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Our event series with AbbVie UK, involving face-to-face and digital events with a host of interesting and inspiring speakers, has focused on the nitty gritty of how change happens.

What drives successful (and sustainable) system change? This won't stop being a relevant and compelling question. We should perhaps acknowledge though that, at least in terms of healthcare, we have a prevailing orthodoxy - that top down, mandated and performance managed changed is the default method.

We at the Stroke Association are boldly pro-reconfiguration. As an organisation representing over a million stroke survivors and advocating for the best possible treatment and care, how could we be anything else? 

Stroke is not the same as cancer. Maternity services are not the same as psychological therapies. But is there learning to be gained from thinking about how system change happening in one clinical area could be transferred to others? 

Dr Angus Ramsay looks at the learnings from our recent webinars on the reconfiguration of stroke services, where we had wide-ranging discussions of key aspects of major system change.

I'm excited about this month's upcoming events to discuss the lessons of the changes to stroke services in London and Greater Manchester. The events will draw on the findings of the study led by Professor Naomi Fulop of UCL, which brought together a team of researchers, clinicians and service users from London and Manchester to examine the effectiveness of stroke reconfiguration.

Our systems and institutions are not strong enough to support the level of debate and discussion we need to make resilient policy. If we stopped to think about what we were doing critically, would we change course so often? Maybe we would be more likely to uncover what we don’t know.

I know you’re in the middle of something – thanks for even stopping by – but could I borrow you for two quick thought experiments? Only be a minute.

Culture is possibly the most important, but also over-used and, at times, meaningless concept deployed by those interested in the organisation and improvement of healthcare. But what is culture? Is there 'good' and 'bad' culture? How can we use our understanding of culture to improve our current healthcare system?