System change is notoriously difficult. Trying to change models of working, group ethos or ensure best practice is a hard fight a lot of the time; but it’s not impossible. In fact change is inevitable: nothing stays the same forever.
When trying to find where the power lies in healthcare reform, it’s easy to come up with a list of people who have powerful job titles and make important decisions. But what if we stop thinking about power as something a person owns; as a fixed currency or as something that you have over someone else.
What if we think of power as an energy. As something that cannot be created or destroyed, but as something that transforms and grows as it is shared and spread.
Types of power
Power can manifest itself in different ways and academics have been debating this for years. Personally, I like the following definitions:
- Visible power – this is the most obvious type of power. It’s the people in the boardroom making decisions.
- Hidden power – this is the step behind visible power. This is the people who decide who sits in the boardroom in the first place and whose agendas are therefore less transparent.
- Invisible power – this is the most difficult power to pinpoint and goes yet another step further. Invisible power is the ideologies and norms that we as individuals believe and that then prevent us from exercising our rights. This is the belief that there’s no point in me applying to be in the boardroom because those people would never listen to anything someone like me would have to say.
Invisible power in healthcare
There aren’t many people who believe that person-centred care is a bad thing. But how many people believe that achieving person-centred care isn’t possible? How many think change is too difficult? How many don’t even attempt change because they instead listen to the invisible power that states that change is too difficult?
Trying to influence the visible and hidden power structures will only take us so far. It is when we start looking beyond the obvious power structures and instead at the invisible powers at play that we can start thinking of new and different ways to spread change. This is how we begin to change culture and how we start to see long term impact.