An Introduction To The NHS Change Model - NHSGGC

NHSImproving QualityAn introduction to theNHS Change Model

An introduction to the NHS Change ModelNHS Change ModelContentsWho is this workbook for?Introduction4The workbook is for all staff involved in or leading changeprojects or programmes.Why does the NHSneed to change6The parts of theNHS Change Model7Three ideas17An exercise tocomplete22Further resources23Considerations formanagers24How to use this workbookThis workbook is for you to work through in your own time.The learning is self-directed and you will not be assessed on theoutput from it.When you have read through the workbook, you will be askedto complete an exercise: to reflect on what you have learnedfrom this workbook and contribute your reflection in the NHSChange Model online learning community or add a commenton the NHS England Intranet.A video demonstration will show you how to do this.Throughout the workbook, you will find greenboxes like this one which encourage you to reflecton what you are learning.You are advised to make notes in response to the questionsposed in these green boxes. At the end, you will be able todraw on your notes to complete the exercise.23

An introduction to the NHS Change ModelAn introduction to the NHS Change ModelgIntroductionThis introductory workbook to the NHS Change Model comprises: this workbook a short video demonstration of the online learning community an exercise to be undertaken.Once these three elements are completed, you will have an awareness of: the reasons why change is needed in the NHS three important concepts within the NHS Change Model the eight component parts of the NHS Change Model.You will also have: considered how the eight component parts of the NHS Change Modelapply to a change that interests you contributed to the NHS Change Model online learning community.The NHS Change Model wasdeveloped with hundreds of NHSstaff at all levels who wanted to buildenergy for change across the NHS byusing an approach to improvingpatient care that everyone agreed onand that was based on solid research.NHS England uses it as a frameworkfor making change happen in theNHS, so everyone working for us isrequired to have a basicunderstanding of it.There are eight component parts they have to be used together inequal measure to make changesuccessful.You can use the framework on anychange that matters to you, nomatter how big or small.CLICK on eachcomponent part ofthe model to findout more about it.45

An introduction to the NHS Change ModelAn introduction to the NHS Change ModelWhy does the NHS need to change? Improving people’s lives and experience of care is at the heart of whatmatters to us and helps to drive the change we want to see Digital and other technologies create opportunities for new andinnovative service models The NHS currently faces massive financial challenges Our aging population and increasing rates of multiple morbidities havecreated a higher demand for health, care and integrated services Our current speed of change across health and social care, including thespread and adoption of innovation is too slow The NHS Change Model has been developed to provide a commonframework for delivering a service that is agile and sustainable in the faceof these challenges.What would you like tochange in the NHS?Does your change link toany of the issues identifiedabove?Our sharedg purpose Our shared purpose isfundamental to any changeand is the place to start - itholds all the other parts of theNHS Change Model together This is about our values andwhy we joined the NHS - theNHS Constitution sets out apurpose for the NHS Our shared purpose needs to beshaped by everyone involved inor affected by the change. Thishelps to define what needs tobe achieved and how it relatesto the things we all really careabout It is important to keeprevisiting our shared purpose –to ensure that it continues toconnect us with our vision forimproving people’s lives.Do you know of others whowant the same change asyou? If not, how would youidentify those who want thesame as you do?67

An introduction to the NHS Change ModelAn introduction to the NHS Change ModelEngagement to mobilise*The NHS belongs to us all. It is there toimprove our health and well being, supportus to keep mentally and physically well, toget better when we are ill and, when wecannot fully recover, to stay as well as wecan to the end of our lives. It works at thelimits of science - bringing the highestlevels of human knowledge and skills tosave lives and improve health. It touches ourlives at times of basic human need, whencare and compassion are what matters most.NHS Constitution Think about who you need to talk toand what you would say Understanding who is involved in andaffected by our change means morethan just holding a list of names ofpeople involved in or affected by thechange We need to understand whatmotivates them to support thechange, so we need to ask questions Our questions need to help us connectwith their values – and find out whatvalues we share We are more likely to gaincommitment to our change through adiscussion about our shared purpose,rather than targets Our engagement efforts must fit withother parts of the NHS Change Model:for instance we must be rigorous inmanaging the delivery of our changewithout demotivating people.What would you say to people toget them interested in making yourchange happen?89

