Twin Mum, Consultant Physician interest in Critical Care, Associate Medical Director, Celtic season ticket holder, Lourdes Doctor, SQSFellow. All views my own

Perth, Scotland
Joined October 2011
Monica Doyle retweeted
How can we navigate more adaptive, continuous approaches to change when our organisations still see change as a series of initiatives? What got me thinking is this graphic that the Change Management Network posted on LinkedIn. It describes a journey "from managing change as an initiative to building change capability in a continuously adaptive organisation". What I write below is not a criticism of the network. I agree that we need more adaptive capability for change and I appreciate that the Change Management Network is enabling this conversation. My question is: should we frame this as binary "from/to"? Change leaders adopting the adaptive approach promoted by the graphic will still have to continue to work with (and struggle with) most features of the "change as an initiative" approach that the graphic sets it against. In the complex systems most of us work in, this isn't a tension we can resolve. We have to hold and navigate both continuously and that won't change anytime soon. The direction of travel is towards organisations with the capability to adapt continuously. Yet the systems we work in today still fund, govern and judge change as a series of initiatives. As leaders of change, we are accountable for delivering the project in front of us. We are also the best placed people to build the adaptive change capacity our organisations will need for the evolving future. I would frame our strategic task as follows. Rather than moving away from “change initiatives” towards a different future, use them to build that future from inside the present. Five ways we can do this: 1) Hold two horizons at once. Seek to deliver what the initiative promises. At every stage, ask what the organisation will be able to do after the project closes that it could not do before. 2) Make capability part of the accountability. Work with programme sponsors to write capability outcomes into business cases, benefits plans and final reports. 3) Design for handover from day one. Share decision making with the people who will carry the change forward. Help build their skills in improvement and data and their sense of agency while the project team is still there to support them. 4) Turn governance moments into learning moments. Milestone reviews and Board papers can ask what we are learning and how we are adapting, as well as whether we are on track. 5) Connect the initiatives. Many organisations (especially in health and care) run dozens of change programmes in parallel. If we link them, share learning across them and grow a common change community, we can build adaptive capacity across the whole system. The future of change leadership is being shaped now, inside the initiatives we lead today. We want each project to leave people more able to spot problems, test ideas, take action and adapt. This isn’t “from/to”. It’s “both/and”: the initiative can become the vehicle and the adaptive capability can become the legacy. Graphic comes from a post by the Change Management Network on LinkedIn: linkedin.com/posts/change-ma…
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I work with some amazing managers in the NHS and I’ve learned so much from them. We all bring a different skillset to the table. I doubt any of the brilliant managers would have any issue with this and would welcome this suggestion. #triumvirateworking
Accountability must apply to everyone working in the NHS. That's why we're calling for regulation of non-medical managers. Read our full response to the Thirlwall Inquiry bma.org.uk/bma-media-centre/…
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A national wonder - as much as we’re under pressure to deliver increasingly complex healthcare, still free at the point of delivery no matter who you are ❤️❤️❤️ #loveourNHS #NHS78today
The NHS turns 78 today! If everyone who has been grateful for the NHS in that time followed and retweeted we’d reach a million in minutes.
