Onwards and upwards? Or sideways and diagonally?

Stephen Sutcliffe, director of finance & accounting at NHS Shared Business Services, on the shape of change in the NHS and why flexible planning is important to avoid common pitfalls.

“Onwards and upwards!” said a colleague of mine the other day, as a meeting ended.

If my smile looked awkward, it’s because I was biting my tongue. In many cases, progress – particularly in the NHS – isn’t so much characterised by ‘onwards and upwards’ as ‘sideways and diagonally’.

Okay, that’s a little tongue-in-cheek (like mine was) but I do think there’s sometimes a failure to understand the fundamental shape of change – particularly the big, hairy change that gets labelled with that peculiar new word, “transformation”.


Let me explain.

If you’ve done any sort of management training, you’ll have been introduced to some neat change models. Google them if you want – there’s McKinsey’s 7-S model; Kottler’s change management theory; Lewin’s Change Management and plenty of others. They’re all good; I use many of them in my day-to-day work.

But they’re all based on the same premise – that you’re at A, you want to reach B and you need to take people with you.

Which is great. On paper. Sometimes even in real life. But what happens if you’re not sure whether B is your goal? Should you be aiming for C, D, or maybe E?

It’s difficult to manage transformational change when your destination and route are subject to alteration. And to those who say you shouldn’t even try, and that absolute clarity should be a prerequisite of any change programme – well, it would be wonderful to have that luxury. But in a world where social, political and technological changes happen almost overnight, it’s not going to happen. Take the RAF’s flagship fighter jet, the Typhoon. It’ll be in service until at least 2035. At the point it was first conceived, though – in 1983 – the internet hadn’t been invented. CD-ROMs were cutting-edge tech. The designers knew this wouldn’t stay the same – they needed to build a future-proof jet, even though they didn’t know what the future looked like.

Our world is constantly evolving, and if we wait for it to pause before we plan, we’ll be waiting forever.

That’s why sideways and diagonal planning – more formally known as flexible planning – sometimes makes more sense than the linear onwards and upwards. Think of it as building a staircase.  Planning every single step might be very difficult, but you know the direction of travel, and you can certainly plan the next few steps ahead. Using the staircase approach also means you can truly give each step the consideration it deserves.

This doesn’t mean you can lose sight of your destination altogether, of course – the Tyhoon’s designers didn’t end up building a submarine! But embedding flexibility into your plans right at the beginning isn’t a cop-out; it’s a sensible way of avoiding some common pitfalls like the sunk cost fallacy (when you should abandon your plan, but don’t, because of the amount you’ve already invested in it) or the “colouring your revision planner” trap – where crafting beautiful, intricate and complex plans takes so much time you can’t actually do anything in them. (Readers of a certain age may remember an episode of the comedy sci-fi series, Red Dwarf, dedicated to exactly this phenomenon).

It sounds easier than it is. For people like me, who like change, and who are frequently asked for ‘a high-level overview’ (is there any other sort?) the temptation to firm up plans too early can be overwhelming, particularly as CEOs and boards are not known for their comfort with ambiguity. But I, for one, am a convert to flexible planning – although it might be a while before I round up a meeting with a rallying cry of ‘sideways and diagonally’!


I love chatting with NHS colleagues about their experience of change – you can contact me on Stephen.sutcliffe1@nhs.net or follow me on X @sasutty