Is it possible that a preoccupation with improvement science is getting in the way of efforts to genuinely transform our approach to health and social care provision in Scotland?
This question was prompted for me by attending the recent Health and Social Care Academy Think Tank on Creating Wellbeing. Our task was to discuss: “What is needed to transform Scottish society so that all citizens are able to thrive?”Fairly quickly we got on to the progress achieved in different areas of Scottish public service through the implementation of what has become known as ‘improvement science.’ This, it was suggested, was our best tool for achieving the transformational change we were invited to discuss.
Championed by an increasingly broad range of agencies and intermediaries, improvement science refers to a set of change methods which are founded on the sensible idea that you have to figure which changes are most likely to lead to improvement. In testing a variety of small changes, and with careful monitoring of the impact, it is possible to more fully inform organisational change.
This is a worthy aspiration given that change initiatives are often based on an assumption that certain interventions and ideas will work in the absence of evidence to support that assumption. All of the proverbial eggs can end up going into one change basket. When things inevitably don’t work out as well as we all hoped they might, change fatigue and cynicism are fuelled. There are also well evidenced and tangible impacts from change programmes across the Scottish public sector.
So what, you may ask, is not to like? For me despite the merits of improvement science it is designed to do something which is fundamentally different from transformational change. With an improvement approach the past is the fundamental reference point, it’s essentially seeking to achieve an improved version of the past – a past which is better, faster, smarter. While transformational change honours the past it seeks to create the future. With improvement the boundaries for change tend to be set by past experience while transformational change is limited only by imagination and courage. Change realised through improvement can be small or complex and these are changes which can be accommodated within an existing values system. Counter to this transformational change is always fundamental and is founded on new and different values.
How to initiate transformational change is quite another matter. What is clear is that it is a long-term, even generational process and takes the kind of long-term thinking and risk taking that our political representatives, with their time limited terms of office, can find hard. That for me does not change the fact that we need to be clearer about whether we are seeking to develop an improved version of the past – the better caterpillar – or a transformational change: the butterfly.