Helen and Chris:

In this blog post we are starting to share with you the lessons that we learnt around the flexible use of communication styles, dialogue and messages utilised, through trial and much error, to engage multi-disciplinary, multi-organisational and multi-community groups of people to buy into our vision and commit to join us in our social movement journey. The ride was by no means smooth, so strap in, as the road was certainly bumpy!

At the risk of being accused of trying to teach you to suck eggs, firstly we are going to reflect on what we believe it is about change that makes it seem so difficult, but is essential to achieve for those who are in the sustainability game.

Creating a climate of positive engagement for initiating a social movement for health was never going to be a gentle walk in the park, for a start it’s not what the NHS was initially set up to do. It was set up in 1948 to ‘fix things’ within the framework of a hierarchy, command and control that can now be referred to as ‘old power’. Indeed the seemingly but necessary chaotic essence of a social movement flies directly in the face of the highly controlled and precise, scientific nature of how business is usually done in the NHS and points to the need for ‘new power’, a different, collaborative way of doing things. That said we shouldn’t throw the baby out with the bathwater rather, instead we should be looking to blend the elements of the two, learning how to nimbly respond, improvise and transition, just as if we were playing in a jazz band.

In 1991 William Bridges declared that “It isn’t the changes that do you in, it’s the transitions. Change is situational: new policy, new boss, new site. Transition is the psychological process people go through to come to terms with the new situation. Change is external; transition is internal“. What Bridges described in 1991 was the ‘dis-ease’ resulting in fear that many people experience when change is first suggested or upon them. Brightman (2001) suggests that it is based on perceived threats to a person’s sense of mastery. Asking someone to make a change can call into question the value placed on a their skills and contribution, often challenging their work identity and their sense of purpose. The change that we were suggesting went even further, it encouraged the sharing of power and at times the standing to one side and letting go, enabling another to step into the ‘powerful position’, ie a loosening of the ‘control reigns’, moving from an inward to an outward mindset and to take a leap of faith into a form of social prescription.

Henry Timms & Jeremy Heimans describes the differences between Old and New power, the parts that they play and how best to blend these in the modern world. This is exactly the strategy that we needed to take with HOPE.

Many people working within the NHS are shackled to ‘Old Power’ rules, the way that our services, systems, processes and long cherished hierarchies have been set up. In order to shift the balance of power we needed to blend and adapt our messages and approaches; giving the appropriate amount of expected deference, while managing to introduce a challenge to their ‘world view’ about what is possible and achievable when there is a prepared willingness to try a different way.

Perhaps on paper that doesn’t seem too difficult a task but in reality shifting the balance towards new power takes time, patience and is underpinned by high levels of trust. The NHS doesn’t have the luxury of time to wait before it transforms into the new world, this is something that needs to be acted upon now! However as we all know ‘now’ in the NHS can take an extraordinary length of time.

If only we had spent time from the outset, identifying the team’s and individuals adoption profiles before we entered the ‘colosseum’ of delivering presentations, we would have saved ourselves much time, anguish and frustration. The graphic below will give you a better idea of what we are talking about, however essentially, many working in the health and care arena sit on the right side of ‘THE CHASM’

This is something to celebrate when what you need is a safe pair of hands, who are rarely distracted and are highly skilled in their specialist fields. Having been a patient in the hands of such a skilled professionals it is of paramount value to feel confidence in their profound competence.

This said when you are looking to disturb the status quo and introduce uncertainty into their world, the people comfortably sitting on the right hand side of the graph are not the place to start conversations leading to transformational change – a painful error that we made on several occasions, forcing us to question what on earth we were trying to achieve and retreat to a quiet corner in order to lick our wounds and regroup.

There is a great saying in the world of Organisational Development (OD) “Go where the energy is“, when you are trying to bring about change. On reflection we kicked ourselves that although we knew this, why did we not pay enough attention to this from the outset, and instead repeatedly made same mistake over and over again?

What we found was that those individuals and groups who sit on the right hand side of the diffusion of innovation curve, would readily invite and welcome us to their group meetings, where they would be present in force. They would politely listen to what we had to say and thank us for our time, then ‘politely’ turning us down, before pointing us in the direction of another area who may be interested in our offer. On the other hand, those people who reside on the left-hand side of the curve sought us out for initial conversations, to explore possibilities and we very quickly recognised that they were our local innovators, visionaries and creators who were able to share our vision and passion for the new and join us on our amazonian journey.

On reflection we mistook and misunderstood the apparently open welcome of the teams sitting on the right hand side as the energy that we were seeking to follow. As the jungle drums began to beat, more and more of the same tribe invited us to their meetings, only to respond in similar ways, disappointing to us. Which brings to mind the The Spider and the Fly  poem by Mary Howitt published in 1828 where the opening lines are: ‘Will you walk into my parlour?’ said the Spider to the Fly.

(Note to selves – be mindful of the innovation profiles of those people you seek to engage with)

The energy contained in ‘new power’ has ability to reach and unnerve us all. Why? you might ask. In order for a true shift in power to occur, to be seen and felt as authentic by the receiver, the language that we use needs to be followed through by congruent actions. Whilst this it would seem is not a new concept, the ability to put ones ‘ego’ and self interest to one side isn’t often easy to achieve, particularly in turbulent and frequently chaotic environments that stir the beast of fear in the most level headed and professionally competent of us.

Moving to a position of true partnership between all parties and away from where one person or group holds the perceived power is Utopia in the land of true personalised care https://www.england.nhs.uk/personalisedcare/ however in our experience the Amazon jungle path is fraught with vines, creepy crawlies and ferocious beasts, all sent to floor our well-intentioned attempts.

If you’d like to learn more about old and new power and how you can utilise these to best effect in your situation, NHS Horizons School for Change Agents 2019, is a great place to start. If you missed the formal 6 week online ‘school’ you can still access the live recorded video sessions here: https://www.youtube.com/channel/UC1s_kDDit3FJgxR_QtawhLg/videos

We tantalised you in our last blog about sharing some chucklesome remarks and terminology that people used in an apparent attempt to deflect our efforts so here you go! (forgive us for being human – we have tamed our typed thought responses so as not to cause offence;)

Next time we meet, Chris will be sharing with you her musings and learning around the power of developing relationships and conversations to help us more easily navigate through the jungle undergrowth.

If you haven’t seen the short film “Your Very Good Health” that introduced the NHS to the population in 1948, it is well worth a watch and shows us how far we have come already – it appears that the NHS has always brought about large scale change after all – who would have thought! https://www.youtube.com/watch?v=VFhEB3gG8HA

Published by change unlocked today

Helen Davies-Cox and Chris Edworthy are 'Architects of Extraordinary Change' , having over 60 years of experience in the NHS between them, leading and engaging in change projects throughout their careers. email: changeunlockedtoday@gmail.com

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  1. This is a fantastic work of reflection on your journey. Having met Helen at the recent Billions Institute Spread and Scale event in Cardiff, it has been really useful to see many of the concepts to do with transformation in this blog. Helen’s analogy of Consultants always hunting in packs is one I concur with and good to see a picture illustrating this! Thank you so much for writing this.


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