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NHS Transformation : Practical Steps ?
Comment on practical steps for NHS Transformation
3 key reports concerned with transformation (innovation, cultural change and service change) in the NHS prompted me to write this comment.
Together these reports build a picture of NHS organisations in real need of extensive user engagement services; services which will provide well needed practical steps for change.
This comment is an attempt to engage with the NHS about how I think we can help ensure successful transformation at this exciting yet critical time. I would value comments and feedback.
The 3 key reports which inform this comment are:
Lord Darzi’s report High Quality Care for All, available here:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825
- 3 key aspects for improved NHS services, services which are “clinically effective, personal and safe”
- the importance of innovation adoption and diffusion as a means to improve services
Listening to the Front Line from the Cabinet Office, available here:
www.cabinetoffice.gov.uk/media/219600/sunningdale-report.pdf
- the need to engage with front line staff and service users; encouraging innovation at the front line to ensure high quality care is provided to all
NHS Institute for Innovation and Improvement report The Next Leg of the Journey: How do we make High Quality Care for All a reality?, available here:
http://www.hsj.co.uk/journals/PublicServices/HSJ/SITEUSER/2009/7/20/Next%20leg%20of%20the%20journey%20-%20Bevan%20Ham%20Plsek.pdf
- attempting to translate policy recommendations and service transformation vision into a practical programme for change
The overall message which develops out of these 3 reports is that:
1) In order to encourage “clinically effective, personal and safe” NHS services the front line (both customers and staff) must be engaged with effectively.
2) Innovation adoption and diffusion and translating vision into reality can not take place without practical steps to engage with stakeholders and sustain change.
But an additional message stemming from these reports is that the practical steps for ensuring change are not known. Indeed, I am yet to find a report which provides the concrete steps to ensure transformation. Thinking about benefits and drawing up policy and proposals is very far from the tangible realisation of benefits.
The NHS Institute for Innovation and Improvement report does provide a step from vision to specific areas where practical steps need to be taken:
- ensuring “capability building” is ” ‘hard-wired’ into the daily work of NHS staff”
- facilitating “‘inside out’ change“ – the “capability of the system to change itself”
- “that many of the answers to the problems that exist lie within”
- “engaging front-line staff much more fully than has been the case hitherto”
- “supporting staff though education and development”
- “measuring and comparing performance”
- using “performance data, linked to incentives” to “drive quality improvements.”
The report should be commended for identifying these areas and also raising the spectre that how these areas are approached will be a defining feature as to whether transformation will be successful and how long it might take:
We now have new goals for the future, but we have had new goals before, have we not?
We have approaches for executing on new plans and goals, but these have never quite delivered fully on what was so enthusiastically envisioned at the initial release of the plans, have they?
We have been at this point in the journey before, have we not?
The question now before the NHS leadership community as we contemplate how we will execute on the changes outlined in the national and regional plans is:
What will we do this time round – simply more of the same, or something different?
(NHS Institute for Innovation and Improvement report The Next Leg of the Journey: How do we make High Quality Care for All a reality?)
There are two comments in the report which indicate significant scope for us to help the NHS in ensuring these transformations happen and are successful:
1) That executing transformation plans will be “even harder work” than developing the vision for change.
2) That “implementation processes are likely to be the weakest link in turning the High Quality Care for All proposals into reality”.
These two statements indicate a degree of trepidation about actually doing change. They also indicate a potential gap in the NHS in terms of repeated experience of successfully delivering change. Effectively executing visionary plans and implementing change is not necessarily about working harder but working differently, doing things differently.
We have found when working with Police Forces on the extensive and critical Mobile Information Programme that by supplementing in house services C-innovate have been able to ensure successful change. Though we approach change differently to those Forces we worked with, we were also able to meet our clients in the middle, realising benefits and change in context and in practice.
For us the implementation process is the most exciting and the area in which we ensure success; it is also the area we have most experience of; where working at the coal face of organisations implementing change is essential in order to actually do change.
Recalling the NHS Institute for Innovation and Improvement reports identification of the specific areas where practical steps need to be taken, our services help to:
1) Enable work practice change.
2) Empower front line staff to innovate and reflect on their work practices.
3) Gain buy in to change programmes from the front line.
4) Ensure front line feedback feeds into the design of change programmes.
5) Develop training which gets the best from staff and empowers them to relay information to others.
6) Develop benefits measurements and evaluate performance.
7) Ensure the leadership is there across the organisation to ensure successful change, be that through Champions, Supervisor empowerment, supplementing the project team, working with senior stakeholders or indeed a combination of all of these.
The picture below of our services at each project stage provides a useful guide; more information about each service is of course available on our website.
Given that, as the NHS Institute report states, “Evidence from a range of sources suggests that many local NHS organisations and systems lack the change capacity and capability to deliver the reforms” the supplementation of NHS services C-innovate can provide would be extremely valuable.
Though inside out change is preferable many organisations need an initial service supplementation, from those who are experts in change and benefits realisation, to shepherd them. Though the “experience of high performing organisations is that they have invested their own resources in building capability among staff and promoting ‘inside out’ change…” many NHS organisations simply do not have this capacity or are not yet primed to do so. Supplementing current capabilities with C-innovate services is a quick way to bolster the capacity for effective change.
From our perspective the centrality of user engagement to successful change programmes is clear. I believe the NHS report also shares this view when it states
We need to consider how we frame implementation of High Quality Care for All to gain wholesale staff and public engagement not just in planning and prioritising, but in the entire change implementation process.
(NHS Institute for Innovation and Improvement report The Next Leg of the Journey: How do we make High Quality Care for All a reality?)
We want to engage with the NHS – get in touch with us, let us know what you think about this comment. I believe it marks an important juncture where the identified areas by the NHS Institute for Innovation and Improvement are provided with tangible services.
C-innovate can provide both thinking differently and acting differently, ensuring successful transformation in keeping with Lord Darzi’s report, the Cabinet office report and the NHS Institute report.
Tags: Cultural change, Culture, engagement, front line, organisational change, technology implementation