Readiness of Chief Executives for transformational change across Health, Councils and Third sector in Scotland to lead public service reform: A Grounded Theory Approach

Abstract

Introduction: The Chrisitie Commission Report (2011) set out a proposition and key recommendations for the public services in Scotland to embark on a journey of transformational change, and to improve the outcomes for the people of Scotland. The scale and scope of the reform is very large and transcends, Health, Councils and Third Sector. This research is timely and investigated the readiness of chief executives of organizations from each of the 3 sectors to achieve Christie’s Transformational agenda. Methods: A constructivist grounded theory method was used (Charmaz 2000). This involved detailed conversations with 3 chief executives from each of Health, Councils and Thirds Sector organizations to gather rich data. Using a constant comparative method, key themes emerged, which led to the development of a substantive grounded theory. Results: Strong cohesive themes around culture, power, change and relationships emerged which articulate the barriers and enablers currently in play in implementing transformational change for these sectors. This research has run parallel to the consultation on Health and Social Care Integration, publication of the Public Bodies (Joint working) (Scotland) Act 2014 and the beginning of the implementation of that Bill. The results capture the nuances and deep meaning the Chief executives hold relating to this agenda in Scotland. In the context of Christie’s proposition the three sectors relate to change and transformation as part of a journey and they each have differing barriers and enablers in fully achieving transformative change. Political influence and ‘autonomy to act’, impact on the receptiveness to change and the perception that reform is either an opportunity or a transactional event. Discussions: Across the public service sector Chief Executives recognize fully the key drivers which have resulted in the need for radical change. There is a general dislike of the term “Transformational” and the use of “reform’ is more widely accepted. Health, Councils and Third Sector Chief executives collectively demonstrate a skill-set which is diverse. Emergent change theory drives a more relational based approach to achieving transformational change and the International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-116999 – http://www.ijic.org/ 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 2 leadership skills required to do this are very different to the traditional models of leadership, evident in some parts of Public service. Transformational or radical change does not need to be large to be impactful and Christie’s vision for the people of Scotland is possible to achieve with a greater emphasis on new ways of engaging and thinking about change theory. Conclusion: Public services in Scotland are currently on the edge of something emergent. The desire to reform is clear amongst the leaders across Public services. To achieve the change required at pace and scale, to maintain sustainable services and the outcomes aspired to by the Christie Commission, requires a significant review of how we think about change, engage with the public and third sector and utilize fully the diverse range of skills evident in the chief executives as a whole in Scotland. Readiness for transformational change is variable, indicating that considerable support will be needed to fully achieve this goal. Lessons learned: This research offers an important insight into Scotland’s public service leaders readiness for transformational change. It offers new knowledge and evidence, not published elsewhere. The lessons learnt are topical and of value to many organizations at a time of great change. Limitations: The research samples a cohort of chief executives from the public services in Scotland at a point in time. A substantive theory was generated as a result and in keeping with the methodology and iterative process. Suggestions for future research: Given that the implementation of integrated services is currently underway in Scotland it would be of value to investigate further the views and perceptions of change within the Chief Officers employed and charged with running these new public bodies and contributing to public services reform.