Why is top down change so problematic? Any organisation that imposes “top down change” risks alienating its employees – simply because they feel forced to work in ways that don’t work for them – they haven’t been consulted and if you are ordering top down change from too far up at the top how can you know what happens at the bottom? It probably seems like a good theoretical idea but will it work in practice? The people on the ground have to cope with the unintended consequences and still keep the show on the road – being compassionate and kind to patients and one another; providing quality care and meeting management demands. Granted in an emergency a leader doesn’t always have time to consult widely but in most situations there is time to consult, consider and reflect before imposing “top-down” change.

by Dr. Megan Joffe