Why working harder isn’t fixing healthcare...

If you’re leading in healthcare right now, the pressure isn’t something you read about, it’s something you are dealing with on daily basis. It’s there in the decisions you’re making all the time about what has to wait, prioritising what can't slip, and where risk is being absorbed because there simply isn’t another option. It’s also present in the meetings where everyone is working hard, yet the same issues keep resurfacing, and in the growing sense that the system keeps asking more without giving you the space to change how work is actually done.

Every day brings another headline about elective waiting lists, missed cancer targets, or leadership teams under strain, but what the headlines rarely capture is the tension underneath and how people are truly feeling. It feels relentless being expected to recover performance while delivering savings, improving quality while vacancies remain unfilled and you need more "hands on deck". Supporting teams who are tired, committed, and stretched (often all at once!) and as a leader you're concerned about burnout... None of this reflects a lack of care or capability, it reflects a system under sustained pressure.

What we see most often is not failure, but too many layers of work piled on top of each other. Workarounds layered on top of workarounds - processes which have grown over time but were never redesigned. Decisions slowed down by duplication, unclear ownership, or data nobody fully trusts. When everything feels urgent, there is no space to step back, and improvement becomes something we talk about rather than something we genuinely do.

This might paint a bleak picture... but there is a way forward:

Continuous Improvement

This gives people permission to pause and look honestly at what is getting in their way. Embedding improvement at all levels creates a shared language for exploring problems without blame, and for separating the people from the issue itself. As Brené Brown describes it, progress happens when we put the problem in front of us rather than between us; this distinction is especially powerful right now in high-pressure systems like healthcare.

In practical terms, improvement means being willing to look at waste and inefficiencies which have built up over time. This might be time lost to duplication because roles aren’t clear, waiting built into pathways because handovers don’t work as intended, or extra steps added “just in case” because confidence in flow has eroded. Most of this made sense when it was introduced, but left unexamined, it drains capacity and morale while giving very little back.

Approaches such as Lean Six Sigma offer structure by helping teams slow down to see what is really happening, take one step or one hurdle at a time, and test changes properly rather than relying on fixes which don’t stick. Used well, this builds confidence, standardises what works, and supports better decisions grounded in data rather than assumption.

“Doing more with less” has become the default narrative in the public sector, but it doesn’t have to be the only one. Reframing how work is done requires leadership that is willing to create space for improvement, even when delivery pressure feels relentless. Without this space, pressure simply accumulates and nothing truly changes.

Healthcare will remain under strain, but leaders and teams do have choices in how they respond. Creating time to understand how processes are really performing is often the first, and most relieving, step forward. Sometimes, clarity begins with something as simple as taking five minutes to look honestly at how your system is working, and asking where effort is being lost, not because people aren’t trying, but because the process itself needs attention.