Living life on the edge in the NHS

‘I want to stay as close on the edge as I can without going over. Out on the edge you see all kinds of things you can't see from the center … Big, undreamed-of things – the people on the edge see them first.’ Kurt Vonnegut, Player Piano.

The idea of ‘leading from the edge’ is persuasive in a fast changing world. Organisations need to innovate and innovation comes from thinking differently. It’s also attractive because it sets employees free from the usual constraints of organisational hierarchy. We have licence to act, to try things out. And that can be inspiring. As Maya Angelou put it, ‘If you are always trying to be normal, you will never know how amazing you can be.’

The idea – and the challenges in putting it into action – lies at the heart of the School for Health and Care Radicals, a free MOOC (online course) provided by the NHS. The CIPD’s recent evaluation of the school gives some interesting findings about the impact it is having, in particular on five aspects of what it takes to be a change agent.

Firstly, we saw the most improvement in participants’ knowledge about organisational change. This is perhaps not surprising given that the school centred on five taught modules. Much of that content will take some time to become embedded into people’s thinking, put into action, tested and refined.

But we also saw evidence of changes in behaviour. So, secondly, there was an increased willingness to ‘rock the boat’. They became more willing to act radically, to lead from the edge, to challenge received wisdom and established practice. Third was a change in how participants did this. Participants tended to connect with others more after the school than before. This reflects the social nature of the school’s online forums, as well as its core message, which emphasises social connection and building support for change.
It seems that many of us feel held back by the usual bureaucracy and are primed to experiment. All we need is to be told, ‘Go ahead, try things out, make a change’. Others need encouragement or a reminder. As one participant noted, ‘It’s sometimes easy to forget the power that one has inherited in one’s role, because you just think, “Oh, I’m just me.”’

Yet willingness to challenge may also be a case of being honest about an elephant in the room. One participant recalled, ‘It was just a general team meeting and I just brought up the fact that I thought everyone was very unhappy and that we needed to change the way we were working … how burnt out everybody felt and how completely bogged down with the amount of work we were trying to do.’

The fourth area was ‘staying in the boat’, or maintaining relationships while leading from the edge. Here we saw little or no improvement in practice, probably reflecting how difficult this is to shift. You can inspire people to act, but managing the potential fallout is a harder skill that will take time to master. Still, many noted a change in how they perceived colleagues, as one participant noted: ‘I would have maybe labelled them in my head as laggards or resistors to change but now I think of them, to try and understand their viewpoint and think maybe they just don’t know as much about what we are doing.’

What of the fifth area? This was people’s strength of purpose and motivation to make improvements and we saw little difference in this too. But we started from such a high baseline that this is understandable. Most people engaging with the school have an inherently strong sense of purpose, something that – despite failings like Mid-Staffs – can be seen in the NHS more widely. The purpose of improving healthcare across the UK is a simple and compelling one. The greater challenge is to put that strong purpose to use.

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