How about this for an act of ‘transformation’. Publicly blow up (yes, with explosives) one of your cherished Civic Buildings.

Not some ugly multi-storey concrete carpark. No, go for a Hospital; a large, relatively new one, in the middle of a City. Now that screams ‘TRANSFORMATION’…….things will never be the same again.

I know that I advocated a ‘Small and Imperfect, Minimum Viable Transformation’ approach in my last post, but sometimes we do need to do big things. Big symbolic things that absolutely demonstrate that things really have changed significantly, transformed.

Who would blow up a Hospital? The Canadians it turns out. They were quite busy blowing up hospitals back in the late 1990s. That’s not as reckless as it sounds, these weren’t random acts of civic vandalism, there was a clear strategy behind the ‘controlled demolition’. It was all part of their ‘transformation’ of health services, and response to the extreme financial pressures on public services (sound familiar?).

I’m not about to advocate a similar approach in the UK, but now that the dust has settled (literally) I do think its worth looking at what the Canadians did almost 20 years ago.

Before getting into the detail, here’s a shortened video (14mins) of the hour-long special News Channel report, broadcast on the day of the ‘implosion’ of the Calgary General Hospital, 9am, 4th October 1998.

Learning from the Past. Obviously there was a lot more to the changes in the Canadian healthcare system than just ‘blowing up hospitals’. I am intrigued though, if the changes are ever discussed, it is generally the ‘blowing up hospitals’ part that gets mentioned.

The memory and symbolism of such a destructive act lives on and dominates the public service narrative. Anything else that happened around these relatively few acts is ignored, forgotten or dismissed. It’s almost like a huge programme of transformation is defined by a limited number of ‘controlled explosions’. The likelihood that ‘we could never do that here’ (blow up hospitals), means that anything else they did isn’t relevant to us either……? I’ve included an example of this selective remembering in a video from the ITN World News at the end of the post.

If you want a much deeper analysis of what happened in Canada during the 1990s have a look at these resources from the Canadian Foundation for Healthcare Improvement (CFHI): Healthcare Challenges in a Period of Fiscal Restraint; lessons learned and enduring legacies.

It is interesting to note that on the home page of the resources there is the aphorism from the Spanish Philosopher George Santayana: “those who cannot remember the past are condemned to repeat it”. I’ll leave it up you to work out what’s behind using that phrase and whether or not the ‘enduring legacies’ of the changes in Canada were; good, bad, or a bit of both?

Just to whet your appetite here are a few of the key things I took from reading the report and watching the videos on the CFHI pages:

• Canada had a huge financial problem that drove the changes.
• Everyone speaking in the videos knew the numbers, they could confidently quote the figures.
• Government in Ontario created a separate Arms Length Commission which was mandated to take decisions around closure and consolidation of facilities.
• The Commission was made up of appropriately qualified people, who acted in the ‘Public Interest’.
• The Politicians in charge, supported the work of the Commission, and ‘wore the decisions’ (that’s an interesting phrase / idea).
• In Ontario, they moved from 225 down to 150 facilities, which included the closure of 30 hospitals.
• Securing a level of acceptance from service users involved ‘showing people a better future for healthcare’, not just structural change in response to the financial pressures.
• Service users often reserved their judgement on the impact of the change for many years.
• One impact of reducing the number of staff was an increase in productivity.
• Another impact was an increase in waiting times.
• 20 years later, there has been a re-investment in healthcare.

If you only have time to look at one thing from the CFHI resources I’d recommend this interview with Mark Rochon talking about the Ontario Arms-Length Restructuring Commission.

Symbolic Transformation. The act of ‘blowing up a hospital’ is hugely symbolic. It screams out….. things are going to be different! For better, or worse, nothing will be the same again.

This does make me think that if you are planning for a BIG Transformation (rather than the Minimum Viable Transformation approach), is it worth thinking about some big symbols to go along with it? You don’t have to just ‘blow things up’ either, building things is also an option. It’s the sort of thing that people remember for years, so it’s worth getting right.

Here is the link to the ITN World News video I mentioned earlier.

So what’s the PONT?

1. Big symbolic acts send a very clear message, and get remembered for years.
2. If you really want to change (transform) something on a big scale, it’s worth thinking about the big symbols.
3. Other people have done this, it’s worth a look at what happened, otherwise as George Santayana says: “those who cannot remember the past are condemned to repeat it”