Darwinism – the key to sustainable change


The health and social care system is not rocket science. It’s far more complex than that!

I’m sure we have all experienced how changes in one part of the health and social care system have the potential to impact on another that may not be beneficial, anticipated or attributed to the change that took place.  Throw into this mix the addition of numerous stakeholders and a workforce based on a professional hierarchy  all of which have different agendas, then it is clear why this is more difficult than the complicated, yet non-complex task of putting a man on the moon.

Initiating a change requires people who are inspired to engage in the change effort, galvanising a social movement with the aim of turning a vision into a reality.  This takes considerable energy, passion and commitment………sometimes I think pushing the Titanic up the dunes of the Sahara in a sand storm would be easier!

As challenging as it is to initiate this momentum, it is harder still to sustain large scale change within health and social care systems.   Sustainability is about lasting change – the endurance of systems and processes.   The lack of sustainability in the NHS is reported widely in the NHS press and wider social media.  We frequently see stories related to the low rates of sustaining change or news about an NHS organisation that lost its way-#Morecambe Bay, #Mid Staffs or those heralded as exemplar commissioners or providers of healthcare who then perhaps  fail expectations #Circle Health.

Why do healthcare organisations fail to deliver sustainable change? The NHS is subject to a myriad of influencing factors including local and national politics; funding pressures across both health and social care; and user demand and expectations that are impossible to manage.  This drives NHS organisations to a culture of short term planning and delivery.  Complacency within an organisation at any level will compromise performance and may usurp any attempts to sustain performance or change.  When a change effort stalls, it takes twice the effort to re-ignite it and regain momentum as hearts and minds have already been lost.  You further risk losing those who were key to creating the vision when this happens which can impact on the overall execution of your plan.


So what’s the answer?  How do we sustain change and improvement?

Click on the this link to download our short guide on how to sustain improvement


Use intelligence driven prioritisation, focusing on the right improvements to achieve a sustainable health and social care system.


 Develop a compelling narrative to gain buy-in


Acknowledge that whole system change and large scale transformation take time to realise the desired outcomes


Measure improvement to offer evidence of success and be confident that you are focused on the right things to achieve system improvement.


Utilise both the hard and soft processes of change management in order to execute the change.


If it’s not working, don’t throw the baby out with the bath water- seek to understand why – and tweak improvements.  Remember,  once a change effort stalls, it takes much more effort to re-ignite the fire


 Bottom-up change is needed to engender wider engagement and buy- in.


 Support individuals’ personal transition through the change.


It is crucial that key stakeholders who will be implementing change plans are fully aware of the why, what, when, how and who in order to achieve it.


“It is not the strongest or the most intelligent who will survive but those who can best manage change.”

― Charles Darwin