Multi-sector transformational change: A potential model for the NHS

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Our recent Do OD event People Transforming Systems brought colleagues from the OD community together to discuss our response to Sustainability and Transformation Plans (STP), vanguards, mergers and other important system changes. As part of the day, OD consultant and doctoral student Marty Jacobs joined us from the USA to discuss her model of multi-sector transformation. In this blog, Marty explains the core principles behind her model and its relevance to our complex NHS change challenges.

OD practitioners understand how challenging transformational change can be. How do you help people see things differently in order to come up with more effective approaches? Now add to that multiple organisations trying to collaborate and coordinate a large-scale change effort, and the challenges can feel overwhelming. It can feel like herding cats.

Complex problems require adaptive leaders who create spaces for solutions to emerge. When I started my doctoral program two years ago, I found that there was little information available about multi-sector transformational change, so I began to develop a model for addressing these complex problems. Although it is still very much a work in progress, I believe it will be useful to the NHS as you shift toward a more collaborative environment with multiple organisations.

The model, called the Emerging Systems Transformation Change Model (ESTCM) comprises the following five phases:

Phase 1 - Identify and engage stakeholders, build relationships, and assess current reality. 

Phase 2 - Assessing capacity for change and establishing a reflective practice. 

Phase 3 - Setting up communication systems, and implementing a capacity building plan and work plans. 

Phase 4 -  Launching a performance measurement system and planning for sustainability. 

Phase 5 - Conducting a formal evaluation, adapting systems, and disengaging if the project has an endpoint or cycling through again if the project is ongoing. 

It is important to note that this work does not happen in such step-wise manner. Frequently, participants may go back to different stages and then jump ahead. One of the most important aspects of this model is developing a reflective practice that helps participants determine the actual path of the project.

Multi-sector transformational change does not come without its challenges. Here are some of the major challenges:

  • Scope: the scope of multi-sector transformational change is much more extensive than change efforts within single organisations.
  • Complexity: multi-sector transformational change efforts are also far more complex than those within a single organisation.
  • Leadership: the challenge of leadership is to shift from a command and control style to one of adaptive and participative leadership. Moreover, leadership may be shared, rotated, or distributed, depending on the needs of the project at the time.
  • Relationship building: it takes a concerted effort to help organisations and stakeholders find common ground and build trust.
  • Time frame: the time frame for multi-sector transformational change is much longer than that of a change effort within a single organisation.
  • Structure: the challenge of structure comes from the fact that you need to create a structure within each partner organisation that will support the change effort, as well as creating a structure that spans all organisations and governs the overall effort.
  • Lack of history: in multi-sector transformational change, often partner organisations do not have a history of working together, so it can take longer to build relationships.
While these challenges may seem large, they are not insurmountable. Developing comfort with uncertainty and ambiguity and maintaining the flexibility to allow solutions to emerge will carry you a long way in this type of change effort. Establishing a reflective practice from the start will ensure you stay on the right track and are responsive to environmental changes.

Meanwhile, here are some questions to ponder:

  • Do your current structures support change at the right level?
  • Are you clear on the level of commitment needed to deliver within/throughout time frames?
  • How will past actions influence future ones?
  • Does the NHS currently have the capacity to develop transformational leaders?
  • How do you achieve a shared purpose?
  • What key factors will determine the scope and boundaries of the project?
  • Where is the energy in the system?

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