A Journey to Pathology 3.0: Transitions

The question under wraps at the NHSE Pathology Network of Networks Event next Friday will be why only a few of the twenty-seven networks gained the "exit velocity" required to thrive in the changing healthcare environment. The Pathology Consolidation Programme was initiated six years ago in response to the growing recognition that pathology required a bold and coordinated approach to address the mounting strategic challenges.

The concept was both bold and logical. Consolidation will reduce unwarranted clinical, operational, and financial variation, safeguard the quality and affordability of the service, provide a platform for addressing the growing demand-capacity gap and future-proof the adoption of new technology and scientific innovations.

However, the coordination of approach left much to be desired. Numerous key decision-makers, influencers, and pundits felt that there must be twenty-seven effective ways to transform twenty-seven networks, and the legacy approach to transformation—partial solutions high on tactics but lacking in strategy—drained momentum. The additional strategic debt exposed during and in the aftermath of the pandemic further contributed to the overwhelming change fatigue in the system.

Yet, while discussing how to unlock and accelerate the change in the networks that have not effectively met that challenge, we tend to ignore another critical but largely unappreciated issue. It is not the change but the transition that grinds us down.

Change and transition are not the same thing. Change is situational. For example, relocation to new premises, transfer to a new organisation, reorganisation of teams and team roles or introduction of new IT or analytical platforms. Transition is a psychological process in which individuals internalize and gradually come to terms with the realities of the new circumstances brought about by change.

I do not underestimate the complexity of the change agenda and the energy invested to make it happen. Still, despite changing things, we should not assume that anything is truly different just because we changed things. Leading people through the transition process is critical for the change to succeed as intended.

Leading and managing transition is not optional, if-you-have-the-chance-to-do-it stuff because transition is not just “unfinished change”. Change depends on new things and starts with focusing on desired outcomes. The starting point of transition is about leaving the old situation behind. The psychological transition depends on unplugging from the old reality and identity one had before the change took place.

One of the critical strengths of thriving pathology networks is that they have not neglected the importance of the letting-go process and the feelings of loss it generates. They did not wither from the objectives and managed to set off seemingly quite radical agendas but have also understood that there are no transitional shortcuts. External situational change can come fast, but psychological transition takes time and leaders who wish to rush it through do it at their own peril.

Once people begin to let go of the old reality and before they fully embrace the new one, they find themselves in a psychological no-man's land, “the neutral zone”. The neutral zone is an emotional limbo; one can feel disoriented, less competent, exhausted or discouraged,

This stage may be painful but cannot and should not be bypassed. It is not “chaos”; it is a “physiological” component of the adaptive repatterning process when the old habits are replaced by new ones better suited to the new environment.

The neutral zone, the transitional space between the old and the new, is also a period ripe with opportunities. To borrow the terminology introduced in previous articles, it is the Second and Third Horizon seminary, the innovation sandpit, and the time the organisation is most open to renewal.

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