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A sustainable approach is vital when managing change


Learning to approach change differently requires a fundamental rethink. My predominant experience of change in the health service is that we continue to privilege the more traditional approaches to managing change. So much so, that managing change becomes an organisational ritual, which paradoxically maintains the status quo.

So, what do I actually mean by “an organisational ritual that paradoxically maintains the status quo”? Pause to consider the number of nursing practice issues that are repetitively raised. For example:

  • Pressure area care;
  • Nutrition;
  • Falls;
  • Healthcare associated infections;
  • Communication.

And what happens when an important issue is raised in a trust? Typically, a scandal, a complaint or a report from a regulator triggers a hype of activity in order to resolve the problem as quickly as possible. This in turn leads to a short term improvement and then, within weeks or months, the patterns of behaviour that led to the original issues reappear.

‘There is often an assumption that you have control over the system as if it were central heating, and as a result there is a failure to pay attention to the human side of change’

The traditional approach to change is to look for the problem, carry out a diagnosis, and find a solution. The focus is on what is wrong or broken; when we look for problems, we find them. By paying attention to problems, we emphasise and amplify them across the organisation.

I ask myself why this happens and a review of traditional approaches to managing change highlights some important themes that may help to explain this pattern:

  • The use of tools tends to predominate - innumerable “fix it” mentality tool kits have been developed, all of which imply a mechanistic approach to change as if you were fixing a car;
  • Attention is focused on the tool itself rather than on the social interactions - I have spent much time listening to discussions in which people have lost sight of why they are meeting and so end up discussing the tool they are using to help them resolve the change (for example the plan, do, study, act cycle);
  • The approach is linear and predictable and underpinned by a desire for the leader to be in control of what is happening;
  • There are traditional expectations for the leader to be a hero, fixer or fortune teller;
  • Based predominantly on systems thinking, there is an assumption that you have control over the system as if it were central heating, and as a result there is a failure to pay attention to the human side of change, which is so important to the longer term outcome;
  • The approach is solution focused rather than inquiry focused.

Instead, we should consider using the appreciative inquiry approach to manage change; it is less deficit based compared with traditional approaches. It asks questions about what works in an organisation, rather than what isn’t working, thereby amplifying good practice.

This approach to change is highly engaging and motivating for members of staff. The results of the engaging and inquiry process is a series of statements that describe where the organisation wants to be, based on the high moments of where they have been when things have worked well. Owing to the fact that the statements are grounded in real experience and history, people know how to repeat their success and change becomes more sustainable.

About the author

Geraldine Cunningham is head of learning and development, Royal College of Nursing


Readers' comments (5)

  • this approach cd lead to an environment where people look out for what's going well which wd be motivating in itself

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  • Peter Goble

    Appreciative enquiry has as much chance of sustainability as a candle has in a hurricane.

    The whole medical enterprise is based on a linear problem-predicated outcome-oriented model presided over by heroic fortune-telling megalomaniacs who cultivate obedience and use threats to maintain rigid control.

    The solution is to eliminate the megalomaniacs, but one's real experience and history is that they will eliminate you before you can have the thought, let alone make a statement of intent.

    The probability that this will not be posted is evidence in itself; if it appears that will be a "high moment" for the author....

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    In simple words nobody likes change. but society needs to accept change ,change happens.
    The old adage 'If it aint broke don't mend it does not hold water any more. Society moves on and change happens. let us embrace it and look forward to a new life. just think of all the innovations in nursing that have helped society we need to educate people regarding change.

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  • Peter Goble

    Well, Sandra, society IS people, so if society is changing that's because people are changing it, and being changed by it. It's not a disembodied thing for individuals to embrace, it's an integral part of each of us, going on all the time.

    I think it's more important to experience the life we are living NOW than fantasise about a rosy speculative future. I don't trust "the vision thing", it's a dose of corporate narcotic to dope people's awareness of what's going on in the present behind their backs :)

    What we all need to do, perhaps, is wake up to reality NOW. Innovation will then take care of itself, everything is changing (as you rightly say) so everything is always being renewed (or innovated, as the PR gurus prefer it).

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  • It is refreshing to read these perspectives from Geraldine. There is much to be gained from using methodologies such as appreciative inquiry alongside other person oriented and practice based approaches such as practice development that focus on working with people to create effective workplace cultures that are receptive to change and development. Change isn’t easy but support is out there, such as FoNS’ Patients First Programme, which enables nurse-led teams to lead practice improvements which are more inclusive and sustainable. Visit to find out more.

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