Transformation is one of those words that is beginning to mean less the more it is used. Increasingly desperate and/or strident calls to ‘transform’ services are shorthand for ‘we are in a fix, have failed to redesign services so far but that is not going to stop us using the word as it makes us sound as though we are on the case’. Watch how everybody nods and agrees when you use the ‘T’ word. So comforting, so aspirational, so ambitious.

Lets just think about it for a moment. Glaciers transformed our landscapes, the Reformation transformed culture and art, the Industrial Revolution transformed economies, air travel transformed the tourist business. None of those was a ‘Great Leap Forward’ – a single bound into a new state freed from the shackles of the old. What they were was relentless evolution, a myriad of steps and changes all heading roughly in the same direction. Multitudes of experiments, successes, failures connected and shared. In some cases that evolution was more rapid than in others – in a connected world with competitive economic and political pressures you would expect more rapid evolution, but still comprised of a series of uneven steps. Another characteristic was that there was no central guiding mind or master plan for any of these transformations. The change was the sum of the efforts of the many, not the few, although a few might initially have influenced the path.

There are quicker transformations, the instantaneous sorts are earthquakes, volcanoes and other major natural disasters. These are the ones where the collateral damage is significant and painful.

So when our leaders call for transformation what mental model is in their minds and what comes to our minds? Our mental model will determine how we respond. Cataclysmic change or rapid evolution?

The illusion of transformation can be achieved by reorganisation but rarely does this impinge successfully on the fundamentals of the service. The alternative is to shout more loudly – transformation by diktat and the stick disguised as a carrot. That rarely goes anywhere constructively except to resistance, riots, a lamp-post and a handy noose.

The reality is that what really needs transforming is the way we think about change and how it is best achieved, how we can accelerate the evolution of the service – transforming spread and adoption, transforming engagement, transforming mobilisation, transforming how we equip and support staff and clients/users/patients to increase the rhythm of change, to create relentless and rapid evolution.

The challenge facing public services and the NHS in particular, in a feeble economic environment and with the relentless increase in demand from an ageing population with increasing prevalence of multiple morbidities, is ‘epochal’. Most NHS organisations have made the ‘easy’ savings – although many have failed to make these savings fully recurrent so are pushing a growing bow wave in front of them. Now they need to get to grips with the challenge of radical redesign – the change equivalent of climbing Mount Everest in the early days of mountaineering.

Those organisations that succeed will have understood what transformation really means, have understood this for a long while and done something about it. Staff at all levels will have the tools, leadership, support, permissions and space to undertake the ‘climb’ and will probably have already have done a lot of the smaller but challenging peaks. But from my experience these are in a minority. The majority are facing a stiffer challenge and ill-equipped to tackle it without the ‘collateral damage’.

Climbing Mount Everest for the first time was not a ‘transformation’, it was a culmination of many years of trying, failing, dying. The transformation was new techniques, training, advances in equipment and knowledge about how the human body and mind responds in extreme environments.

Just how well equipped our are staff to achieve the ‘transformation’ we exhort them to achieve? Or are we really asking them to climb Everest in trainers and a t-shirt? How many bodies are we going to leave on the slopes before we learn?

(This is a revised version of a blog originally posted in December 2013)