An introduction to the NHS Change ModelAn introduction to the NHS Change ModelLeadership for changeSpread of innovation You can build commitment to a sharedpurpose from wherever you sit in thehierarchy – we all have a leadershiprole in delivering change By creating a deeper meaning for thechange we can expect our leaders tobe role-models of effective behaviours,skills and attributes and set a highambition for performance;empowering others to commit toaction - we can also expect this ofourselves The evidence suggests that theleadership style most likely to deliverlarge scale change is one thatgenerates a commitment to a sharedpurpose through collaboration Successful leaders of change will needto bring together all parts of the NHS Change Model to deliver successfuland sustainable change.What one thing can you do today, topractice being a leader of change?10 The NHS has a unique opportunity tospread and adopt good practicebetween and within its teams andorganisations We need to accelerate the spread ofinnovative solutions to deliver the costsavings required while improving thequality of care This means all of us sharing, learningabout and adopting successfulinnovations from within and outsidethe NHS Research shows these seven factorsthat help or hinder spread andadoption of innovation in healthcare:risk taking, resources, tools,information, relationships and rewards There is a wealth of knowledge, toolsand approaches that will help usrigorously deliver the spread ofinnovation and measure our success.What could you do to find outwhether others out there haveachieved the kind of change youwant to?11

An introduction to the NHS Change ModelAn introduction to the NHS Change ModelImprovement methodology An evidence-based improvementmethodology ensures that our changewill be delivered in a planned waythat follows tried-and tested methodsfor assuring success The improvement methodology is thegame plan – but large scale changeacross systems will demand differentapproaches to small scale processimprovements Different methodologies are availableto support different kinds of change A carefully chosen improvementmethodology provides a solid platformfor rigorous delivery of the change It will also support the adoption andsystematic spread of change There are lots of methodologies e.g.Lean, Total Quality Management,Model for Large Scale Change - choosethe one most appropriate for yourchange.Can you name an improvementmethodology? If not, where wouldyou go to get an idea?12Rigorous delivery Project management (or portfolioprogramming) is fundamental fordelivering a change successfully It involves identifying plannedbenefits that are of strategicimportance, monitoring progresstowards planned objectives, clarifyingroles and responsibilities andcontrolling finances and quality Having shared and clearaccountabilities will enhance the scaleand pace of change A rigorous approach requiresdiscipline and focus and is notoptional - without rigorous deliveryother elements of the change modelwill fail It should reinforce activitiesundertaken within the other parts ofthe NHS Change Model.Do you know of an approach tostructuring a change project thatyou can name? If not, where wouldyou go to find one?13

An introduction to the NHS Change ModelAn introduction to the NHS Change ModelTransparent measurementSystem drivers In healthcare, we tend to measure forthree reasons: to identify whetherplanned improvements are takingplace, to judge people’s performanceon the job, or to inform researchevidence Identifying and collecting the mostappropriate data is often a biggertask than we anticipate it to be. Itrequires having a clearly definedshared purpose and this can take timeto achieve Making data available to the public(e.g. comparative data) creates a leverfor improvement, by increasingpatient power and choice Measuring the return on investmentfrom the implementation of changehas become increasingly important, aswe strive to meet our financialchallenges.Can you think of an example of ameasure that would increase publicpower and choice?14 Conditions need to be in our favour ifthe change we want to see is going towork and be sustained Sometimes they aren’t: For instanceour payment systems incentivise activityin acute hospitals whilst our policydrivers push for care closer to home System drivers create the broadconditions for change – we need toconsider what they are in relation toour change initiative – and whetherthey can be lined up to support whatwe are trying to do System drivers might take the form ofincentives for change, or specificstandards to be achieved if penaltiesare to be avoided In designing system drivers, we needto ensure that they are to be able toevolve and respond and changeappropriately.Can you think of a system driverthat affects your change?15

An introduction to the NHS Change ModelAn introduction to the NHS Change ModelThree ideasImproving people’s lives andexperience of care is at the heart ofwhat matters to us and helps to drivethe change we want to see.There are three key ideas on which theNHS Change Model rests. It is worthconsidering all three key ideas to ensureyour change is effective and sustainable.They are:NHS Improving Quality2. Anatomy and physiologyof change1. Intrinsic and extrinsicmotivators for change3. Balancing commitmentand complianceAnatomy andphysiology ofchange16Intrinsic andextrinsicmotivators forchangeBalancingcommitment andcompliance17

An introduction to the NHS Change ModelAn introduction to the NHS Change ModelIdea 1: Intrinsic and extrinsicmotivators for changeWe are all driven by a mixtureof external and internal forces– the intrinsic motivators comefrom our values and what isimportant to each of us asindividuals.The forces that are external tous – regulation, paymentsystems, the way the rules ofthe system work – are alsoreally important and can feelbeyond our control – these arethe ‘extrinsic motivators’.Intrinsic motivators:Connecting to shared purposeEngaging, mobilising andcalling to actionMotivational leadershipBuild energy and creativity18In the NHS, often the extrinsicmotivators have overwhelmed theintrinsic ones, leaving people feelingexhausted and disconnected fromtheir fundamental intrinsic values.Drivers of extrinsicmotivation:To get the best out ofeach other, and todeliver sustainablechange, we need tore-balance so thatthere is equalemphasis on bothtypes of motivators.System drivers and incentivesPayment by resultsPerformance managementMeasurement foraccountabilitycreate focus & momentumfor delivery19