Could abandoning titles and hierarchy be the answer to true STP transformation?

April 2017

By putting people at the heart of solving the challenges facing the NHS and making them into active citizens, we can better understand what we are trying to achieve and create in relation to goods and services of public consequences. With limited stakeholder input into the STP plans so far, and no public consultation as yet – how can we be sure that these plans meet the needs of citizens and therefore, will actually make the difference we need to see, both financially and in improving patient care?

To achieve this, leaders will need to reframe 'disruptive coproduction' and rather than avoid it, embrace developing relationships, not alienating people, as this is when true disruption really happens. We are all too aware of stories around local campaign groups who are actively trying to overturn decisions to prevent closures and proposed changes to services, proving that unengaged and alienated citizens can be extremely powerful - after all, people don't resist change, they resist control.

This is also true of healthcare delivery – involving citizens early in the redesign of services means we have to be prepared to hear things that make us uncomfortable or that we don't agree with, however this doesn't invalidate them.

As a society we all have to be prepared to leave our egos at the door and listen to each other. 70% of all transformation programmes fail, and this is simply because we don't take the crucial first step in opening out the conversation, for fear that others won't agree with us and we can't do it 'our way'.

In working in collaboration with citizens and using their insight and expertise, we create a well formed need – one which we are absolutely certain meets the needs of end users, improving service delivery, enhancing customer experience and actually delivering against its objectives whilst creating an asset-based model of citizenship.


We need a culture of shared responsibility, where titles and hierarchy are abandoned and we interact with each other, as people, on the same page. It is only then that change and transformation can truly begin to be effective.