The nation should not be experiencing the current NHS crisis, which is surely down to a failure of successive government healthcare initiatives. The changes introduced by consecutive UK governments and the enormous resources given to supporting these service improvements and innovations should amount to an effective and efficient NHS, with improved quality of care, productivity and a happy workforce. However, despite the huge resources allocated, the evidence points in the opposite direction. The workforce is in crisis, and the nation’s health shows growing inequalities.
Comprehensive reviews point to limited successes of healthcare changes, few benefits to patients, little change in productivity and many financial challenges (Ham et al, 2015; Anandaciva et al, 2017; Accounts Commission, 2018). Most targets have not been met, or have been changed, or policy direction has been changed to such an extent that the original target is meaningless (Palmer et al, 2020). The health of the nation does not fare any better. Infant mortality in deprived areas has risen, and inequalities between the wealthy and the poor, and ‘deaths of despair’ in parts of the population between the ages of 45 and 54 years are growing (Hiam et al, 2020; Raleigh, 2022).
The links between staff experience, patient satisfaction and outcomes have been well researched (Dawson, 2018), and insufficient staffing levels are cited as one factor that adversely affects workforce wellbeing (Sizmur and Raleigh, 2018). Among nurses, there is considerable dissatisfaction with their work. Many are experiencing compassion fatigue, burnout and secondary trauma, with the emotional labour of caring, taken together with the sheer volume of work, having a negative impact on both their personal and professional lives (Kester, 2018).
Does it mean, then, that we should surmise that inept NHS leaders have squandered resources on inappropriate and irrelevant change projects, leading to the current crisis and making no difference to the quality of patient care?
There is an urgent case to be made for shifting thinking on how to lead healthcare changes to prevent future crises. Successful change management in health care means that change leaders striving to address inhibitors to improvement and innovation should reorient their focus and energy on people. With the impact of emotional labour already taking its toll on the workforce, change simply adds to the emotional burden. The critical role of emotion and how it affects change needs to be acknowledged and addressed. People are the greatest resource and strength of the NHS, and current conditions do not lend themselves to ensuring employees’ emotional and cognitive readiness for change, which is potentially the key to successful change management. It could provide the energy, motivation and engagement needed for change (Chowthi-Williams and Davis, 2022).
Change leaders need to understand the significance of emotional and cognitive readiness for change, and actively assess this readiness prior to implementing any change initiatives. This will ensure that the voices of the workforce will contribute to the preparedness of any plan for change and subsequent implementation, thereby ensuring a smooth transition of change. It will ensure that staff feel valued, engaged in the change process and that their feelings, views and opinions are respected (Chowthi-Williams and Davis, 2022).