Why is Healthcare Transformation So Hard?

At Nexus Consulting, we've had a front-row seat to the challenges and triumphs of healthcare transformation across the NHS and Social Care. Working as clinicians and managers in acute provider organisations and as management consultants, we've seen firsthand why driving meaningful change is so complex and critical.

The Stats Don't Lie

The harsh reality is that despite being a world-class healthcare system, the NHS struggles to meet demands. A 2019 study in the BMJ estimates that yearly NHS spending would need to increase by 4.1% to meet needs and account for factors like an ageing population. On top of that, workforce gaps are significant, with the King's Fund reporting a shortage of nearly 100,000 staff across NHS trusts (2022). On the social care side, the Health Foundation (2019) found that delayed transfers of care from hospitals to community settings cost an estimated £347 million per year. While the statistics are sobering, these issues only begin to scratch the surface of why transformation is so difficult in healthcare. From our experience, much of the challenge stems from the sheer complexity involved.

The Complexity Challenge

Healthcare delivery requires the precise coordination of people across dozens of roles, specialities, facilities and care settings. Change that impacts one part of this intricate system can have ripple effects across the entire care pathway. Introducing anything new requires incredible attention to change impacts and a deep understanding of how the system fits together. Adding the regulations, standards and clinical guidelines on top, with a need to control and improve clinical effectiveness and patient safety, begins to describe the complexity we face.

The Human Factors

The biggest obstacle is often the human factors. As the saying goes, "Culture eats strategy for breakfast." Healthcare is delivered by dedicated professionals who have trained for years and poured their lives into providing outstanding patient care. Changing long-held behaviours, beliefs, and ways of working is incredibly difficult. The most successful transformations are almost always ground up, driven by clinicians and frontline staff, using leadership partners to facilitate rather than lead change. They must not only understand the "what" of the changes but also the "why" behind them. This level of co-design and top-to-bottom involvement is essential for achieving sustained change that makes a difference.

Where next?

Despite the challenges, we've also witnessed incredible resilience, passion and creativity from healthcare teams in the face of change. The results can be game-changing when you get processes right, embrace new models, and equip staff to work at the top of their license. At Nexus, we've seen integrated care pathways that eliminate delays and duplicated work. We've seen new workforce models that better use advanced skills while creating more rewarding team-based roles. We've seen technology implementations that reduce manual overhead so staff can focus on higher-value activities.

In each case, the common thread was a steadfast commitment to putting patients at the centre, fostering true partnerships with healthcare professionals, and rolling up our sleeves to do the hard work required for meaningful transformation.

Change is never easy, but some changes are essential. By taking a people-first approach that combines clinical expertise with a passion for process improvement, we can redesign healthcare for the future - together.