ABSTRACT
This chapter seeks to identify what is wrong with approaches to change management in health and social care. It explores what an alternative would look like, with particular emphasis on how change can be effectively sustained and spread, before considering the practical applications of such an approach. The chapter suggests that change induces anxiety and considers what can be done to address this. There is ample evidence concerning what is required in order to ensure both sustainability and spread in order to achieve desirable change. Sustainability involves ensuring that systems leadership is perceived as central to the effectiveness and survival of the local system and all its elements. Change makes many people anxious. Anxiety can therefore have destructive or self-limiting effects, but can also potentially provide the energy which is needed in order to risk being honest, direct, challenging and different.
