“LEADERS MUST MAKE SENSE OF THESE THINGS”

Helen Bevan has spent 25 years overseeing change initiatives at England’s National Health Service, which serves more than 50 million patients and employs 1.2 million health care staffers. She spoke with HBR about the challenges of preserving the gains from one initiative while launching new efforts. Edited excerpts follow.

Q: Why is it so hard to sustain an initiative’s improvements?

A: It’s an issue of energy. And when a new initiative comes along, people ask, “What do we do with the old one?” Much of our workforce models the behaviour of senior leaders, and when those leaders shift their energy to something else, it’s hard to sustain things.

What differentiates changes that stick?

Sustainability starts at the beginning, in how we frame a project and what it means to the organisation and our purpose. It’s the difference between behaving like a buyer and behaving like an investor. If we’re asking doctors to get on board something that’s under way, it’s already too late. We need to get them invested in the project, and thinking like owners, well before it begins. When I look at the difference between projects that are sustained and ones that aren’t, it often has to do with taking time at the beginning to set them up, frame them the right way, and get people invested.

Is this especially hard in a health care setting, where efficiencies may seem to conflict with quality care?

Our purpose is health and wellness. That’s what motivates people in this sector; they don’t come for the pay. If we can frame a project as relating to things that really matter to the people who work here, they will connect with it on an emotional level. Even doctors, who make decisions logically, are more likely to engage and be motivated if an initiative fits with their emotions and

values. So, we show data and avoid jargon. If we talk about “lean” and “agile” and use words like kanban, kaizen, and scrum, it feels like we’re taking away people’s autonomy. We can convey those concepts perfectly well without those words.

But don’t people worry that the programmes are actually about cost cutting?

Of course we focus on costs – we have finite resources. But it’s about framing. Instead of talking about waste, we focus on unwarranted variation in care. Every patient with the same condition should get the same high-quality treatment; when that doesn’t happen, it can be a matter of life and death. Variation also adds to cost, so reducing unwarranted variation increases care and reduces cost. We see more success when we frame things in terms of our mission, which is care.

How do you start an initiative without losing the gains of the previous one?

Four years ago, we did a crowdsourcing exercise in which we asked colleagues about the biggest barriers to change. The most common answer was “confusing strategies.” People said that when a new initiative, target, goal, or focus comes along, they don’t know whether it’s more important than the previous one. We have to find ways to continue the journeys we’ve started by sustaining people’s energy while creating space for new things. Managers and leaders must make sense of those things and reduce ambiguity.