Why I Returned to Organisation Development After 15 Years

More than twenty years ago I wrote about Organisation Development in the NHS during another period of substantial structural change.

I have returned to it because one question has never really gone away.

Why, after so much reorganisation, do so many of the same organisational problems continue to appear?

Organisations have been created, merged, renamed and abolished. Management arrangements have changed. New approaches to quality, improvement, governance and patient safety have emerged. Yet we continue to encounter failures of communication, professional and organisational silos, people struggling to raise concerns, leaders becoming disconnected from frontline experience and lessons apparently having to be learned again.

That is what led me to write Beyond Reorganisation.

The publication of the Thirlwall Inquiry in September 2026 made the question particularly difficult to avoid.The Inquiry inevitably concerns events of extraordinary seriousness, but the organisational questions reach far beyond one hospital. How does uncomfortable information travel through an organisation? What happens when somebody challenges authority? How do leaders respond when the evidence does not fit the reassuring picture? And why do organisations sometimes fail to learn lessons that appear obvious after the event?Lady Justice Thirlwall's observation that “It is behaviours that need to change” goes directly to the argument I make in the book.Policies matter. Structures matter. Regulation matters. But ultimately organisations behave through people.

My central proposition is that culture changes when leaders change first.

Leaders have a disproportionate influence upon what becomes possible within an organisation. People notice whether challenge is welcomed or punished, whether mistakes can be admitted, whether senior people genuinely listen and whether the values displayed on the wall survive contact with difficult decisions.

This is also where what I call the Shadow Side of the organisation becomes important. Every organisation has conversations that take place outside formal meetings, assumptions that are rarely challenged, informal power relationships, defensive routines and subjects people know about but hesitate to discuss.

The objective is not to pretend that these shadows can be removed. It is to lighten them — to create sufficient openness, trust and courage for the undiscussable to become discussable.

Beyond Reorganisation is therefore not another argument for a particular NHS structure, nor is it a new change-management formula.

It is about developing the skills and behaviours that help organisations understand themselves: listening properly to patients and staff, diagnosing before intervening, following the patient rather than the organisation chart, questioning assumptions, developing leadership at every level and turning experience into learning.

These are not abstract ideals. They are preventative skills.

I have decided to make the full digital edition available free from my website.

I have done that deliberately. I would like the book to reach NHS leaders, clinicians, managers, students and anybody interested in how organisations can become safer and more capable of learning.

The paperback is available for those who prefer a printed book, but there is no charge for the PDF.