Change by Care

Changes, transformations and innovations are first and foremost a social process. That requires a care-based approach, captivating stories and flexibility. The healthcare sector hold many lessons and opportunities for this approach and method of dealing with change.

But what makes a good and resilient spatial transformation in the care sector, and what can we learn from that for other transformations? To find out, Kornelia Dimitrova interviewed 9 experts who have led this kind of transformations, and brought their lessons and experiences into one visual roadmap.

NL-versie

Mapping spatial transformations in the care sector.

Published on 3 May 2023.

Many healthcare organisations are in the process of such transformations as they look for ways to adapt to the changing societal needs. Frequently, real estate redevelopments overlap with organisational changes. These processes hold many uncertainties, span over longer periods of time, involve a variety of expertises, affect multiple stakeholders and require a chain of strategic decisions. This research set out to grasp the bigger picture of spatial transformations in the healthcare sector in the Netherlands.

​For the people shaping and guiding the process of such transformations, the ability to keep a sense of the bigger picture has become ever so important. Envisioning the end result is essential. But the process we create to go there is even more impactful on our ability to reach that point. Having an overview helps with seeing what is really important and keeping it in focus. It helps with managing the changes, expectations and decisions along the way. It facilitates good communication and collaboration and in turn leads to more thoughtful decision-making and a better experience of the transformation.

The digital publication below aims to make visible how spatial decision-making works in the Dutch healthcare sector in practice. Over the last 30 years many such transformations have been developed in and with the healthcare sector. This research brought together 9 experiences into one roadmap, giving an overview of the process in practice. It highlights 6 aspects that define a resilient and robust transformation approach. While such a publication can rarely be complete, this roadmap is proposed as a living document, where the dialogue can continue and the experiences knowledge from practice can continue to be collected and shared.

Browse the Miro board publication.
Would you like to find out more about the research or request the digital publication? Contact us by email.

Best Practices

What makes a good and resilience transformation in the care sector?

1. The importance of the torchbearer. Give them the space and opportunity to build the knowledge and vision needed to craft a story of change. Also give them the space to take actions early on, to try things out and to engage the rest of the organisation and its clients into the making of that story.
   
   
2. Framing the reason to change. Take a critical look at the tasks and challenges you see. What knowledge formation and actions need to be deepened internally or externally? What was the impulse for this transformation? How is the current situation assessed? What values and hopes are embedded in the future vision? do you address behavioral change, infrastructure and governance?
   
   
3. Every plan is at best a carefully-crafted assumption. Expect each step to bring new knowledge, and be sure to preserve space for learning, experimentation, adaptation and action. Change and spatial transformations are a creative process. Experiments, iteration and prototyping can inform and inspire decision-making around complex socio-spatial transformations. It helps test assumptions on time, it is a way to embrace learning, accept mistakes and reflection. This is an attitude that should be at the core of a transformation initiative, as well as the organisations culture. In the short term, it seems to slow things down, but the organisations that have done this said 'it was expensive, but it was totally worth it'. 
   
   
4. Change and spatial development is primarily a social process. Change is not something you do alone / in your team. Find allies early on, and work towards co-ownership of the change and spatial development. Co-creation comes not only in the planning, but also in the execution, and especially in the perception of the desired future. How do you engage people, and how do you keep them involved in that story?
   
   
5. Envision the transformation as a choreography. There is a story, a stage and a director. And then there is a sequence of events and actions that unfolds. To make it work all actors and technicians need to know their parts, they need to have rehearsed them, and to perform them at the exact time. Both time and timing are important. For the care process, time has an important role, sometimes it is about making the right moves quickly and precisely, sometimes it is about taking longer, consistent steps in the right direction.
   
   
6. Balancing time perspectives. Meaningful participation and change trajectory requires to balance institutional and human perspectives on time. In a trajectory where landscape transformations are a part of it, the time frame of trees, rivers and animals also comes into play. Understanding the mindset over time is precisely important in spatial transformations, it affects patients, expectations, motivation and enthusiasm. The crux of managing them is in respecting the time frame of the other.

On Listening, Slowness and Uncertainty
In simple terms, change is a process of 4 steps - initiate, plan, execute and stabilise. In broader terms, this is true, but it might mislead us to believe that this transformation processes are also linear, and so we might plan, prepare and communicate about it in this way. In practice it is rarely so, and plans turn out to be little more than carefully-crafted assumptions. In the care sector, spatial transformations a little more complex and entangled. Individual opinions, preferences, (dis-)engagement, sense of ownership and belonging play a crucial role in such a transformative process. This is why it should be considered as a social, rather than a structural or technical one.

A linear approach to planning and enacting spatial transformations misses the chance to learn and adapt along the way. And this might lead us to miss or overlook some crucial facts and factors. For instance, a plan that has been designed a few years ago, might turn out to be outdated due to new regulations, new ideas or new members of the team or community of the organisation. Such a plan would get scrapped, and a new one would be made instead. More often to conduct meaningful participation and change trajectory requires those in charge torchbearers to balance institutional and human perspectives on time, on care and on change. In a trajectory where landscape transformations are a part of it, the time frame of trees, rivers and animals also comes into play. A cyclical or iterative approach would focus more on the process of the transformation and would prioritise engagement and action. In other words, this approach would be qualitative and cultural.

Roadmap 

Explore the Miro board version of the research. 

Not used to Miro's interface? This is how to access it: Click on the button 'See the board', then zoom out until you see the full picture. At the left-most side you'll find the table of contents. The reading order follows from left to right, from top to bottom. At the core of this research is the roadmap and a collection of good practices and personal experiences collected through the interviews - those are the two long horizontal boxes.

This research has been partly made possible by the Creative Industries Fund NL.