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Tension 1 – pace vs patience

This blog is part of a series of reflections by the Re-imagining Healthcare SIG. Here Matthew Bell shares his thoughts about the first of six 'tensions' that surfaced during his efforts to create organisational change.

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We are discussing each tension during our monthly Zoom calls and the mini series captures the responding reflections and thoughts as a group.

I started with a few (sub) tensions in my mind:

  • How do I stay true to what motivates me, but allow myself the time to bring others with me?
  • Do I try a big bang approach to change or a gentler stepped approach?

I concluded that I needed a way that allowed me to be open about what I was passionate about, but took a step by step approach  –  I recognised that there was no way a big bang would work when I hadn’t even started with the organisation.

So I started as described in the Corporate Rebels blog. I took the approach that I would enter into conversations in a way that was true to my own style, values and beliefs, but that I would not aim to engender any change straight away.

However, by creating the conversations, I created the space for issues to be raised. By creating the space and the issues to be raised I then I felt we couldn’t ignore the issues and needed to at least think about responding. A wiser person has suggested I lost control of the narrative of the change and I would agree I had in that moment. By responding to the issues, or at least even talking about them, there was this sense of significant change even if the actual changes were very minor.

I think given patience this would have been a hurdle easily overcome, but in the context of the tensions above, the necessary trust to provide this patience was not there.


  1. Hi Matt – following on from our discussion…
    I wonder whether pace vs patience is the right tension or whether the underlying issue is more about how uncertainty was manifesting through the change? Any change brings with it uncertainty and with that, anxiety. Perhaps by opening up the ‘big issues’ you also opened up some big uncertainties? That’s not a bad thing but it needs anchoring back into something concrete fairly quickly or else runs the risk of creating spiralling anxiety.
    For example, when a ‘big issue’ like how power and authority are used in an organisation surfaces, it can be useful to anchor back to something concrete like, “What sorts of decisions do we routinely have to make, where is best to make them and what information needs to be present so that good decisions are made?”. This takes something that could feel like a significant threat to people’s power bases, belief systems, risk appetite, etc and makes it something more manageable, capable of being approached in chunks, through tests of change or in various other ways that allow people to better manage their uncertainties and anxieties.
    I wonder therefore whether the key issue is really about pace vs patience or more about how to address inevitable uncertainty through concrete action?

  2. Thanks for the discussion on Friday, I really enjoyed it. My experience is that there are many tensions and competing challenges at work within any organisation and that is even more the case if you are trying to implement a different kind of approach to the wider system you operate in. The whole debate around how to develop and embed a different culture and way of working through ‘power with’ not ‘power over’ (I really like that phrase Andy) whether it is based on self management or something else – and how to take people with you on that journey – is still in it’s early stages I think. Within health and social care there is a lot of high level interest in the ideas and organisational examples within ‘Reinventing Organisations and the concept of Teal but for us the real challenge has been ‘how’ … what are the practical step by step processes / tools/strategies you need to make these changes, while still providing assurance and maintaining the confidence of the wider system… especially within the rigid regulatory framework we operate in… Perhaps what’s needed is a mix of pace to enthuse people and establish new processes and then patience while everyone pauses to assimilate and adapt to this new way of working – building in reflection and constant revisiting of the process to ensure it is enabling effective team building and building in quality assurance at every level

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