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On this day in 1967, Celtic won the European Cup in Lisbon. 12 men born within 30 miles of Celtic Park defeated Helenio Herrera’s Inter Milan to become the first non-Latin team to win the trophy. The greatest achievement by a Scottish club. Immortal 🏆
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Our Scotland. You’re an easy country to love… #FIFAWorldCup | @FIFAWorldCup
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Monica Doyle retweeted
The teams that deliver the strongest performance in periods of rapid change are those that experiment & learn the fastest. That’s a central finding from @RonFriedman's latest @HarvardBiz article "How to Build a Superteam That Keeps Getting Better." He surveyed more than 6,000 knowledge workers across many sectors, including healthcare. He identified "superteams": those getting top scores on performance & effectiveness. Three things set them apart: (1) they get more done by managing time, energy & attention; (2) their members actively make each other better & (3) they keep building skills & improving over time. The research identified seven practices, all relevant to change leadership (here with my comments). Superteam leaders: 1) Run more experiments. Superteams experiment nearly 50% more often than average teams. Small, focused tests beat big rollout programmes. The key leadership role is making it safe to try (& fail). 2) Make curiosity contagious. Leaders of superteams are 56% more likely to ask thoughtful questions & 53% more likely to genuinely learn from team members. In change work, the formal leader rarely holds the most important knowledge. Curiosity is how we access it. 3) Ask "What are you stuck on?" Superteam leaders orient discussions toward problems, not updates that signal control. Issues surfaced early get addressed. The ones buried in progress reports become crises. 4) Roll up their sleeves, even when they don't have to. The difference between involvement & micromanagement comes down to intent. Leaders who work alongside their teams signal no task is beneath them & gain real-time understanding about where change is stalling. 5) Make feedback feel like support. More than 90% of superteam members say their leader delivers feedback that motivates without feeling critical. How we respond to setbacks shapes whether people keep trying — or go quiet. 6) Support team member’s growth, even when it takes them elsewhere. It is not a loss - it’s an investment. Superteam members are twice as likely to feel supported on leaving and three times more likely to remain connected. For change work, that extended network is an asset. 7) Lead with meaning, not just metrics. Leaders of superteams are 59% more effective at helping people understand why their work matters. Purpose is not a “soft extra”. It’s the difference between sustained commitment & change that fizzles out. The article's case study is the Oklahoma City Thunder: a basketball franchise that rebuilt itself twice from the bottom of the league to championship level by trading away stars, abandoning conventional tactics, & treating every setback as data. Their motto is “Labor omnia vincit”: work conquers all things. Those of us leading change in health & care can see the relevance. We build great teams through routine leadership habits: curiosity, experimentation, honest feedback & staying close enough to the work to know what is actually happening. That’s not a change programme: it’s a daily practice. Link to the HBR article: hbr.org/2026/05/how-to-build…
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Professor Graham Ellis today launched the Realistic Medicine and Value Based Health & Care for Senior System Leaders Resource. Impressive turn out of almost 200 people, excellent presentations from senior NHS leaders. Find out more at learn.nes.nhs.scot/86703
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Monica Doyle retweeted
Organisational "fungibility": part 2. (Fungibility = the mistaken belief that you can restructure, redistribute roles & replace people without meaningful loss.) Summary of comments in response to my last post across multiple social channels. Four themes surfaced. 1. Relational infrastructure is the real asset Alison Leary observed that workforce commentary lacking grounding in social science misses what matters. Relational infrastructure is a systems concept, not an HR one. Allen C. Stines asserted that what organisations call capacity is actually relational capacity — sitting in connections, not only in individuals. Sheni Ravji-Smith noted that social capital (value created through connectedness) is often undervalued — but naming it as a fundamental component of effective services, rather than a replicable by-product, is a starting point for change. 2. The true cost is hidden — but can be made visible Tim Curry argued the field is developing clearer ways to quantify lost social capital — making that case before decisions are taken, not only after. Dami Osibona noted that in the NHS, formal structures often get rebuilt first & informal trust takes years. That gap is where transformation fails. Ish Ahmed connected this to NHS mergers: performance dips even when capacity looks unchanged on paper, but knowing this in advance means leaders can monitor the right signals & intervene earlier. 3. Misreading the signals — & what to do instead Anthony Lawton argued the fungibility assumption is a measurement failure: most restructures occur because informal networks are compensating for broken systems, which leaders misdiagnose as structural dysfunction. Asking why those networks became essential before any restructure begins changes the quality of the decision. Bill Powell & Mohammed Naseer Khan observed that post-restructure signals (slowed decisions, people defaulting to old contacts, hesitation where there was once flow) are misread as resistance. Yet the barrier to change is frequently fear of losing relationships & accumulated experience, not unwillingness to act differently. They are the loss of relational pathways. Alison Jaap added that leaders who understand how decisions flow through informal networks can design restructures that protect connective tissue rather than sever it. 4. Building forward Paula Beattie stressed that rebuilding connectivity & agency are achievable starting points of recovery — & that planning for the human aftermath produces better outcomes. Cornelia Junghans Minton used the example of a GP with 30 years of patient relationships to show that accumulated relational knowledge can be seen, valued & protected. Jeppe Vilstrup Hansgaard argued the most practical leadership action is also the most basic: clarity about who connects with whom, about what & when. Done well, this builds the relational infrastructure that restructuring so often destroys. There was little dissent amongst commenters - rather a collective recognition that the web of relationships is where value lives in organisations. Leaders who understand this can act on it. Thanks to all who commented.
