NHS Change Day: Small distance, big difference

Claire Cater, 27 May, 2014

It’s a funny thing, change. It has a habit of taking you by surprise, making you see the world afresh.

That’s exactly what happened to us recently when we moved from London Bridge to Bermondsey Street recently.

Essentially, we’ve only moved around the corner. The distance is small but the difference is big. We didn’t want to move, we loved our space, but development calls for new, bigger buildings and so we had to pack our boxes (which in the new world means only a few small ones – what did we fill our offices with in the 90’s apart from the trendy Yukka plants?).

Off we went. Down the escalators of the Shard, turned left and wound our way to Bermondsey Street. We walked in and fell in love not only with our big windows, the wide space, the fabulously interesting people in our building, our new neighbours, the great places to eat and culture to explore on our doorstep – but with our business, what we do, who we are and why we are doing it.  No, I kid you not, it’s true.

Our new space has given us fresh perspective and, quite literally, a new window through which to view the world. So we’re doing just that.


In our new surroundings, fuelled only by good coffee (this too is true – cocktails will follow) we reflected on this step change and the things that mattered to us.  It got us thinking about our involvement earlier this year with NHS Change Day and the lessons this inspiring social movement and the fabulous NHS folk taught us.

Aware of Change Day since its early beginnings – a debate between a group of curious innovators about how to bring about widespread service improvement – we watched with interest as it ‘came from nowhere’ and the seeds were sown for an influential and inspirational social movement.

And naturally, when the chance came to be involved in NHS Change Day 2014, we jumped at it.

That’s partly because Change Day reflects everything we hold dear at The Social Kinetic. It’s inclusive, ambitious and bold. It seeks to energise and mobilise people by asking them to approach the world from the perspective of what matters to them and society. It speaks to our belief in creating social capital (we think profit – not just financial – is pointless without purpose) and our commitment to push boundaries and swim against the tide where necessary in order to break the status quo in the pursuit of something better.

Breaking the status quo

Yes, we like to rock the boat but stay in it. We are radicals who see more possibilities than challenges. There is little point is creating waves so big that people fall overboard and sink.  You need to take people with you on the journey – even if it’s rocky.

As Martin Luther King described it:

‘The saving of our world… will come, not through the complacent adjustment of the conforming majority, but through the creative maladjustment of a nonconforming minority.’

Change Day also excited us because it was an opportunity to throw away some of the assumptions that have underpinned communications and change surrounding NHS reform in the past.  Things such as ‘the key to lasting change is leaders leading from the top’. The truth as we see it is actually that the top is the front – the frontline that is. Leaders are those who take permission to lead – the traditional leaders often become the facilitators. This requires bravery and trust on both sides.

Change Day was something different. It wasn’t a campaign – it was and is a social movement, grown from the NHS grassroots, fuelled by a combination of belief, commitment, goodwill and community. The belief and commitment was simple – to do something better, to change something that would benefit patients and the NHS.

This was an opportunity to throw away the rule book and find new ways to empower the frontline to own and run their own movement – which is about as exciting and interesting as it can get.

A Commitment more than a contract

We knew from the outset of our work with the Change Day founders that there could be no brief we could stick to or simple checklist we could follow.  We had to be prepared to join and be part of it – and that meant being committed to do whatever it took to make it possible.

So we were determined to make our relationship with Change Day more than a contractual one. We made the decision to invest a substantial amount of our own time and money to make sure we could do what was needed and see if there were new approaches to stakeholder engagement that we could learn from.

Some thought us a little mad. We are a small company and this seemed like a big leap. And yes, there were times when we wondered too. But that’s the journey. After 20+ years working with the NHS, seeing the doctors doing their day and night jobs alongside their commitment to making Change Day a success, we felt we couldn’t be authentically part of it if we weren’t prepared to do what they were.

So here are our lessons. And before you read them, let’s be clear that it wasn’t always easy. We didn’t always agree.  But we all stayed in the boat and we did it together.

Lessons from Change Day and the windows of Bermondsey Street

Lesson one: Roll with resistance.

Don’t see those who don’t agree or wholeheartedly support your new or big idea as the enemy.  Listen and learn from them – understand that everyone has a point and understand where they are on the ‘cycle of change’.

Resistance is powerful if unharnessed, but harnessed it is awesome.

We have learnt to listen more carefully to the resisters and the opposing perspectives.

Lesson two: Diversity is king

We knew that but Change Day reminded us. Research studies show that teams of people with diverse backgrounds, experiences and views of the world will consistently outperform groups of more talented but homogenous individuals. So embrace differences and diversity. Change Day was certainly diverse – the roles, the perspectives, the people, the skills and, boy, so are we. It works.

As a result of the experience, we are now extending the diversity of our network and bringing it together more often.

Like all social movements, success was made possible by working in partnership – the Hubbies who led at the front line, the NHS staff, Dogfish who created the web site and the platform for pledging, the stories from the people and, Joe McCrea Ltd who led on social media and provided the data and updates on the pledge numbers from the MOOD repository.

