“There is nothing permanent except change itself.” We will all be familiar with these words attributed to Heraclitus, the ancient philosopher, so it’s hardly a new sentiment.
When we initiate change ourselves, as many will have through New Year resolutions, we can feel empowered, energised and committed. However when change is imposed upon us, our feelings, level of engagement and actions can be significantly different. Many doctors will have encountered the work of Elisabeth Kubler-Ross. Although the stages of grief defined in her seminal work, On Death and Dying, were originally applied to improving support through advancing patient communication skills, the change curve has been widely adopted and applied to help us understand people’s reactions to unwanted developments for many years. We refer to this model in a number of our career development courses. Denial, anger, bargaining and depression should all be expected before acceptance.
It is no surprise then that the public face of the NHS front line is one of frustration and despondency in light of the continued use of a top-down management approach to drive essential change.
Positive news arrived this week in the shape of a campaign to “Challenge Top-Down Change”, launched by the Health Service Journal, Nursing Time and NHS Improving Quality who want to identify how to bring about the right type of change in the NHS. They point out that “The most successful organisations in the world give all staff and stakeholders the licence to get involved in change both from the bottom-up and the top-down”. They want the help of NHS workers to understand the barriers faced when trying to implement change and, importantly, “to give voice to solutions that work.”
While this is clearly an opportunity for doctors to contribute, it is also a useful prompt to consider your own leadership style. Do you rely more on the top-down or the bottom up approach? This is a simplification of the topic which we explore during our leadership and management courses and there are pros and cons to both. So what are the implications of your style to implementing change within your own sphere of influence? Awareness, after all, is one of the first steps to making pro-active changes to improving your own style.
