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by Heather Henry
8 January 2014

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Blog: The shape of things to come

Between 2014 and 2020, culture change leader Heather Henry believes social innovation and people power could transform the way the NHS is run. She presents her top five predictions for Management in Practice

The burning platform of rising demand and austerity presents opportunities for innovation. Here are my top five predictions for 2014 onwards in relation to culture and behaviour change in primary and community settings:

 1. Social innovation will come to match pace with technical innovation. 

We have a clear process for technical innovation in the NHS but how we manage the culture and behaviours associated with social innovation is still in its infancy.

The actions of social entrepreneurs, such as Hazel Stuteley of Connecting Communities, Chris Dabbs of Unlimited Potential and organisations like NESTA will be studied and shared routinely. NICE and Cochrane will produce detailed evidence reviews to back this up.

 2. The glass half full will be seen as often as the glass half empty. 

Patients and residents will increasingly be seen as equal partners with talents and skills rather than ‘problems’ needing to be ‘fixed’.

Primary care will wake up and realize that a deficits based approach will lead to dependency and even busier surgeries. Primary care contractors will learn how to harness patient talents and will move flexibly between being leaders (eg of PPGs) to being enablers.

 3. Culture and behaviour issues will be increasingly looked at through the lens of a complex adaptive system rather than a mechanistic system. 

Staff, patients and communities are not like engines – tighten a screw with the spanner of edict and a parts failure like Mid Staffordshire does not recur – but are more like flocks of starlings – what happens is often emergent, given the right conditions. So the science of complexity theory will begin to be understood and researched more fully.

More focus is given to the enabling conditions for change rather than a deliberate strategy. Culture will no longer have strategy for breakfast.

 4. Primary care will recognize that three interconnected things need to exist in order for creativity to flourish in primary care: 

“An understanding or culture, a person/people who bring creativity and a field of experts who support the innovation,” (Csikszenmihalyi, 1998). They will ensure that the three are in place and interconnected when embarking on change.

 5. The tricky issues of adoption and spread of good practice will be better understood.

No longer will we publish case studies and guidance and wonder why nothing changes. The new mantra will become ‘A thousand seeings are not worth one doing’ (Vietnamese proverb).

Social psychology tells us that enactment (behaving differently in front of your peers) and consistency (having staked our position, we strive to behave accordingly) are the shortest routes to doing things differently. So the focus will cease to be placed on writing about doing it / planning it but on carrying out what you say. Putting skin in the game. (Pascale, Sternin and Sternin, 2010).


I have chosen brevity over detail in the hope that you will investigate the references and return to some of my 2013 blogs which illustrate some of these ideas. Enjoy, and let’s hope my predictions come true. 

Happy New Year!