Why is the dialogic change method taking over from the diagnostic method?

Whenever change is to be implemented the method under which it is introduced is vital if it is to be successful. The NHS is arguably still very traditional in the way that change is implemented. The diagnostic model of change is the usual method employed and there is a case to suggest that this should continue. However, disruptors within the health and care field will be quick to point out that change is not readily accepted within the NHS and that a different method of change implementation may be more successful.

The difference between diagnostic and dialogic methods of change

The diagnostic method sees a group of leaders sit down and diagnose the problem or issue and then attempt to implement change through a top down approach. The decisions are filtered down to the ground level staff who are expected to implement the change and be monitored on their effectiveness at doing so.

There are situations where this approach is effective and arguably the best way to carry out the analysis of what changes are needed. However, this traditional approach is now being challenged by the ‘dialogic change’ model which places the focus of change on the mindset and not simply the behaviour.

How does the dialogic method bring about change?

Bushe and Marshak state that there are three ‘transformational processes’ that occur in order for change to be implemented and accepted.

The first is that the current social construction breaks down. A disruption to the status quo occurs which demonstrates that change is needed and that the current or old way of doing something will no longer be effective and that change is necessary.

The second process involves a change to one or more of the core narratives. The core narratives are the ‘stories’ that give coherence to the organisation by providing ‘facts’. If these are changed then it logically follows that change will occur due to the fact that what was accepted previously will no longer be accepted.

The final process is the introduction of the new way of behaving or thinking. Once a disruption has occurred which makes people believe that the old way is no longer acceptable and the core narratives have changed to allow people to accept the implementation of a new idea, it is necessary for that new idea, or change, to be presented.

Why is it effective?

This method of change implementation does not rely on workers blindly, and often reluctantly, accepting the changes that are prescribed to them by leaders high up the hierarchical ladder. The dialogic method instead focuses on changing people’s mindset and in turn allowing their behaviour to change as a result of the change in attitude.

By demonstrating that the old way of doing things no longer works this method automatically promotes worker to look for a new solution. If workers want change then they are more likely to accept it when it is implemented. The core narratives concentrate on changing the attitudes of workers so that when the change is suggested or implemented they are more likely to accept it. If the attitude of the organisation stays the same then change will be difficult to impose. The presentation of the change to be implemented by this point is welcomed because workers have been given the opportunity to understand and accept why the change is necessary.

As the authors state in their conclusion, the diagnostic and dialogic approaches are not two entirely different methods they are simply different ways of thinking and may be most effective when used together. It should therefore not be seen so much as dialogic taking over from the diagnostic method but as enhancing it and providing a more effective way of bringing about the necessary changes.