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Change Challenge: Patients and staff have told us their views now let’s listen


The workforce and users of the NHS have told us about how to make big change happen and we need to listen

A little over a month ago, the “change challenge” was launched as a partnership between the Health Service Journal, Nursing Times and NHS Improving Quality.

We set up the campaign because, in the era of The Five Year Forward View, we saw a disconnect between the need for radical, transformational change and the top-down, mechanistic ways that change is sometimes enacted in the NHS and wider care system.

We sensed the potential to engage lots of different change agents in our campaign; people who deliver care, who use care and who manage care; to get fresh eyes on the big issues and overall, to increase our potential to transform care.

“The way that people have responded to the challenge has exceeded our expectations exponentially”

The way that people have responded to the challenge has exceeded our expectations exponentially. When the request for ideas went out in HSJ and Nursing Times, there were more than 7,500 contributions made, which was a record response in the entire history of HSJ.

I was blown away by just how much effort people who responded put into explaining their ideas for better change and debating issues with colleagues. There was a real sense of the “collective brilliance” of NHS staff and service users.

“There was a real sense of the “collective brilliance” of NHS staff and service users”

Now the hundreds of ideas and discussions have been evaluated and collated and something remarkable has emerged: the first ever socially-constructed theory of change for the NHS. A “theory of change” describes the change you want to make and the steps involved in making that change happen.

Evidence from the wider literature on change suggests that leaders who want wide scale and rapid change are more likely to be successful in their efforts if they work with an explicit model or theory of large scale change.

Research on endeavours to simultaneously create a culture of patient safety across hospital systems in several countries concluded that one of the reasons that some of the anticipated results were not achieved was because ambitions for organisation-wide change were not underpinned by an organisation-wide theory of change.

The people who contributed to the change challenge have identified a powerful set of building blocks for change and key barriers to overcome.

They have given us the unique opportunity to construct a theory of change based on their real life experiences, but what matters now is what we do with it. The distilled principles are based on bottom up change but they are also a roadmap for better top down change.

I would encourage all leaders who are involved in change to look at these principles. Consider the extent to which they are part of your existing efforts and the potential to strengthen the building blocks and avoid or tackle the barriers.

“We want to make this real, relevant and impactful”

For the next phase of the change challenge, we are seeking stories of change and experimental ideas on how to apply the change principles in action.

We want to make this real, relevant and impactful. We need to move from concepts and ideas to practical change that makes a difference.

People who work for and use the NHS have sent us some very clear messages about how they want change to happen and we need to listen to them. They have demonstrated their commitment and passion for change and desire to get involved in change that results in better experiences and outcomes for patients and better use of resources. They have shown that there is a massive reservoir of latent, untapped energy for positive change out there in our system.  

“I hope that you will find inspiration and ideas from the change challenge”

I share their ambition for change processes that are based on collaboration and discussion across the organisation or system; an environment for experimental learning and prototyping rather than “pilots” that doesn’t get evaluated; fewer control-based management processes that suck the energy out of good ideas and new initiatives; a social movement of change agents, with many individuals capable of leading change from the grassroots.

I hope that you will find inspiration and ideas from the change challenge and the learning of the people who participated in it.

Helen Bevan is chief transformation officer at NHS Improving Quality

Follow her on Twitter @HelenBevan


Readers' comments (2)

  • Many Local Healthwatch Groups (HW) have made an impact on improving healthcare standards by getting the Patient Voice heard by NHS Trusts and Commissioners.
    The Barriers and Building Blocks also apply to HW Groups to ensure they are as effective as the best.
    If just one Building Block were to be chosen, for me it is 'Fostering an Open Culture'. The Francis 'whistleblowing' and 'Mid-Staffs Inquiry' put this as a key factor.
    Additionally, this years inspirational Reith Lectures on Medicine focussed on open and transparent working at all levels.

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  • listen? well there's a good idea!

    last time after patiently listening and then waiting for my turn to speak, I tried three times and was told to shut up three times!

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