How grounded optimism could help the NHS change | Dan Charlton

Dan Charlton

Whether it’s about attempting to renew culture, cut costs, improve quality or respond rapidly to what’s happening in the wider world, there’s no shortage of reasons why organisations need to adapt and do things differently. But are they any good at it, asks Dan Charlton, director of communications at Sussex Partnership NHS Foundation Trust.

The common claim that organisational change fails about 70 per cent of the time1 has been rebuked for being propagated as accepted fact by opportunistic management consultants, despite the absence of actual hard, empirical evidence to back it up. That said, there’s a wealth of research which highlights the damage that poorly managed change programmes can do to staff morale, mental health, job satisfaction and retention rates.

Communication with staff is widely cited as one thing organisations often get wrong when attempting to change. Lack of information, insufficient dialogue, use of corporate propaganda and a tendency to oversell key messages all feature on the charge sheet levelled against leaders. And yet the way leaders communicate with the workforce during times of organisational upheaval hasn’t received an awful lot of academic attention.2

I’ve been looking at this issue over the last year while undertaking a study on the relationship between communication and organisational change in the NHS. My MSc research involved a review of over 200 contemporary research articles – spanning communications and public relations, human resources, organisational development, business management, behavioural science and psychology – alongside in-depth interviews with board-level leaders.

One observation that strikes me from this research is the way in which leader communication can all too easily cause cognitive dissonance among the wider workforce. Defined as a negative, unpleasant state which results from individuals simultaneously experiencing contradictory beliefs, ideas or values,3 cognitive dissonance takes hold when what staff are being told by leaders doesn’t square with their actual experience of organisational life. Such a gap between leader narratives and perceived reality can lead to people becoming disenchanted, disengaged and unreceptive to messages about the case for change. This is an acute risk in organisations where warm, well-meant words about values which feature prominently on posters and lanyards don’t translate into the actual behaviours that leaders model, foster and believe are worth caring about. It is also, perhaps, a wider risk in as health and care system which oscillates between central ‘grip and control’ and a desire to foster devolved, local leadership.

The importance of avoiding cognitive dissonance is a factor that leads me to suggest ‘grounded optimism’ as a concept for thinking about leadership change communication. This idea is underpinned by the notion that effective internal communication involves balancing a hopeful, inspiring narrative about the future with a genuine appreciation, understanding and acknowledgement of the concerns and pressures that employees experience in the present. This can only be developed by leaders who are connected with their workforce through ongoing, meaningful engagement activity. In this sense, it is markedly different from the traditional, hierarchical, outdated management approach of broadcasting instructions from the corporate centre in the expectation that they will be followed.

As well as supporting the delivery of organisational change, a ‘grounded optimism’ approach to communication provides the basis for helping shape organisational culture in a way that encourages honesty, openness and mutual respect between leaders and the wider workforce. This goes some way, in my view, towards developing the kind of compassionate culture advocated in the recent published interim NHS People Plan. This isn’t ‘fluffy’ stuff. The direct link between staff experience and patient outcomes means it would be pretty short sighted not to give culture equal weight to managing the money in terms of what we prioritise within the NHS.

‘Grounded optimism’ is about developing a change narrative which is sufficiently bold and exciting to command attention without lapsing into the kind of outlandish rhetoric likely to fuel staff suspicion and cynicism. Such an approach helps reinforce the importance of communication and staff engagement as a prerequisite to effective care delivery, rather than a way of simply ‘selling’ change to overcome potential resistance. It’s one way we can be better at changing on behalf of the patients, families and local communities we’re here to serve.

Dan Charlton is director of communications at Sussex Partnership NHS Foundation Trust. Follow him on Twitter @Dan_Charlton1 

1. Hughes, M (2011), 'Do 70 per cent of all organizational change initiatives really fail?' Journal of Change Management, Vol. 11, no. 4, pp. 451–464.
2. Men, LR (2014), 'Why leadership matters to internal communication: linking transformational leadership, symmetrical, communication, and employee outcomes', Journal of Public Relations Research, Vol. 26, no. 3, pp. 256-279.
3. Festinger L (1957), A theory of cognitive dissonance, Stanford, CA: Stanford University Press.


Why Register?

Great reasons to register with NHS Confederation

  • Access exclusive resources 
    Access member-only resources and tailor member benefits and services
  • Personalise your website
    Select topics of interest for recommended content
  • Comment and recommend
    Rate and share content with colleagues
  • Never miss a thing
    Register now to keep your finger on the pulse of the NHS Confederation

Log In