When leadership turns over like dry leaves: what Roy Lilley’s forest fire analogy means for the NHS

Roy Lilley’s “forest fire” metaphor from his nhsManagers.net article 'Improvement' on

9th January article captures something NHS leaders have felt for a long time: the ground shifting faster than anyone can keep steady. He’s right about the high turnover, the loss of experience and the way constant reorganisation makes improvement harder. But underneath all of this sits a simple truth — the human one.

Management theory has long shown that major restructuring leads to a predictable loss of leaders. The current NHS turnover isn’t unusual when seen through that lens — it matches what the evidence says will happen when a system is under sustained pressure and constant change. The real risk isn’t the turnover itself, but what that predictable loss does next: how it weakens memory, confidence and stability at the very moment the system most needs them.

From Roy’s article - Michael Porter’s work on mergers and major organisational change suggests that around 18% of top leadership leave during periods of significant restructuring. Other studies of mergers and acquisitions put senior executive turnover even higher — often 20–30% within two to three years — especially when roles, authority and accountability are reset mid‑flight. And in the NHS right now, the picture is similar: a reasonable estimate is that between 60 and 80 chief executives and equivalent senior leaders have left their roles in the last eighteen months. Taken together, the pattern is clear — this level of churn is predictable, and predictable churn brings predictable human consequences.

This is the pattern we see again and again: leadership churn creates uncertainty about who holds authority and where the system is heading. That uncertainty reduces psychological safety. And once safety drops, people speak less, take fewer risks and focus on short‑term survival rather than long‑term improvement. What begins as turnover quickly becomes a human risk that slows the whole system down.

Waiting for stability only increases risk because the damage happens long before the system feels steady again. By the time instability shows up in performance or culture, the human risk has already taken hold — trust has dipped, people have withdrawn and improvement has stalled. Human risk has to be identified early, not retrospectively, because rebuilding confidence is far harder than protecting it in the first place. For Board Chairs, NEDs, Chief Executives and system or transformation leaders, this is a clear reminder that human risk needs to be seen early and acted on quickly, long before instability becomes visible in outcomes.

Leadership turnover is a human risk, not just a structural one

When leaders leave, the NHS doesn’t just lose a job title. It loses the person who held the history, steadied difficult conversations, earned trust and understood how decisions were made. That’s more than “institutional memory”. It’s meaning, continuity and psychological safety.

In our work at Akumen, we see the same pattern again and again. People don’t resist change because they’re awkward. They resist because they’re worried, overloaded or unsure who to trust next. When leadership changes too often, people stop speaking up, stop trying new things and stop believing change will last. It’s a natural human response to instability.

Constant transition creates emotional fatigue — and emotional fatigue stops improvement

You can hear it in what staff say:

• “This will change again soon.”

• “We’re firefighting.”

• “I don’t know who to ask anymore.”

• “What’s the point.”

  
  

These aren’t operational problems. They’re psychological warning signs. They show that people are losing their sense of control and purpose. A system can cope with turbulence. It cannot cope with hopelessness.

Why evidence‑based listening matters now

The NHS is dry tinder: unclear responsibilities, political pressure, tight finances, leaders with responsibility but shrinking authority, and staff who feel exposed and unheard. Stability helps, but the real answer is spotting human and cultural risks early — before they flare up.

Traditional listening vs evidence‑based listening

Traditional listening captures comments, complaints and opinions — often in large volumes — but it rarely shows how those experiences fit together or what they mean for the organisation as a whole. The NHS is good at collecting information, but far less good at making sense of it or turning it into action.

Evidence‑based listening goes further. It brings together the lived experience of both sides of the frontline — patients and staff — and turns it into clear, reliable insight that can be used at every level of the system. This matters because improvement happens in three distinct places, each with different needs and different points of view.

• Strategic level (the 50,000‑foot view):

  Senior leaders need a concise, accurate picture of what is happening on the frontline from both perspectives. They need trends, patterns, benchmarking and a clear description of organisational pressures so they can decide what to fund, what to prioritise and which structural barriers need removing.

  
  

• Organisational development level:

  OD teams need a deeper understanding of the whole patient pathway and how changes in one area affect others. They need evidence that is broad, honest and unfiltered — not hand‑picked or diluted — so they can prioritise effort, manage stakeholders and design interventions that work across the system.

• Frontline improvement level:

  Frontline teams need to know whether an intervention is making things better or worse. Their focus is practical: what is helping, what is hindering and what needs adjusting in real time.

  
  

Evidence‑based listening connects these three layers. It gives each group the insight they need in a form they can actually use, turning raw narrative into something stable, comparable and actionable.

Narrative Experience 360: making the invisible visible

Most due diligence focuses on numbers, yet most failures come from people and culture. Narrative Experience 360 analyses lived experience at scale and turns thousands of pages of narrative into clear, repeatable measures that show:

• cultural mismatches

• leadership misalignment

• psychological friction

• early warning signs

• risks to stability and integration

• morale and resistance patterns

• values gaps

• readiness for change

  
  

Human risk behaves in the same way across sectors. The language changes, but the patterns do not.

Why this matters for NHS leaders

Roy highlights turnover rates that match major change research, but research rarely captures the emotional reality: fear, uncertainty and loss of meaning. Narrative Experience 360 gives Boards, ICBs and national bodies a clear view of:

• what people are experiencing

• where instability is forming

• where trust is weakening

• where cultural friction is growing

• where leadership confidence is slipping

• where psychological safety is breaking down

  
  

These insights protect people — and improvement depends on people.

If we want improvement, we must protect the conditions that allow it

Improvement doesn’t fail because the NHS lacks skill or commitment. It fails when the emotional climate becomes too hot for people to think clearly. To create the right conditions, we need to:

• reduce fear

• stabilise relationships

• protect experience and memory

• give leaders real authority

• give staff safe space to speak

• create clarity

• understand the human reality behind the charts

  
  

An investment in clarity, stability and improvement

The “forest fire” metaphor is a warning: the NHS cannot keep losing leaders, confidence and experience at this pace. These conditions are not inevitable. They are predictable — and preventable — when we have the right insight early enough.

Narrative Experience 360 provides that insight. It gives a reliable, evidence‑based view of human and cultural risk before it becomes instability, turnover or loss of value. And because it works across sectors, it offers a consistent way to understand human risk wherever people are navigating change.

If Roy’s metaphor tells us anything, it’s that the work now is about spotting embers early, creating firebreaks where instability is forming, and cooling the conditions before anything ignites. That is how systems protect their people — and how improvement is given the space to take root.

Read the original article from Roy Lilley on 9^th January. Contact Eross@akaumen.co.uk if you would like to discuss with the team how we can support your organisation to get a 360 view of risk, improvement, and opportunity.