tools and techniques, as their worlds move forward informed by the writings of Foucault, Bourdieu, and Greek philosophers. Whereas practitioners disparage me for not placing enough emphasis on tools, techniques and their application. I exist between these two very different worlds. At times it feels very uncomfortable writing for the liminal space between worlds. Most of the time I enjoy the creative tension between these very different world views and the demands their proponents make.

There are at least five ways in which Hughes (2007) would be very different if written today.
- That change management thingy
- Change as dynamic
- Subject expertise, definitions, language and discourse
- Context is everything
- Practical judgement
That change management thingy – In UK universities change management really arrived in the mid-nineties. At Brighton, we were pioneers in launching an MA Change Management in 1995. Today, the words appear very rusty and dated implying that change management is a thing to be accomplished, a tick-box ticked and then onto the next tick-box. However, academics and practitioners had this realization that they were dealing with something far more fluid. It was a process, although even claims that there was a beginning, a middle and an end were increasingly questioned.

We began to appreciate that an organizational change such as a cultural change could take years to bed down and even then, it would be a fluid and emerging phenomenon, rather than a thing. An appreciation of processes and process thinking was not restricted to change, increasingly, for example, we engaged with the nursing process and education processes. Back to organizational change and we increasingly moved away from change management as a thing towards managing change as a process. So today the paper would embrace the processual nature of managing change tools and techniques.

Change as dynamic – Closely related to appreciating the processual nature of organizational change has been a greater appreciation of the dynamic and ambiguous nature of organizational change. Mantras such as ‘change is the only constant around here’ and ‘we are living through an era of unprecedented change’ are misleading rhetoric.

Many constants in organizations do exist, think of staff working relationships which may last over many years. Every decade I have lived through is billed as an era of unprecedented change, every era by definition cannot be one of unprecedented change? Beneath the empty words, we need to better appreciate the dynamic nature of organizational change. In terms of evaluation, today’s failed change with time may be perceived as a success and vice versa. Different managing change tools and techniques may be more or less appropriate at different stages of dynamic changing processes.

Subject expertise, definitions, language and discourse – In 2007 I was naïve in assuming the existence of a bounded set of change management tools and techniques, with certain tools included and excluded from the change management toolbox. Today, I appreciate that the world isn’t like this, subjects such as strategy, organizational development, project management and HR have their own tools and techniques. Some of these tools and techniques are relevant to organizational change, others less so.

Tools and techniques raise issues of definition and I like the notion of tools being nested in a technique. In the past quality circles may have been labelled as a tool, nested within a total quality management technique. The language of tools and techniques is slippery and equally the discourses of the latest management fashions seek to persuade and shape our thinking. So today if I was writing the paper it would have been bounded such as managing change tools and techniques for quality management or for HR development.

Context is everything – I was mindful of the significance of context back in 2007, unfortunately however perhaps we pay lip service to context. I have seen Harvard Business School models applied in voluntary and public service in the UK. The implication being that such application brings business acumen from the world’s leading business school to these sectors. However, the HBS models tend to be based upon American businesses, in terms of their underpinning research, their target audience and their application. It’s like taking some daffodils which look lovely in an English country garden and expecting them to flourish in the Sahara, context really is everything. So today if I was writing the paper it would be set in a specific context such as managing change tools and techniques for quality management in hospitals.

Practical judgement – One of the best books I have read recently is Tools and techniques of leadership and management (Stacey, 2012). The book informs organizational change understanding without featuring that much about organizational change. The book’s title must have frustrated many readers, I must admit the reason I came to the book was when I was writing the new chapter. Early on you realize that Stacey (2012) is not selling notions of tools and techniques. Instead, he appears to have become disillusioned with an emphasis on tools and techniques in management and leadership.

He draws on his experiences of working with managers and leaders, suggesting that the more experienced managers were far less reliant on tools and techniques and far more reliant on exercising practical judgment.

Practical judgement is the experience-based ability to notice more of what is going on and intuit what is most important about a situation. (Stacey, 2012:108)

So today if I had been informed by Stacey’s (2012) account of tools and techniques I probably wouldn’t have attempted to write a paper on change management tools and techniques.

Further Reading

Hughes, M. (2007)The Tools and Techniques of Change Management. Journal of Change Management 7 (1): 37-49.

Hughes, M. (2019) Management and leadership tools and techniques. In Hughes, M. (2019) Managing and Leading Organizational Change. London: Routledge.

Stacey, R.D. (2012) Tools and Techniques of Leadership and Management: Meeting the Challenge of Complexity. London: Routledge.
The Tools and Techniques of Change Management
July 13, 2018