NHS Change Readiness – It’s not good news

When assessing NHS change readiness – it’s not good news.

NHS managers within CCG/CSUs lack confidence, are resistant to change and are underperforming. This is not the perspective of NHS outsiders, rather it is how NHS managers feel themselves.

Over the last three years over 150 mangers from over 15 Commissioning Support Units (CSUs) and Clinical Commission Groups (CCGs) have been sending junior to middle managers on development programmes. Engage has been used as a key diagnostic to assess thoughts, beliefs and attitudes – in order to drive personal development.

What Does Good Look Like?

Those who are most likely to engage in change are typically possess greater self-confidence, have belief in their own capability to do their role and are more confident when dealing with others.

They are also more open in their communication style, seek to engage with others, are receptive to new ideas, agile and remain positive in the face of setbacks.

In addition, they are more likely to be committed to the organisation, motivated to deliver, engage in discretionary behaviours and feel they are performing optimally.

By assessing these characteristics, Engage provides organisations with a unique ‘change readiness’ culture map. Engage also provides clear practical guidance on how organisations can leverage change accelerators and overcome barriers to change.

NHS Change Readiness Profile

The NHS is undergoing constant and unyielding change. As a result are they more flexible and open to change than other organisations?

By aggregating personal scores an overall perspective of how NHS employees compare to others can be assessed. Here is a high level summary.

NHS Change Readiness Summary

At a high level the picture is not good news. Lower in engagement, confidence, openness and impact.

Engage Profile – Detail

Engage measures thoughts, beliefs and attitudes relating to change and performance. Our confidence, openness and beliefs around impact are a key determinant to personal development and performance.

The following shows the 15 Engage scales for the CCG/CSUs as a whole, compared to Norm. It provides a unique NHS Change Readiness profile.

By reviewing each score we gain a unique perspective on those thoughts and beliefs which drive the NHS, and those which might be derailing or hindering change and performance.

High scores

High scores typically accelerate change and performance. When individuals score very highly, there is the potential for blind spots or derailers which might negatively impact those they manage.

  • Marginally higher emotional commitment and intention to stay. This suggests that these employees feel slightly more committed, motivated to stay, and loyal. For individuals who score very high on these scales the potential derailers are a displaced sense of loyalty, lack of confidence to go for promotion with a narrow view of career options.

Low scores

Low scores typically inhibit or interfere with change and performance. In the case of the NHS it is difficult to know where to start. There seems to be a systemic and widespread lack of confidence, openness and impact.

  • Confidence – These employees lack confidence in themselves. They score substantially lower in awareness of self or others. They don’t feel confident about their ability to do their job, and to a lesser extent feel uncomfortable in unfamiliar settings.
  • Openness – Though slightly higher than confidence, they are more closed and resistant in communicating, are slightly more distant and aloof when relating to others, less open to new ideas and feedback, more rigid in their approach and hold a more negative attitude to personal development.
  • Impact – A more surprising result is the lower scores on voluntary behaviours (which due to to the slightly higher level of emotional commitment one might expect), a lower sense of drive to set and exceed targets, and the lowest score around performance, that is their belief on how successful they feel in their own role.

The result is a group of employees who substantially lack confidence, are more closed and resistant to change and feel unsuccessful in their jobs. This is likely to have a significant negative impact on performance. If this profile is mirrored across the rest of the NHS – it’s not good news.

Causal Factors to Change Resistance?

Taking a more holistic view to the NHS change readiness profile raises some interesting questions:

  1. Are interviewers hiring in their own image?Without an active recruitment strategy oriented towards openness and change, at all levels within the NHS, there is the danger of selection bias. Those recruited are likely to be risk averse, don’t speak up, challenge or drive new ways of doing things.
  2. Does the prevailing culture actively resist change?Those working within a culture resistant to change are likely to experience barriers when seeking to change the way things are done. Those championing change will grow increasingly frustrated, marginalised and disengaged. The likely result is the very people needed to affect positive change leave.
  3. Are NHS employees change weary?Environments where change is constant and poorly executed frequently results in change weariness. Trust is eroded as change programmes fail to deliver stated outcomes. Restructures typically mean job losses, increasing resistance to change. The challenge is to engage with employees, communicate clearly and build the case for change.

The risk is that the NHS is stuck in a self-perpetuating loop of systemic and continuous resistance to change. With an ageing population, on-going austerity cuts, and the changing landscape pre/post Brexit, the challenges will only multiply.

Is the Future Private?

Does the NHS’ resistance to change explain the rise in private sector bodies delivering services on behalf of the NHS?

These private (and commercially run) bodies have a different attitude to change and risk. As a result of TUPE, their challenge is to deliver services using the same employees who delivered the services previously. These private organisations will need a strategy to actively support sustainable change in order to deliver as promised. Their potential advantage is that these employees are brought into a different organisation with a different culture. The challenge remains however, they need a strategy to help these new employees change and adapt to new ways of working.

Way Forward

Large organisations face complex challenges. In the absence of clear strategies to support people through change, this complexity increases. Targets will be missed, more hospitals will be placed in special measures, and ultimately, more patients will suffer or die unnecessarily.

Working with these managers it is important to address each of the scales measured by Engage. Through organisational design interventions, using both Engage interventions and others, the challenge is to address the prevailing culture starting from senior management. With Engage, the impact of these interventions can be measured over time, providing return on investment data.

If senior managers don’t lead by example, en masse, in order to positively affect the prevailing culture there is little hope. Where systems and processes hinder change, they need to be changed. New desired behaviours need to be modelled and supported through the entire employee lifecycle.

Over the coming months we will inviting these same managers to complete Engage again, to assess the degree of shift. Additional validation data will be gained from line managers as to impact of the development programme. This will support future development activities to increase confidence, openness and impact. The hope is that this provides a blueprint to increase NHS change readiness, enabling patient care long into the future.


Engage provides a scientific approach to determining blockers and enablers to change and improved performance. By determining individual change readiness, accelerators and blockers we are able to measure whole organisations. Engage also provides a robust personal and organisational development methodology to support sustainable change. To find out more contact us here.

Author :Mark Bateman, CEO of Engage Coach International.

©  Engage Coach International 2017