Relationships and change in the new NHS

Spanning system boundaries is part and parcel of what charities aiming to improve healthcare do – we work with healthcare professionals, leaders, policy makers, people living with health conditions and managers. All have diverse views and levels of certainty about what is right or wrong. This means that relationships, and managing them effectively, play a key role in driving forward change.

When I started on GenerationQ, the Health Foundation’s leadership programme, I hoped to gain greater knowledge about how to lead, how to deliver change and the technicalities of improvement methodology. And yes, I did come away with a lot more theoretical knowledge. But what I really took away from my experience of working closely with a group of fantastic colleagues, all working in different NHS roles, was the value of relationships in bringing about change in such a complex environment

In my work at Diabetes UK, I lead a number of campaigning and influencing programmes – the skills I developed as part of GenerationQ have been an invaluable addition to my skill set. Defining the problems diabetes patients face – such as lack of access to 24 hour assessment of diabetic foot disease in some areas and variation in number of amputations – is relatively straightforward. What is much more challenging is using the right approach to catalyse change to solve these problems. Do I challenge, question, encourage, listen or support?

The GenerationQ programme is based around four leadership domains, each designed to encourage fellows to think about improvement with a different focus. By applying the teaching from the programme around contextual, relational and personal leadership, I am increasingly adapting my approach and style according to who is in the room and the specific goal at hand. I have become more aware of the range of different approaches needed to engage with so many different people – patients, healthcare professionals, managers, policy makers etc.

There are more risks involved with taking some approaches than others. For example, naming areas where care is poor brings with it the risk of being perceived as a threat and being critical of staff – the same staff who we also want to support who may then feel disengaged, and choose not to involve us. I have learned through bitter experience that speaking out can result in broken relationships. It is possible to be a critical friend – for example, highlighting areas without multidisciplinary specialist foot teams in place has resulted in them being prioritised for development in some areas.

It’s not easy, but there are many ways of catalysing change. Being adept at emerging through uncertainty is key to working with the NHS to bring about improvement. The question is how do different organisations and individuals achieve this working together, with their different perspectives and agendas?

For leaders, our first priority is to engage, listen to and understand all the stakeholders. Get under the skin of what their views are and understand where they’re coming from. It’s then that you can define the goals clearly enough to set the direction of travel, ensuring the patient voice is loudly heard at every step of the journey. 

Bridget is a GenerationQ fellow and Director of Policy & Care Improvement at Diabetes UK.