Since the findings of the Mid Staffordshire Inquiry, there has been a wide-reaching backlash toward heroic management in health and social care. Heroic management is characterised by heavy egotism, superior knowledge or skill and isolated decision-making. Because of these characteristics, it is generally agreed within the NHS that heroic management is damaging to the efficacy and sustainability of organisations, and that any associated practices should be put to rest.

Even in this post-heroic era however, the change management approaches that are advocated for in NHS leadership guidance, education and training continue to support heroic management in a number of ways. Every guide to successful change management will eventually come to the point at which gaining buy-in becomes a critical factor. General consensus signifies that for a change or innovation to be implemented with any sense of success, those who will be required to see the change through must ‘buy into’ it, recognising its need, agreeing with its implementation and be willing to support its delivery. The way in which approaches to buy-in are currently presented, however, within health and social care and further afield, may just be the reason why we are not appearing to improve the success rates of our change efforts.

Change management to convince, not consult

The process of buy-in is meant to be an opportunity for those leading change to consult stakeholders, enabling them to determine and shape change within their organisations. The issue here however is that the majority of change management approaches start from a place of certain correctness on the manager’s part. The change that needs to be ‘bought into’ is presented as the right change, happening at the right time.

Few change management approaches advocate for engagement prior to the decision to make a change is agreed upon, perpetuating the idea that those who lead change, most notably managers, have specialised knowledge, skills or insight that enable them to more accurately identify what changes are best for their organisation. While a few change management approaches advocate for feedback loops between managers and employees as a way of allowing stakeholders to raise issues throughout the change process, this lack of engagement from the outset damages this ownership before engagement has begun.

Even those who advocate for a participatory approach to change management seek this approach again as a method to enable people to accept and support change, not necessarily to allow them to shape or alter it. This approach perpetuates heroic management by teaching managers their job is not to build a future vision with stakeholders, but instead convince them that the way forward that has already been decided upon is the correct one.

Change management to discredit, not empower

Change management is also often advocated as a way for those who lead change to enable stakeholders to experience ownership of the change, empowering them to shape the future. While this is a common view, those who are considered ‘resisters’ are frequently portrayed in ways that appear to deny their ability to do just that. Often those who resist change are commonly seen to be the target of what can only be considered managerial propaganda.

Of these negative portrayals, the resister’s ability to think logically and rationally about their organisation, work and environment is most commonly questioned. They are frequently presented as led wholly by their emotions, often holding personal vendettas against change and in so, unable to raise serious considerations for debate……..lll

Maurer’s categorisations of resistance, for example, embody each of these concepts completely: “I don’t get it,” “I don’t like it,” and “I don’t like you”. These approaches support heroic management by infantilising employees and reinforcing the idea that only one person can lead successful change as they are more logical, more emotionally ready and exhibit more professional maturity than those they are requesting buy in from.

Change management as a battle, not an opportunity

Finally, buy-in is portrayed as a way to include people in change, not ‘do’ change to them. The depictions of those who resist change however can be, at worst, combative and can be seen to push a ‘them’ and ‘us’ rhetoric. Gaining buy-in is considered so important in some change management circles that selected commentators believe those who do choose to openly resist change should be handled as an immediate and direct threat to the success of a project’.

Even when resistance to a change is portrayed as a potential tool for improvement or progression, the change agent is seen to require resilience, already presenting those who are resisting as in issue that is required to be overcome, not colleagues who may have identified issues not previously considered. This supports heroic management firstly by separating out those who were previously colleagues into two distinct groups, widening the gap between manager and stakeholder and secondly, through the presentation of a good vs. evil narrative, reinforcing internal heroic personas and external ‘causes’.

Where next?

Instead of utilising the process of buy-in to determine what changes are possible and wanted within the organisation, buy-in when presented in this manner can be considered a high-stakes game of manipulation. In a world where we are meant to respect and include all views in the way our organisations are run, cultures which develop faux participatory approaches to change ultimately allow heroic management to flourish.

Whether reducing empowerment by denigrating concerns to issues of emotional reaction, or taking a hard-line on removing resistance, we need to be aware of the potential to create fearful silence and the negative impact this can have on successful change idea creation and development. By ignoring resistance, we might just be ignoring sound advice that will save us from harming those we have in our care. It is therefore time to start considering how we practically align change management guidance, education and training to the progressively collaborative agenda that health and social care have theoretically signed up to, benefiting from the knowledge and contextual awareness of all.



  • The post gives the views of its author, not the position of LSE Business Review or the London School of Economics.
  • Featured image credit: Road, by Tookapic, under a CC0 licence.
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polly-pascoePolly Pascoe is a senior manager in the NHS, focusing on quality assurance and knowledge productivity. She is also currently a PhD candidate at the University of Bradford, studying support mechanisms for evidence-based management.