If you always do what you’ve always done, you will always get what you’ve always got.

By Fraser Ferguson @fraserahp

National Improvement Advisor. Scottish Government

screenshot 2019-01-27 at 16.33.26Whether it was Albert Einstein, Henry Ford or Mark Twain who came up with this quote it is a high ranking entry in the ‘No S*** Sherlock’ top 20.  Within healthcare we do this too often. And usually we do it because we are genuinely trying to help patients, and to offer the very best service and care we possibly can. We do it because we are so busy we don’t think we have the time to take a step back and see where change can have a positive effect. We do it because we think our line managers are fearful of change and will not support us. Or, when we do take the plunge, we often make a change blindly; we don’t take the time to do any groundwork which allows us to measure impact. When I saw ‘we’ I could just as easily mean me. Over the years I guess I have been in this situation more than once and I have also worked in services that have done this.

I am now at the mid point of the Scottish Improvement Leader Programme (Come on Cohort 18) which gives me the great privilege to work with like minded peers and to take time to step back and recognise that I need to never go back to that way of working. I can instead work creatively and keep change happening as a means of supporting improvement.

So, how can we stop doing what we’ve always done? Sometimes we are unsure why we have always done what we’ve always done, and often there is no real evidence to show if our good intentions are being realised.

Creative thinking could be one answer to this.

screenshot 2019-01-27 at 12.36.18

What is it?

screenshot 2019-01-27 at 12.54.08So what are we trying to change? Is this really clear in our mind? Have we spoken to the subject matter experts in the area? This can seem a really easy, D’oh step but my own reflections are that this is not as simple a step as you think. Beware – a mistake here, can lead to a whole lot of pain!

Who is it for?

screenshot 2019-01-27 at 13.07.23


So we have our change plan. Does this actually fit in with who it is intended for? It might be your well intentioned idea but does it fit in with the actual requirements of who you are working the change for?


Who are you communicating with?

screenshot 2019-01-27 at 13.09.17Who have you got on your change improvement team? As well as the key management leads have you been brave enough to get the ‘can do’ folk involved? You know these people; forces of nature who believe in your change idea and push early adaptation of your plan.

(Bringing in the folk who are wholeheartedly against your change to your communication circle can help too)

How it works?

screenshot 2019-01-27 at 16.23.52Do you know how the process, or the system you are trying to affect change on actually works? These cannot be changed successfully until you have understood this. A key ScIL self evaluation for me is learning to pause and plan. It has come as quite a shock to me that I am not an expert in everything after all! Take the time to find out who are the actual subject matter experts in the thing you want to change. They can help you understand fully what and where change will come.

screenshot 2019-01-27 at 16.27.35

How to access

Creativity is not just about coming up with original ideas. It really can be see about making new connections between existing ideas. This means creativity suddenly seems less scary.

As Steve Jobs said (last overindulgent quote I promise!):

“Creativity is just connecting things. When you ask creative people how they did something, they feel a little guilty because they didn’t really do it, they just saw something.”

What you need?

What are you going to need to bring about change? Are you going to be able to get the resources to make fundamental change – for example, developing a brand spanking new shiny online tool to access out patient appointments or just enough to make short term remedial change ( a newly redeveloped paper referral form). screenshot 2019-01-27 at 12.58.34

You don’t want to fall between two stools. (Apologies for the truly awful imagery pun!)

So my ScIL resolution for the rest of 2019 and onwards is to always think, if we keep on always doing what we’ve always done, then stop! Take the time to think about how things can be done differently. Dare I use words like ‘better’, ‘improved’, ‘slicker’, ‘leaner’, ‘more person centric’? I think I will dare. What’s there to lose? Who’s with me….?


screenshot 2019-01-27 at 12.31.03The Scottish Improvement Leader (ScIL) Programme is a key part of Scotland’s innovative approach to address increasing demands across our public services by developing QI capacity and capability.

The aim of the ScIL Programme is to enable individuals to:


  • design, develop and lead improvement projects,
  • lead and generate support for change, and
  • provide expert QI support and advice in their organisations.

Find out more about ScIL here







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