This article is the second in a two-part series of articles on Thinking Differently About Change. You can read the first part on Creating the Conditions for change here.

Part 2: Tending the Fire

Change Is a System We Co-Create

In healthcare, change is a constant. Yet too often, we treat it as an isolated event, a policy update, a structural tweak, a new tool to be "rolled out." What gets lost in these programmatic approaches is the human essence of change: how it is lived, experienced, and sustained.

After decades in clinical governance, strategy, and system leadership, I have come to see change less as a set of tasks to be managed and more as a condition to be cultivated. Change is not just what we do; it is a relational space we hold.

I often think of change as tending a fire. You don’t start with the biggest log. You begin with kindling, small, intentional sparks. You create room for oxygen. You watch, you adjust. You steward the flame.

This is the heart of generative change. It’s not about top-down implementation. It’s about co-creation. Conversation. Emergence. And this shift is not only philosophically compelling, but increasingly evidence-based.

Moving Beyond Programmatic Change

A colleague of mine, Brad Hastings PhD, Insights Associate, UNSW Business School, contrasts two approaches to change: programmatic and generative.

Programmatic change is what many of us know: linear, diagnostic, often top-down. It asks: What’s the problem? What’s the fix? And then it moves quickly into planning and implementation.

Generative change is different. It recognises that in complex human systems, change doesn’t emerge neatly. It is dialogic, emergent, and bottom-up. It asks: What’s already growing? What needs sunlight? It creates space for inquiry, not just execution.

Hastings’ recent systematic review found that generative approaches have significantly higher success rates than traditional ones. Furthermore, blending the methodologies to provide structure and space for emergence is the most effective. This resonates with what many of us have observed in practice: people support what they help shape.

Holding the space for integrating a generative approach to change into your leadership toolkit, try asking yourself: what truth hasn’t been voiced yet? What would happen if I stopped trying to lead the change and started listening for what wants to change?

Leading as a Steward of Conditions

As a healthcare leader wanting to influence change, I have intentionally reframed my mental model.

This means:

• Making space for reflective practice and psychological safety.
• Using language that invites rather than instructs.
• Creating governance structures that enable, not control.

In generative models, leadership shifts from control to convening, from vision-casting to container-building, from answering to inquiring.

I see this play out in working with communities of practice, where the most sustainable changes emerge not from directives, but from dialogue - when people feel safe enough to learn out loud, to test ideas, and to grow through experimentation.

Why Metaphor Matters in Change

Generative change also embraces metaphor as a leadership tool. Metaphors help us think differently, feel differently, and act differently.

My metaphor for change is "Tending the fire". It is more than imagery. It shapes how I lead:

• It reminds me to go slow where I’m tempted to rush.
• It asks me to protect what is fragile.
• It values rhythm, ritual, and relational awareness.

Language creates realities. When we say, "roll out" a program, we position people as passive recipients. When we ask, "What wants to emerge here?", we honour their agency.

This is why psychological safety and language are deeply intertwined. What is spoken, and what is left unsaid, determines what is possible in change.

Generative Change Is Like Tending a Fire

• Kindling → Small tests of change
• Oxygen → Psychological safety
• Flame movement → Emergence and sense-making
• Logs added slowly → Layered interventions
• Wind break → Leadership support
• Hands nearby → Stewardship, not control

The Future of Change Is Generative

If we want to navigate change well in healthcare, especially under the pressure of reform, we need more than frameworks. We need fluency in the art of emergence.

Generative change invites us to slow down, to notice, to co-create. It asks us not to fix people, but to be curious with them. It reminds us that the conditions we create are just as important as the strategies we write.

So next time you feel the pull to push change forward, ask instead:

• What’s the spark that wants to catch?
• What does this system need more of - not from above, but from within?
• And how can I hold space for that fire to grow?

Let us be leaders who tend to the fire.