Leaders in Action

Leaders in Action


October 15, 2008 to November 6, 2009


Scholarly Activity Role: 
Organization Name: 
National Health Service, UK: Institute for Innovation & Improvement
Role or Title within the Organization: 
Director, Consultant, Coach

Introduction: Academy for Large-Scale Change

The Academy for Large-Scale Change (ALSC) was a nine-months leadership initiative for 90 senior level healthcare executives governed by the National Health Service’s (NHS) Institute for Innovation & Improvement (III).  As the largest employer in the UK, the NHS is known as a top-down “command and control” organization.  Despite their strategic planning process and the clarity about measuring regional outcomes, region reports show that they are not meeting many of their priority change goals.  A closer look reveals that important decisions may be communicated in emails and employee engagement needs to be significantly increased.  In this context, the creation of the ALSC was established, using innovative methods to transform vs. make incremental change in the UK, NHS.

Prior to the start of the program, each of the 90 healthcare executives was interviewed by phone regarding background and ideas about making an important change that would make a difference. Executives wrote their plans, using templates for guidance.  Before being accepted into the ALSC, each executive needed the approval of the region’s senior leader.  The intent was to ensure alignment with the region’s overall plan and how each executive’s plan “fit” with the vision/mission and goals for the year.

Four consultants joined the ALSC’s Director to provide services to support the every six weeks' meetings of the healthcare executives and to coach/consult with two of the ten UK NHS regions.  As one of the four consultants, I was responsible for two regions and worked collaboratively with the ALSC Director and the other three consultants to generate ideas for the goals and design of the "every six weeks' meetings" and to participate as faculty by presenting, using experiential and active learning strategies and volunteering for sections of the meeting.  My role was also to feed back to the group how things were proceeding in my two regions.

Using Boyer’s “Integration,” I was consulting with and to an interdisciplinary team as the delegates represented a broad range of disciplines across each region.  As an experienced consultant with specialties in leadership and learning, I created and presented to a broad UK-wide audience both in the region and at the ALSC every six weeks’ meetings.  Many of the professional development workshops, particularly in the regions, were intended to build leadership community and skills that bridged disciplines.

Given the nine-months and the multiple meetings of the ALSC and the region meetings, there are multiple designs for meetings in regions and at the ALSC.  What follows are representative examples of my collective and individual work:

  • An Introduction to the Theory and Practice of Large-Scale Change, and Its Relevance to the NHS.  This white paper written by the ALSC Director with input from the five consultants. The document clarifies definition and importance of large-scale change.  (Attachment #! ALSC Introduction to Large-Scale Change theory and practice)
  • ALSC slides for launch meeting (Attachment #2: ALSC Launch Oct 15, 2007
  • ALSC meeting May 9 included a review of goals/outcomes to-date and a shifting to next steps, including taking stock and quick wins. Wisdom is the room focused on accomplishments to date of ALSC delegates, providing an opportunity for peers to learn from peers.  Also, included at this meeting is a session I conducted on the World Café. (Attachments:  May 9 meeting slides, detailed agenda, and the World Café slides-3 attachments).

Sample results: As coach/consultant to ALSC change leaders in building capability to drive large-scale change projects for improved health outcomes, here are two representative and tangible outcomes:

  • Established central source to provide children with the right providers at the right time
  • Redesigned dementia pathway across four organizations leading to reduced NHS costs and clarification of roles and responsibilities to eliminate overlap.