The Challenges of Change Agents

 

I don’t know about others, but when I think of my own improvement attempts on my unit, I usually recall challenges, resistance, hitting walls. Yes, I was told it will be difficult, and once you realize that you are not alone in your passion, it is even harder to get back to the daily whirlwind. It is discouraging, and some days are worse than others. And then I am thinking: for sure others have the same challenges, but does it make a difference if you would be in a formal position of authority rather than front-line staff? Would you be able to influence and leverage more for your ideas?

Quality improvement (QI) is not new. But England’s National Health System (NHS) gives a good example on how QI can build a community of radicals who succeeded to make important changes to an old system. Although a dominant approach to change is still present, NHS has an extremely strong and forward thinking focus on quality improvement. What is outstanding also is that they are honest and transparent about the need for change. In a recent paper, NHS talks about 5 enablers for transformational change in the future. The first one: (It’s time for heresy!) “Activate disruptors, heretics, radicals and mavericks!”(That’s not to be confounded with destructive troublemakers; we are talking about those people who rock the boat, but still stay in it).

OK, so the future sounds bright. But still? A study conducted and published in HBR, looked at 68 change initiatives in the NHS over a period of 12 months. They compared data from formal hierarchies and informal networks, and mapped the trail of successful change agents. In one passage, the report reads:

Formal authority is, of course, an important source of influence. Previous research has shown how difficult it is for people at the bottom of a typical organization chart—complete with multiple functional groups, hierarchical levels, and prescribed reporting lines—to drive change. But most scholars and practitioners now also recognize the importance of the informal influence that can come from organizational networks.

There are some great examples illustrating this theory: the physician at the top of the organization who failed in leading change, to the nurse who implemented successfully an initiative. It is all in the type of network you build and the alliances you make. Although the formal authority may give you the illusion of power, informal networks always matter. There was clear evidence that these factors improved the odds of successfully implementing reform in the NHS, and these results could be generalized for other organizations. 

As for those dark days, when you feel alone and spinning your wheels, maybe this study is a good read. It reminds you that you can still do something, anything, and that giving up is simply not an option.