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Monica Doyle retweeted
Organisations are not "fungible". “Fungibility” is an assumption that if you redesign an organisation & replace one set of people with a different set, you will still get equivalent outputs. This mistaken belief underlies many organisational restructures: that you can redistribute roles, reporting lines & teams without meaningful loss. I've been reading "Communities Are Not Fungible", a recent essay by @JoanWesten7568. She examines 1960s urban renewal, when planners believed demolishing old neighbourhoods & rehousing residents would allow communities to reform. They didn't. The residents moved. The community did not. A community is not a set of people: it is a historically produced web of relationships between them. Destroy the web, & you have strangers in a building. The parallel to organisational life is uncomfortable. When we restructure, we may preserve many of the people but destroy the relational infrastructure that made them effective. The informal trust that lets someone ask for help. The shared knowledge of who to call when a process stalls. The accumulated understanding of each other's judgment. These live in relationships, not individuals. Redrawing an org chart doesn't transfer them. Research backs this up. Tacit knowledge - the "knowing how" driving real-world performance - depends on trust to flow. Break those relationships & you block the transfer. Studies show informal networks persist along old lines long after formal structures change, creating tension between old loyalties & new mandates. Social capital is the value created by connectedness. It can be destroyed in restructuring & take years to rebuild — a cost that almost never appears in a business case. What leaders can do to protect collective value: 1. Audit informal networks before redesigning formal structures. Use, eg., System Network Analysis or Relational Coordination. Breaking key network nodes causes capability losses no productivity model captures. 2. Treat relational capital as a real cost. Business cases for restructuring rarely account for social capital destruction. Making it visible leads to better decisions & stronger cases for change. 3. Design around high-value relationships. Identify relationships carrying the most trust & history & actively design the new structure to protect them while enabling necessary change. 4. Invest deliberately in building new relationships. Create conditions for them to form through shared work, peer learning & social connection. 5. Give explicit attention to belonging & psychological safety for everyone (not just those who lose or change roles): This creates conditions for the discretionary effort that makes new structures succeed. 6. Slow down at the point of irreversibility. Ask not only "what do we gain?" but "what do we lose - & can we recover it?" The value of an organisation is not the sum of its people's individual capabilities. It is the web of relationships between them. That web is not fungible. Link to Joan Westenberg's essay: joanwestenberg.com/communiti…. Thanks to @charlie_psych who sent me the essay.
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Monica Doyle retweeted
Peer influence is the single most powerful driver of change adoption. It’s something those of us working in change practice have long known: the trusted colleague who says "this worked for us"; the visible shift in practice from someone others respect; the informal chat that carries more weight than the top-down directive. Peer influence is change experienced through relationships, not instruction. And guess what? New research from @Microsoft (Nancy Bahm & colleagues) confirms that peer influence is also the most important enabling factor in AI rollout. AI adoption is stalling. Uncertainty makes people choose caution over experimentation, so learning goes underground. When they see trusted colleagues use AI, adapt it to real work & share learning, they’re far more likely to regularly use it themselves. Without social proof, even the best infrastructure & training can’t drive progress. The research data shows the importance of peer influence in AI rollout. A one standard deviation increase in positive peer influence raises the likelihood of being a heavy AI user by 8.9 % points, & increases the probability of using AI agents by 10.4 points. Leadership mandates have no direct effect on usage once peer influence is accounted for. The conditions for change are clearer than ever. Culture, psychological safety & trusting relationships aren't "soft" enablers - they’re the powerful mechanisms through which change spreads. In their absence, even the best technology investments fail to scale. Six actions for leaders of change: 1. Create visible learning environments: We can’t scale AI by urging adoption. We scale it by making experimentation seen, shared & socially safe. Learning channels, group forums & dedicated team spaces can make a big difference. 2. Model use publicly: Leaders who demonstrate their own AI use (including their failures) give others permission to try. Seeing a leader use AI in a meeting normalises it more powerfully than any communication cascade. 