Using NHS Change Model to support improved care

Categories: Leadership.

We’re all aware of areas where we could make
improvements, where standards could be higher,
where outcomes could be better and where staff are
working hard but still things do not go according to
plan. If an end of life care service is not achieving
outcomes as good as others, for instance, and fewer
people are dying in the place they have chosen – what can we do?

Often we know what we should be doing. We
know what service standards should apply and
we know which processes we should be following
but we don’t know how to make the change
happen so that everyone’s outcomes are improving
all the time and more people are dying where they

The NHS Change Model is designed to help. It is
based on our cumulative knowledge and experience
of change so many or all of its components
are familiar. What it offers is a common language
of change and a framework to think about how we
make and sustain quality improvements. It doesn’t
tell us what to do but gives us some good ideas
about how to do it.

Hundreds of senior leaders, clinicians, commissioners,
providers and improvement activists helped shape the
model, which was published in June 2012. It identifies
eight fundamental components of change:

  • shared purpose
  • leadership for change
  • engagement to mobilise
  • system drivers
  • transparent measurement
  • rigorous delivery
  • improvement methodologies
  • spread of innovation.

So how does this work in practice? Starting with shared
purpose, we need to connect with our common values
– why we came into the NHS and what drives us to
want individuals to have the best outcomes possible – so
that we recognise that we have a shared understanding
of what needs to change and why.

Normally in the NHS this isn’t something we talk
about. We tend to take it for granted that we are all
here for the same reason. But our experience shows
that spending some time thinking about and discussing
our real shared purpose helps us understand and
agree together how we need to change things for
the better. It allows us to make emotional connections
with each other which help us work together
when times are tough and to identify what is really
important. Involving individuals in these discussions
and ensuring no decisions are made without them
makes the process even more powerful. Our shared
purpose for end of life care, for instance, might be
that we (users, carers, clinicians and others) work together
to ensure that every patient approaching the
end of their life chooses where they will die and has
the care that they choose along that journey.
Connecting our shared purpose with the other elements
of the Change Model so that they reinforce
one another will help ensure our change is delivered
successfully and is sustained over time.

For instance, connecting purpose with the goals we
have to meet and the contracts (system drivers) and
making sure that in working to meet our targets we
stay true to our purpose will resonate better with
people and maintain their sense of commitment
and common purpose. Similarly, being clear about
what we will measure to show progress (transparent
measurement), what milestones we have along the
way (rigorous delivery) and showing how these connect
with our purpose will help us all see the point of the measures we are collecting and enable us to
celebrate achievement of milestones.

We all have a leadership role to play in making sure
our purpose is achieved and our leaders have a
particular coordinating role in this (leadership for
change). Throughout the change we need to engage
staff, users, carers and others and mobilise them to
act so everyone knows the part they have to play to
achieve the purpose we all share.

Above all, we need to ensure our changes are
sustainable so that they become part of everyday
practice. And in time these newly embedded ways
of working will themselves need to be improved
upon in a cycle of continuous improvement. Doing all of this in a systematic way will make each initiative
sustainable locally and will enable our approach
to spread to others.

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