Billy Boland: Coping with change

billy_bolandThe only thing certain in life is change. So the sooner we’re able to tackle dealing with change the better. I’m naturally an optimist as a rule, but the fortunes of the NHS over the immediate and long term future are enough to test even the sunniest of perspectives. I marvel at managers faced with the constant pressure of cutting expenditure and making “efficiency savings.” How do they not buckle under the pressure? These are not ideal circumstances to foster creative solutions to our current problems. Yet once solutions have been sourced for the coming financial year, new ones are needed for the next. The cycle grinds on.

I LOL’d internally at a session on coping with change recently. The speaker was telling us how they had implemented change in a large organisation, how there had been resistance, but they’d got the job done. I re-read the programme more than once to make sure I hadn’t got the wrong end of the stick. I’d come to hear about coping with change, not making it happen. A seemingly equally confused delegate took his opportunity at the end of the talk to try and get what he came for. The reason he had come to the talk he told the speaker was to meet his own needs. He recognised that organisations needed to change, but he wanted to learn how he personally could deal with the result. The reply came (and I’m paraphrasing) that things were better following the change they had gone through. Sickness was down, patient satisfaction was up. They’d never had it so good.

The delegate sat down, I suspect as bewildered as me. Had we all been at cross purposes? Later in the day, dawdling by some posters it occurred to me that maybe we hadn’t been at all. That could be how many people cope with change. “Knowing” that things will better, that a process can been painful but worthwhile can give meaning. Furthermore having a sense of achievement in accomplishing difficult tasks can be something to hold onto when times are tough and the future seems out of sight.

Perseverance in the face of adversity is a key skill for leaders.

But what works for some does not work for all. Coping with change may be easier in some ways if you are leading it. Developing a vision and taking it forward can be invigorating and affirming. But what if you’re being done to? What if you’re asked to comply with a change you do not agree to?

I started to think maybe I was asking the wrong question. If change is inevitable in life then maybe being changed is also inevitable. Even the simple act of observation causes a change to what is being observed (The observer effect). Perhaps there is no way we can avoid influencing change.

So on reflection, I think my lesson is one of perspective. Change means different things to different people. One person’s innovation is another’s disruption.

I know myself that when I see a need for change my bias is to see only the benefits. My optimism can give the future an overly positive hue and I can too easily gloss over potential problems. Giving more time to attending to these may help bring people with me. Conversely, when faced with change by others I think unwise, I hope to try to ask better questions about the need for change to understand what’s driving it. If I “get” the vision, I’ll be in a better place to influence. It’s important for me to remember others may plough on with projects overlooking or minimising problems too. Getting communication right around that is a skill in itself.

Billy Boland is a consultant psychiatrist and associate medical director for quality and safety at Hertfordshire Partnership University NHS Foundation Trust. You can follow him on Twitter @originalbboland

Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.