3. Build psychological safety first: Fear suppresses adoption. People who feared falling behind were less likely to experiment. Safety is not a precondition: it IS the intervention. 4. Invest in social capital: Trusted peer relationships are the channels that AI learning travels through. We must actively build connection within & across teams. 5. Encourage consistently, not in “bursts”. Heavy AI users were 4 times more likely to describe their leaders as "consistent" in encouragement. Lists of approved tools & mandated training modules do not build cultures of learning. 6. Carve out protected time for peer sharing: A standing 15 minutes in monthly team meetings to share AI prompts & real outcomes creates the informal learning loops that formal training never can. The research confirms what change practice has long taught us: people change through their relationships, not through policy. AI rollout is just the latest, most visible proof. hbr.org/2026/03/peer-influen…
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I love this concept and it’s really practically helped me in both my professional & personal life since learning about it at @SQSFellowship
There’s so much change happening at present. It’s easy to feel powerless and overwhelmed, particularly when many of the factors affecting our situation sit outside our direct control. I enjoy working with new ideas and practices for change (most of the time), but with many of the teams I’m working with now, I keep returning to a classic model: Stephen R. Covey’s ‘circles’ model from "The 7 Habits of Highly Effective People". The practical value is that it draws a clear distinction between (a) big concerns we care about, (b) what we can affect, and (c) what we can directly change through our own actions. Used well, it can help us prioritise better, reduce time spent unproductively “spinning our wheels”, and translate pressure into concrete next steps. In pressured systems, our attention naturally gravitates to the biggest risks and threats. The problem is that many of those risks sit in the circle of concern, where effort does not translate into impact. The "circles" model is useful because it deliberately redirects our limited time and headspace towards areas where action can produce measurable change. It also helps prevent a common failure mode in change: treating system constraints as if they are team-level problems. When teams repeatedly try to “solve” issues that require decisions at a higher system level (funding, policy, workforce supply etc), it creates frustration and helplessness. Separating concern from control creates a more realistic basis for action: escalate what needs to be escalated, adapt where adaptation is required, and take action where we have a level of control. One way I use this model is to ask the team to identify a shared list of current issues, then sort them into concern / influence / control. The circle of influence is particularly important for enabling change in a system, because system change depends on coordination across boundaries—through relationships, alliances, and shared action. This is not about ignoring the circle of concern. It is about managing it appropriately: acknowledge it, communicate it, escalate it when needed, and then avoid spending disproportionate energy where there is little prospect of change. The central message of Covey’s model is that when pressure is high, the most effective response is to focus on what we can control and what we can influence—because that is where our effort and energy is most likely to convert into outcomes. All of us can make a difference in the world within our “circle of control” and “circle of influence”. Let’s put our energy where it will count: take the next practical step we can take today, strengthen the relationships that enable progress, and act on the things that we can change.
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Monica Doyle retweeted
Here is a link to 50 of the graphics that I posted with my socials during 2025: slideshare.net/slideshow/hel…. These come from posts that were liked and reposted the most during the year. Many of these graphics originate from other people. The source of the content is shown in every graphic (unless I created it). Thank you to everyone who includes graphics in their posts. It makes such a difference to our ability to synthesise and share important principles with others. I hope these graphics and the articles they come from inspire you as they have me. All the original articles should be easy to find if you want to read more. Wishing everyone an outstanding 2026, during which we can learn, share, constructively challenge and debate, improve and make a bigger difference in the world together. Helen
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MCTOMINAY!! 🏴󠁧󠁢󠁳󠁣󠁴󠁿 UNBELIEVABLE! 😲 #BBCFootball
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Monica Doyle retweeted
Last Sunday Martin O’Neill was sitting in his house preparing for a morning Talksport appearance. This Sunday…he’s only gone and knocked Rangers out of the League Cup. What a man.
