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Four enabling change agents 

Surgeon and director of the global healthcare institute, Professor Lord Darzi shares four essential keystones in change management.

By Professor Lord Darzi . 07 October 2015

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The health industry has been among the most innovative in the world. We have had new treatments, new techniques, new means of delivering them and we have made huge advances in the last century.


What has proved much harder is spreading innovation. We, in the NHS, have not effectively used the advances that the innovators have given us. The average time lag between the emergence of an innovation and its widespread use is 17 years. Simon Stevens, chief executive of the NHS, is fond of quoting science fiction writer William Gibson: "The future is already here, just unevenly distributed.”


Identifying change 


Research by the Institute of Global Health Innovation, which I lead, has sought to identify the factors that can facilitate rapid change.  Greg Parston and colleagues examined eight organisations in seven countries that successfully introduced and rapidly spread an innovation that resulted in improved health outcomes.


The examples ranged from the provision of integrated care in Singapore to the implementation of the Picture Archiving and Communication Systems (PACS) programme which saw digital image scanning and storage of x-rays and other scans rolled out across 171 NHS hospitals in four years. Other programmes included improving road safety in Sweden, patient safety in the US, HPV vaccination in Argentina and infant diagnosis of HIV in Zambia.


Despite their differences, these success stories shared four enabling agents:



  • Strong leadership with a clear vision
  • Good communications
  • Dedicated investment in change
  • The creation of a specific programme to make change happen

Barriers to the keystones


Only a minuscule portion of healthcare budgets is spent on spreading new ideas and improving performance. Yet arguably that could save more lives in the next decade than gene therapy, stem cell science and cancer vaccine development – all the stories we read in the news.


Innovation must be focused on improving the quality of care. But it is also essential to meet the immense financial pressures that lie ahead. Across the world, healthcare costs are rising faster than countries' ability to meet them.


Political thinking today seems to be that people should manage their own change – they don’t need or want outsiders or even insiders coming in to help or tell them how to do it. But this study on system transformation has shown that doesn’t work. The reliance on clinical serendipity – the belief that one set of clinicians will naturally adopt a new idea developed by another – has contributed to the long delays between innovation and system transformation.


We cannot wait for change to happen: we have to make it happen.

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