Lesson three: Impact and intention don’t always go hand in hand

If we assume that everyone starts from a position of good intent, then we need to reflect on why we sometimes react to others in the way that we do. A good intention can nevertheless have a negative impact. Our good intentions might not always have the impact we hope for or be understood until later.

Policies and directives are often designed with the best of intentions but don’t have the impact they were designed to – that’s where the frontline leaders and radicals come in. Change Day focussed on impact – making a difference, having the intended impact and creating the real and tangible benefit.

We are now focusing even more carefully on not making assumptions about how to do something. To keep asking: ‘did we achieve what we intended for our clients?’

Lesson four: Build your communities of resilience

These are the networks that make the difference.  We saw the power of that in Change Day as communities on the frontline showed that they could be the resilience that the NHS needs. We experience it at SK. We have a powerful and diverse network who we invite to challenge and support us and our clients – they are our resisters, challengers and supporting community. We have learned to value them even more. They also provide new windows through which to see the world. Perhaps this why our new office has had such a big impact: the windows are big, arched and on every wall, so every time you turn your head, you see something different.

For NHS Change Day we engaged over 300 stakeholder bodies from across the NHS and social care landscape, securing their support for the principles of Change Day and giving them the confidence and authority to let their networks and members really take ownership and support frontline staff, get on board with their pledges, provide channels and reach and vice versa. They provided extra resilience and next year they will do even more.

Lesson five:  Keep turning your head

Keep questioning and don’t get too blinkered under pressure. Look through a new window, walk in others’ shoes or simply look harder and see things from a different perspective.

Lesson six: Working together virtually is hard but important

When we say virtually we mean in every sense. The country, and indeed the NHS, is too big for people to be in the same place often.  But in the case of Change Day virtually had an even bigger meaning – you had to trust tenuous links and a belief system.  You couldn’t seek to control or always sign things off.  Virtually sometimes felt like ‘almost’.

We have learnt to let go a lot more and let people get on with things in their own way. Trust builds confidence in each other and ourselves. Respect it at all costs.

Lesson six: Authenticity is key

We learnt that when it comes to social movements, authenticity is key. You can’t manufacture something so intrinsically organic. You have to empower individuals to act and give them a reason to want to inspire others through their actions. Be true – people see through you when you’re not.

We saw that authenticity was infectious – the media became partners and stakeholders, not just reporters. The result was hundreds of stories (all good) and at the centre of them the people at the frontline – the fabulous NHS folk, pledging, sharing and inspiring. Doing something better for our beloved NHS.

Lesson seven: Facilitate don’t lead

You have to facilitate, rather than provide, leadership. We come from a world that likes to craft brands that people implement to strict guidelines and messages that need to be consistent.  With Change Day, we learnt to create something that people could make their own that was more powerful as a result. We gave people the tools to allow them to craft their own language and ideas that felt right for them – as long as the mission and vision were clear and they were heading in the same direction.

Lesson eight: It’s personal

We also learnt that motivating and inspiring colleagues across the NHS is a very personal thing. Media and social media certainly has its place, and the ‘communitarian’ approach on Change Day provided multiple channels through which staff could share their motivations, their inspirations and their pledges. But at the end of the day, never underestimate the power of the individual.

Lesson nine: It was all about the people

The ‘real voices’ are the ones that convey the most persuasive messages about service change in the NHS. It’s the personal connections between people on the ground, the Post-it notes, posters and pledge walls and the sharing of ideas and all the lessons above that make it what it is.

But in the end, the real success of Change Day boiled down to something much more simple.

It was about the powerful personal stories behind people’s pledges. It was about staff feeling empowered to act and being inspired by each other. The Change Day Post-it notes on the ward notice board were as instrumental, if not more so, in the success of the movement as any amount of newspaper column inches or Tweets.

This was an inside-out movement fuelling the frontline with more recognition and confidence to do what was, in most cases, already on their minds. To use their own learning and share it widely to inspire others.

Lesson ten: Standing back is the bravest thing to do

One of the biggest jobs was encouraging the leaders to stand back and let go, encourage and get behind, resist stepping in front. If you let people take ownership and trust that, the benefits will be significant. It takes courage, trust and self-confidence as a leader to do this.

We see a future where leaders and people like us create the stage, provide the props, the confidence and lift the curtain with applause.  It’s a future based on giving people – staff, patients, leaders – the confidence to express their views about positive change, the tools to share them and the motivation to take personal and very visible responsibility for the change they want to see.

A full circle

So this is where we get back to the beginning. Leaders don’t have to go far to find the answers – it’s a short distance to the frontline.

Our question is this – will the powers that be look through a new window and be brave enough to stand back, walk that short distance to the frontline and let go? Will they resist trying to make Change Day their own or over engineer it?

Please leave it on the edge in the boat.