The School for Health and Care Radicals has been developed on the back of about 15 years of trying to create radical change through top-down leadership and the realisation that informal and bottom-up change are also crucial elements of large-scale, rapid and sustainable change in health and social care.The school’s roots go back to the National Patient Access Team, set up in 1998, and the National Primary Care Development Team and National Clinical Governance Support Team that followed this. After the NHS Modernisation Agency was set up in 2001, NHS leaders started looking at how to develop a change movement in an organisation of a million people. A focus was established not only on service quality improvement and change management, but also on motivating staff for change.
The first School for Organisational Radicals was run in 2004. Based on the assumption that change starts with activists and the recognition that there was a lack of practical tools and techniques to support this, the school aimed to ignite activists to take part in healthcare improvements. This was a one-day face-to-face school that presented theory on social movements in organisational change.
The following year, a social movement called the Power of One, The Power of Many was established. This applied more practical ideas to help people build capability, blending a social movement approach with a more traditional quality improvement approach. This galvanised a series of workshops run from 2004 – not run every year, but sometimes run several times in a given year.
Working across organisational boundaries, the one-day School for Healthcare Radicals was run in 2010. This drew on the insights of Marshall Ganz’s work on community organising, as well as Gary Hamel’s work on organisational change and John Kotter’s work on leadership. The philosophy of the school recognised the importance of hierarchy but emphasised that people needed to want to change for change to be sustainable. It continues to advocate a blending of ‘old power’ and ‘new power’, although its primary focus is on the supporting the development of the latter.
In 2014 the school’s name was altered to The School for Health and Care Radicals (SHCR) to acknowledge the overlap between healthcare and social care systems. This was the first year that the school was delivered as massive open online course (MOOC) open to anyone in the world. The school ran in February 2014 with the aim of supporting and nurturing the next generation of change agents. These hierarchically dispersed leaders are encouraged to become organisational radicals by developing the capability to ‘rock the boat and stay in it’.
In the meantime, NHS Change Day had been established in 2013 to encourage staff at any level in the organisation to make a pledge to make an improvement in how they work. Some have questioned the face value of some of the individual pledges made and questioned whether whole organisations signing pledges, as has happened in some cases, is in keeping with the fundamental message. Nonetheless, NHS Change Day is seen by many as a powerful way of promoting the message that ‘change starts with me’ and of getting rid of the deeply entrenched sense that many staff share that they do not have permission to make change.
The 2014 school was run in the five preceding weeks to NHS Change Day. The SHCR was intended to support pledgers involved in NHS Change Day to take action on their pledges, but making a pledge was not a prerequisite of the course.