Why command and control doesn’t work for QI

We have written a lot in previous blogs about leadership styles and behaviours that are supportive of quality improvement, and you can read more about these here and here.

In a busy, acute hospital Trust like ours, this time of year tends to be when we start to feel a ‘squeeze’ as both the financial and performance standards we set for ourselves become harder to achieve and we can see a tough winter ahead of us.

Much of this ‘squeeze’ tends to come from external parties but some of it can be internally generated too. Although all these parties are undoubtedly working hard and have the best of intentions, we know that ‘command and control’ is not an approach that is conducive to successful improvement and transformation.

We need to remember that we can’t direct people to do QI and, when operational pressures mount, reverting to ‘command and control’ will not bring out the best in teams we are encouraging to be creative in making improvements.  Fortunately, there are other strategies we can employ instead.


We came across this article which describes why “command and control, as a change leadership style, destroys virtually any chance of success in nine out of ten transformational change efforts”.

The article explains how command and control limits the engagement and commitment of teams (which is so important to successful QI) and instead can often actually promote resistance.  It also describes how leaders who try to force change through command and control also “minimise attention to the necessary people issues… and emotional reactions to change.”

There are a number of misconceptions that leaders can often hold about how they should be directing others to make improvements, and these start to surface more when the ‘squeeze’ starts to be felt.  For example, some common misconceptions about leadership of transformational changes include…

– Leaders should know where they are going and have a fixed plan on how to get there

– Employees won’t naturally contribute positively to change and improvement, so leaders need to help them by commanding and controlling their involvement

– Needing to alter our change plans means leadership failure

As the article by the Change Leaders Network explains, in order for change to be truly successful we need our teams to participate as full players in transformation, not to be “coerced victims”.  It is also really important that they “emotionally ‘own’ the change and understand its intent as much as the leaders do so they can contribute to moving it forward in a positive direction”.

As an alternative to command and control, we should be trying to co-create change with staff (and patients) and be adapting to our changing circumstances all the time.  This can be really hard to do when the ‘squeeze’ starts to be felt and pressure builds in the system, but there is lots of evidence to show us that this is the way to sustainable change and improvement.


As a simple starting point, instead of telling our teams “What we need to do is…” start by asking “How do you think we can meet this challenge?” or “What do you think we could stop doing?”; and always be checking if our teams are willing participants who appreciate the value and necessity of the changes we are asking to be made for patients and themselves.

I hope this is useful and would really welcome your thoughts in the comments section below.


Mark – @MarkH_Work


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