A thematic analyses of the barriers identified in phase one of the Change Challenge has revealed 11 building blocks that can support bottom-up change. We can think of these building blocks as the design principles by which solutions can be developed.
1. Inspiring and supportive leadership
Leaders need to inspire and support their people. This means: taking forward ideas to improve their organisations based upon their quality rather than their author; a less hierarchical structure where people have a greater understanding of each other’s roles; and ‘distributed leadership’ where people are trusted and talent is nurtured.
2. Collaborative working
Collaboration between peers within and between organisations leads to broader operational and personal benefits. Operationally, change programmes are more effective, allowing us to improve the outcomes for people and populations, and collaborative working builds more supportive working relationships, which is essential to improve people’s well-being. Peer collaboration therefore nurtures a more positive mind-set and the desire and connections to drive bottom-up change.
3. Flexibility & adaptability
To deliver bottom-up change we need flexibility within the system – both in terms of the formal organisational structure and day to day processes. This will allow organisations, teams and individuals to more successfully adapt to the changing environment in which they are operating.
4. Smart use of resources
We must try to find ways of doing more with the resources we have. The world’s most successful organisations are more resourceful than their competitors. By adopting a resourceful mind-set and providing appropriate staffing and skill-mix, we can try to deliver change within our current means. We should aim for smarter project selection – doing the right projects well, rather than trying to do too much with not enough resource.
5. Autonomy and trust
Increasing people’s sense of trust gives people the confidence and permission to deliver change. This makes the most of the knowledge and passion of people working in health and care. We need to, work within acceptable clinical parameters, remove the fear associated with failure and foster a no-blame culture of reflection and learning upon what does, and what does not, work.
6. Challenging the status quo
Everyone is able to create and identify great ideas, organisations need to nurture and embrace the creativity of all their staff to challenge the status quo and deliver real change. A large part of this requires health and care organisations to experiment more and share their learning, for the benefit of all.
7. A call to action
We must consistently articulate a clear call to action for everyone who works in health and care. To do this we need to clearly articulate the purpose and meaning of our organisations. This will ensure alignment within organisations and across boundaries, and inspire contributions to the mission from the bottom -up in a way that ensures every person is moving towards the same common goals.
8. Fostering an open culture
A commitment to transparency and openness creates a more positive environment. Openness both allows learning to be shared across boundaries and means we have integrity to the people we serve and our colleagues. The most open organisations are the most innovative.
9. Nurturing our people
We need to prioritise the training and development of health and care staff. However, we cannot be stuck in traditional mind-sets. This must develop the right mix of skills in the right places. This will support and nurture our people to take local leadership of the changes that are needed.
10. Seeing the bigger picture
Teams and individuals need to be given the space and freedom to make long-term improvement plans – large changes cannot happen overnight, and we will only be able to dramatically improve the health of populations by successfully planning for the future.
11. Thought diversity
Organisations that value dissenting opinions as much as coherence and conformance are more effective at creating change - thought diversity allows the creativity of our people to flourish and good ideas to be discovered.