Although we describe ourselves as a process change company, and indeed we are, we are vividly aware that healthcare is delivered by people and therefore we are a people change company. This means for us we need to integrate the process change techniques that have arisen out of engineering, for example Lean, Six Sigma and the Toyota production system, with the change techniques that have arisen from the schools of psychology and business. We also integrate that component of human behaviour referred to as “leadership”.
The Gleicher Change Equation: A Framework for Understanding Change
A helpful framework for examining this synergy is the “Gleicher Change Equation”. While it may not withstand the rigour of mathematical analysis, it offers valuable insights into the factors necessary to motivate change and illustrates why Xytal works the way it does.
The equation is:
C = A x B x D > X
Simply, this describes that change (C) is possible if the dissatisfaction with the status quo (A), multiplied by the presence of a clear vision of a desired future state (B) and then multiplied by the presence of practical first steps (D), is greater than the effort needed for change (X).
The Role of Dissatisfaction, Vision, and Practical First Steps
Many healthcare teams feel deeply dissatisfied with their current circumstances (A). This could stem from the challenges in their working environment or the gap between the care they deliver and the care they aspire to provide. However, fewer teams have a clear and shared vision (B) of their desired future. There are many individuals who express how things could be different for them but particularly under the time pressures that exist not many teams have had the opportunity to get together to agree a shared view. This lack of alignment often prevents meaningful collaboration and the development of cross-disciplinary, actionable first steps (D).
Healthcare’s high-stakes environment amplifies this challenge. The consequence of change that fails carries the risk of unintended consequences, potentially compromising patient safety. This natural risk aversion contributes to the perceived effort required for change (X). Furthermore, the scepticism surrounding change is compounded by past experiences with initiatives that failed to deliver meaningful results. Understandably, staff may wonder, “Why would this time be any different?”
DMAIS Methodology: Addressing the Effort of Change
Our published DMAIS methodology, based around the “model for improvement” addresses both the effort of change (X) and creates actual first steps (D) at the same time. Tools and techniques that make visible how things are actually working to the whole team create natural ideas for change which arise from and therefore are a perfect fit for this unique team at this place at this time. The model emphasises the need to commence with small sequential changes monitored by a pre-agreed measure set. Small steps require less effort and are less risky, reducing the effort necessary for implementation.
So much for process change, but what about people change?
At Xytal we are often thinking approach the concept of “power” as “the ability to get an organisation or an individual to do something it wouldn’t otherwise have done”. Leaders are people who deploy power. So this concept of leadership produces an overarching syllabus of the things that people can do to facilitate change, of which a key component is the ability to;
“Clearly articulate and travel towards a vision for the future.”
Bennis and Nanus (1997)
It is not either “leadership” or “process change”, it is both!
Staff are most motivated when they can see their work contributing to a greater purpose. Leaders who can communicate a compelling vision, provide clarity on how to achieve it, and guide their teams with confidence play a vital role in creating a motivated, engaged workforce.
This is why we believe it’s never a question of either leadership or process change—it must always be both. Together, they create the conditions for lasting improvement and ensure that staff feel motivated, valued, and empowered to drive positive change.
