Psychology of Change

Read here for a brief overview of the Psychology of Change. For a more detailed explanation please go to the Education Module.

Within healthcare, and the NHS in particular, there is potential conflict from different stakeholder groups. Broadly, from our perspective as doctors within the NHS as a whole there are 3 main stakeholder groups:

  • Patients and the public
  • Healthcare professionals
  • Management

Understanding that different groups have a different perspective of what 'good' looks like allows an individual who is trying to initiate or drive change, to pitch the project to each stakeholder group.

Given the relationships between the 3 major stakeholder groups, there are few changes that result in a win-win-win result. Patients and the public want more healthcare than they might be willing to pay for through taxation, politicians bring with them political ideology, a well-intentioned desire to leave their mark, and a desire to remain popular (and therefore not raise taxes), and if healthcare professionals could spend all they wanted on each individual patients, the system would be bankrupt very quickly. It is, therefore, almost inevitable, that a change proposed by one group will be resisted by one or other of the different stakeholders.

It is important to recognise that different groups may each group may have different ways of explaining their point of view. Doctors are used to dealing with quantitative evidence with meta-analyses being the pinnacle of our evidence pyramid, but this is not a universal language. This paper from Eivor Oborn demonstrates the difference in language between two groups who disagreed over the downsizing of Kidderminster Hospital. There is a stark contrast between the language used by each group and the fears, and moral arguments expressed are real and just as valid as any statistics.

The emotions associated with change are surprisingly similar to the emotional journey associated with grief. An important part of any change process is the incorporation of a period of neutrality that allows the person undergoing change time to adapt.

The role of the leader within a change process, or indeed any process, is to co-ordinate. There needs to be a clear vision and purpose, with appropriate co-ordination of relevant staff, processes and infrastructure. Fundamental to any development process is an understanding of not only what should happen, but what actually happens.