The NHS Antibodies that Kill Innovation

Reflecting on my experiences of bringing new ways of working to organisations working in health and care in the UK led me back to Laloux and the section in the illustrated version of his book which I have used often. It discusses the many ways to start. Whilst I accept the experiences of colleagues working into other sectors and in other countries, in the UK statutory health and care sector I think that first method described, experiment in a team, is being misused. This is particularly true in the NHS.  There are examples where new teams have been established as pilots and have produced great results, delivering real benefits for the staff, care receivers and their families. However, these projects continue to exist in isolation or once the pilot period is over or the extra funding runs out, the project is closed. This is not unique to the area of self-managed teams, there are other innovative and progressive projects that have produced great results and been closed at the end of the project term. Often at best, a diluted version of their new learning and practice survives and is transferred into a traditional system which sterilises and assimilates it into its mainstream thinking.
Brian Robertson writes about how “corporate antibodies come out and reject the bolted-on technique, a foreign entity that doesn’t quite fit the predominant mental model of how an organisation should be structured and run.” I think this perfectly describes what is happening to many of these projects and pilots in the NHS. They are hosted for prestige and welcomed for the extra resource that comes with them, but there is no commitment to change in the wider host organisation.
Unless we commit and work to achieve a real paradigm shift in the host organisation and wider system, the pilots and projects will continue to fail to realise their full potential. When we do this, we waste time, money and energy and most importantly erode the hope and motivation of the people involved in the pilot work.
Whilst we cannot change a huge organisation instantly we can build intentional architecture to support transformative change.

• Follow the energy, start where there is interest and motivation AND underpin this with a clear commitment from organisational and system leaders that this is the beginning of a whole system change.
• Build organisational structures and processes that enable people to communicate, access information and practice together so they can learn to work well in this new environment.
• Develop leadership that recognises that the organisational transformation requires people to change and grow too. Leadership that is confident in being vulnerable, articulating and holding true to a clear direction and purpose and competent to hold space for people to develop and fulfil potential within new roles.
• Foster thinking that understands this is not engineering work, fixing or maintaining a machine or organisational system. This is the work of gardener, stewarding the land and creating the best conditions for a complex organism to flourish.