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Monica Doyle retweeted
“The 45 degree zone” is an important principle for organisational & system change. It represents the balance point in large-scale change efforts between two vital types of progress: achieving tangible short-term results AND building long-term capacity for further change. Remaining in the 45-degree zone means that, as leaders of change, we advance our initiatives in ways that both deliver impact now & strengthen the system for future impact. Too much emphasis on rapid short-term results can overextend people & processes, risking burnout or change failure. On the other hand, taking our eye off the ball of delivery & focusing excessively on building for the future can slow momentum & frustrate stakeholders expecting visible progress. Leadership research supports the principles behind the 45 degree zone. Leaders who can flex between exploratory (the future: experimenting & learning) & exploitative (the current: driving focus & delivery) achieve stronger performance & engagement. That’s the case even after controlling for whether leaders have transformational or transactional leadership behaviours. Five ways to stay in the 45-degree zone 1. Blend action with learning: Design initiatives that deliver outcomes while generating new knowledge. “Learning by doing” ensures each project both achieves impact & improves capability for the next cycle of change. 2. Develop leaders everywhere: Invest in building capacity to lead & engage people widely in change so results aren’t dependent on a few individuals. This widens future capability without halting present progress. 3. Balance the portfolio of change activities: Adopt hybrid strategies combining fast-progress, narrow-focus projects with broader, exploratory efforts, advancing both the pace & scope of change. 4. Engage decision makers/stakeholders on both fronts: Demonstrate the importance of supporting organisational infrastructure & capability, not just visible metrics of success, reframing investment in capacity as essential to outcomes. 5. Use reflective cycles, bottleneck analysis & other improvement tools: Regularly diagnose constraints that limit progress & performance (e.g., skills, relationships, resources) & address them strategically to relax tensions between achieving results & strengthening the system The “45 degree zone” from the @AspenInstitute & Higher Ambition Leadership Alliance: static1.squarespace.com/stat… Research on balancing current & future focussed leadership by Hannes Zacher & colleagues: pure.rug.nl/ws/portalfiles/p…
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Monica Doyle retweeted
Leading change demands deep emotional strength & self-awareness. Leaders of change have to balance an “inner battle” between agency (the need to drive momentum & action towards the vision) & ambivalence (identify risks, invite reflection & apply caution before proceeding). Typically, agency vs. ambivalence isn’t a resolvable “either/or”; it’s a “both/&” tension that leaders of change have to constantly hold & manage. @RonCarucci says we have to consider this tension across five critical dimensions of inner conflict: 1) Voice: Inspiring others with a compelling picture of the future, yet inviting dissent. 2) Ideas: Reframing possibilities with imagination while fostering unity. 3) Passion: Emotionally fuelling the cause of change & encouraging others to make their own connection to the cause. 4) Discontent: Challenging the status quo productively. 5) Conviction: Believing in the need for change but being flexible about the approach. The leaders who succeed at transformation are those who can live with the tension, read the conditions & repeatedly recalibrate that mix without overfocussing on either extreme for long. The author sets out advice to recognise the dimensions, watch for signs that they’re out of balance & use “guardrails” for sustaining balance as a leader of change: hbr.org/2025/09/the-resilien…
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The 1975 — Glastonbury Festival Tomorrow #The1975 #Glastonbury
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Monica Doyle retweeted
Three modes of organising for improvement: (1) Doing things well (2) Doing things better (3) Doing better things An organisational improvement strategy should focus on all three. Many organisations currently are overfocussed on (1) & (2) and under focussed on (3). This is risky because we can end up focused on improving the "wrong" or suboptimal things. The environment of change that we find ourselves in means that we have to focus increasingly on (3). It won't happen unless we build in the time & space for connection, collaboration, experimentation & learning into daily work. I adapted this table from content in "Improving quality in healthcare: questioning the work for effective change" by Murray Anderson-Wallace & Nick Downham. I really like this book, written by highly experienced practitioners: us.sagepub.com/en-us/nam/imp….
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An exciting opportunity has arisen for a Locum Consultant Gynaecologist in NHS Tayside to support delivery of planned care. Please get in touch if you’d like to hear more about our fantastic team apply.jobs.scot.nhs.uk/Job/J…
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