Are you speaking the right language to land your transformation?
During my studies, the NHS was a hot topic for academics and transformation managers due to its high complexity and profile.
In March 2025, the National Audit Office published an assessment of three NHS transformation programmes worth over £3 billion [1]. One programme broadly worked but missed its targets, and two fell well short: surgical hubs delivered 48% less additional activity than planned, and a programme to cut follow-up appointments by 25% achieved 0.1%. The one that did work, or at least showed promise, earned clinical credibility before investment — its approach was grounded in an independent clinical review and built on securing clinical support. Credibility wasn’t a silver bullet — one of those two had clinical buy-in and still missed. But it was the one thing the programme that worked had, and the worst performer never did — its headline target had no supporting evidence and its own royal college declined to back it.
This isn’t about the scale of the problems the NHS deals with — the NHS just makes it visible. The lesson travels: investment doesn’t transform anything unless people move in tandem.
Hype aside, AI transformation raises the stakes, because it changes what work people do, and how they do it. For some, that evokes fear, anxiety, and uncertainty about what’s to come [2], alongside a real sense of loss. Loss of identity, autonomy, and the tasks that defined them [3].
The work itself will change, and that is inevitable, but the way we lead people can be the difference between a transition that moves or drags. With the change cycle becoming more frequent [4], any negative impact from a previous cycle only compounds in the next [5].
One train of thought is that change is situational, largely driven by external events, while transition is psychological — the process of an individual coming to terms with the situation that change has created [6]. Not acknowledging loss, or imposing direction without consultation, creates what Bridges calls a transition deficit — resistance, low morale, and disengagement. Bridges proposes three questions:
What is changing?
What will actually be different because of the change?
Who’s going to lose what?
Although these provide a useful spine for planning, they are hardly script ready. Here are several I’ve used in the past, which not only support planning, but help you understand how emotions play a part in your change programme:
What did the old way give you that the new way might not? Surfaces loss without requiring people to name it as loss and gives you a sense of where their head is at.
Which parts of your role energise you? Helps surface where their motivation comes from. What energises someone tells you what they’ll fight to protect, and where the change is most likely to land badly.
How do you see your role changing, and why? Helps them start to imagine what the role could look like. Even if there’s no clear answer now, it’s a question worth coming back to. The response can also highlight whether more work is needed with their manager or an exec sponsor to clarify what the change means for them.
Where do you think your judgement still matters? Particularly useful in the AI context, where human judgement still works alongside the tech, especially in compliance-heavy environments.
What feels uncertain right now? Gives people permission to surface their fears in a safe space — just make sure it is a safe space.
These are all common sense, but seldom the first place people go when discussing a new product or process change. The default response is usually to lead with the benefits rather than spending time grounding the change in understanding first. I am not saying that the benefits aren’t important, but in my experience, they won’t land properly until people have identified what they’re losing and can figure out what that means for them.
On the flip side, there is a limit. All of this assumes people are rational — that if you surface the loss and give them room to name it, people will come round. Most will. Some won’t. There’s a difference between someone working through a transition and someone who has decided not to move, and no amount of careful questioning closes that gap. Knowing which one you’re dealing with is its own skill — and dealing with the second is a different beast entirely.
Sources
National Audit Office (2025). NHS England’s management of elective care transformation programmes. Session 2024-25, HC 707, 24 March 2025. nao.org.uk
Brougham, D., & Haar, J. (2018). Smart Technology, Artificial Intelligence, Robotics, and Algorithms (STARA): Employees’ perceptions of our future workplace. Journal of Management & Organization, 24(2), 239–257. doi.org/10.1017/jmo.2016.55
Selenko, E., Bankins, S., Shoss, M., Warburton, J., & Restubog, S. L. D. (2022). Artificial Intelligence and the Future of Work: A Functional-Identity Perspective. Current Directions in Psychological Science, 31(3), 272–279. doi.org/10.1177/09637214221091823
O Morain, C., & Aykens, P. (2023). Employees Are Losing Patience with Change Initiatives. Harvard Business Review, 9 May 2023. hbr.org
Bernerth, J. B., Walker, H. J., & Harris, S. G. (2011). Change fatigue: Development and initial validation of a new measure. Work & Stress, 25(4), 321–337. doi.org/10.1080/02678373.2011.634280
Bridges, W., & Bridges, S. (2017). Managing Transitions: Making the Most of Change (4th ed.). Nicholas Brealey Publishing.