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Enabling effective change in healthcare delivery systems: Did Gerry Robinson teach us anything new?

Denis R. Towill (Logistic Systems Dynamic Group, Cardiff Business School, Cardiff, UK)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 1 May 2009




The aim of this article is to provide health leaders with a clear unambiguous description of a proven modus operandi for analysis, design, planning, implementation, and start‐up of effective and efficient healthcare delivery systems.


The paper builds on previously published reviews of the successful TV series centred on Rotherham General Hospital. This featured Gerry Robinson (GR), a top executive from the public sector, and his endeavours to interact with, and improve, the NHS. Those reviews covered emergent lessons directed at hospitals and the Department of Health plus the de‐briefing carried out by GR. They also detailed the Healthcare Balanced Scorecard, and emphasised the importance of minimising elapsed time.


TV programmes inevitably lack description of an infrastructure since “headline metrics” (preferably disputed) make the news and add to the viewing figures. Missing are some important steps along the way, identification of various key factors; resourcing issues; process monitoring; time scales; and team building. By showing that the GR approach can be related to a proven and well‐documented “engineering of change” methodology, a fully integrated approach to healthcare delivery system enhancement is evident.

Research limitations/implications

The comprehensive approach is based on the systems engineering concept of seamless patient flow achieved by eliminating problems rather than finding ad‐hoc ways around them. This requires team‐based activities involving clinicians, nurses, managers, secretaries, and everyone associated with the healthcare process. “No involvement” usually means “no commitment”.

Practical implications

Emphasis is on “institutional change” achieved via a sequence of carefully selected improvement projects in which the first acts as an “exemplar”. This requires a proactive people‐first organisation practising open‐learning and a culture of continuous plan‐do‐check‐act activity. The “seven deadly sins” indicate what may go wrong and why.


This article assists in the exposure and exploitation of TV healthcare narrative and established “engineering of change” practice by carefully relating one to the other.



Towill, D.R. (2009), "Enabling effective change in healthcare delivery systems: Did Gerry Robinson teach us anything new?", Leadership in Health Services, Vol. 22 No. 2, pp. 176-188.



Emerald Group Publishing Limited

Copyright © 2009, Emerald Group Publishing Limited

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