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Tension 2 – organisational vs team or individual starting points

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

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There was a significant conversation I held in week 2 that resulted in the very positive start. But by holding the conversation at the organisational level, it meant that we were about to bite off a rather large chunk of a problem. You might reflect that 35 people is smaller than an average team in a large organisation, but when it IS the organisation I believe this brings a difference breadth to the available issues that are within the control.

As it turns out the two issues chosen to focus on were:
How might we create a fair and transparent pay and review system?
How might we develop a culture of feedback and reflective practice?

We focused on the first as the most tangible.

In hindsight we could have perhaps read the runes and tackled it in a different way. In my style I simply opened it up. Thinking about the organisation as a whole requires thinking about something not normally discussed and large amounts of new information to be taken on. The subject area was full of new content area and it was highly emotive. This caused increased pressure on an often pressurised workforce.  The complexity of both the content of the decision as well as the open decision making process I championed was, at times, overwhelming.


  1. I think the intention to live the values and follow what people chose to work on is courageous. It's very different working with an organisation making a transition to one set up to work in this way. It's very important to keep momentum and at the same time create space to socialise the ideas behind this way of working. It takes time for people to ask questions and form a view of how the future might be and their own role within it. This will inevitably involve questions and anxieties about pay, job content and security of employment.

    Similarly when people are exploring this with little knowledge or experience; some suggestions about where to start and how to start can help. I've done this at a team level in terms of implementing, rather than at a whole organisation level. This allows the discovery of organisational barriers by the teams which sets the work at an organisational level on a different footing. I found either working on the area the team picked to focus on in tandem with some ground work around how we work together as a team; or undertaking "how we work together" before starting on the teams agenda is helpful. I also found the role of the coach at these early stages vital. Teams without access to regular experienced coaching tended to stand still or dip back into the usual ways of working.

    I also think there is great value to be added by an experienced coach or transformational change facilitator supporting the leader or senior team making these changes. Change is highly emotive and transformational change challenges us to change ourselves not just the way we do things.  To build on Laloux's analogy; having a pilot who can help navigate the ship out of harbour is extremely helpful.  I'm aware that there is a generous tradition of organisations working in this way to offer support to others traveling along this road. Your blogs here and the Special Interest Group  builds on this intention. We hope anyone setting out on this journey will tap into the knowledge.

  2. It feels like perhaps it was just too soon? The emotions involved in reviewing pay put trust, both on a person to person level and in the process, at a premium. Perhaps you were too new to role to have built this trust and perhaps they hadn’t been through enough examples of using the sort of change process that you were trying to help them with for them to trust it? It’s interesting to me that you felt the second option (feedback and reflective practice) was less tangible. My hunch is that focussing there, or perhaps more broadly on “how do we individually and together make sense of our work” could have been a good avenue for building trust?

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