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The shape of things to come - predictions 2014-2020


Heather Henry looks into the future of primary and community settings

Heather Henry nurse and senior manager

Nurse and senior manager, Heather Henry












The burning platform of rising demand and austerity presents opportunities for innovation. Here are my top five predictions for 2014 onwards in relation to culture and behaviour change in primary and community settings:

  1. Social innovation will come to match pace with technical innovation. We have a clear process for technical innovation in the NHS but how we manage the culture and behaviours associated with social innovation is still in its infancy. The actions of social entrepreneurs, such as Hazel Stuteley of Connecting Communities, Chris Dabbs of Unlimited Potential and organisations like NESTA will be studied and shared routinely. NICE and Cochrane will produce detailed evidence reviews to back this up.
  2. The glass half full will be seen as often as the glass half empty. Patients and residents will increasingly be seen as equal partners with talents and skills rather than ‘problems’ needing to be ‘fixed’. Primary care will wake up and realize that a deficits based approach will lead to dependency and even busier surgeries. Primary care contractors will learn how to harness patient talents and will move flexibly between being leaders (eg of PPGs) to being enablers.
  3. Culture and behaviour issues will be increasingly looked at through the lens of a complex adaptive system rather than a mechanistic system. Staff, patients and communities are not like engines – tighten a screw with the spanner of edict and a parts failure like Mid Staffordshire does not recur – but are more like flocks of starlings – what happens is often emergent, given the right conditions. So the science of complexity theory will begin to be understood and researched more fully. More focus is given to the enabling conditions for change rather than a deliberate strategy. Culture will no longer have strategy for breakfast.
  4. Primary care will recognize that three interconnected things need to exist in order for creativity to flourish in primary care: an understanding or culture, a person/people who bring creativity and a field of experts who support the innovation (Csikszenmihalyi, 1998). They will ensure that the three are in place and interconnected when embarking on change.
  5. The tricky issues of adoption and spread of good practice will be better understood. No longer will we publish case studies and guidance and wonder why nothing changes. The new mantra will become ‘A thousand seeings are not worth one doing’ (Vietnamese proverb). Social psychology tells us that enactment (behaving differently in front of your peers) and consistency (having staked our position, we strive to behave accordingly) are the shortest routes to doing things differently. So the focus will cease to be placed on writing about doing it / planning it but on carrying out what you say. Putting skin in the game. (Pascale, Sternin and Sternin, 2010).

I have chosen brevity over detail in the hope that you will investigate the references and return to some of my 2013 blogs, which illustrate some of these ideas. Enjoy, and let’s hope my predictions come true.

Happy New Year!


Heather Henry is founder/managing director of Brightness Management Limited and is leading work for the NHS Alliance on changing culture and behaviour.

© Brightness Management Limited 2013. All rights reserved


Readers' comments (2)

  • I wonder what Heather could come up with for a management who accept no glass half full ideas unless they are free and do not change established practice which is in tuen based on a business model not a service model. ie. pounds first and the patients will look after themselves!

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  • Heather Henry

    This sounds so familiar-it happens all the time. I'd suggest
    You are right that you'd need to give them a financial/ business justification
    This sort of argument comes best from peers who have the tee shirt ie GP to GP, manager to manager rather than try to manage upwards
    Look at point 4 and consider if there is a field of practice that might support a glass half full approach, an academic team, professional body etc.
    Patients in groups have strength and are your allies. Lone patients generally have no power
    Proclaim even the smallest win-- a group of recovering patients with depression start knitting garments for PICU and by feeling they have a purpose their condition improves.
    Be aware that success will be claimed retrospectively by the doubters and accept this graciously.

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