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Making change happen

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Lord Rose’s review supports proposals put forward in the Change Challenge

Confusing strategies, over-controlling leadership, one-way communication, poor workforce planning, playing it safe, undervaluing staff, stifling innovation, inhibiting environment - you may recognise these as some of the barriers to positive change identified earlier this year in the Change Challenge, a joint piece of crowdsourcing work in partnership with NHS Improving Quality. All of us who try to make change happen in the NHS know these barriers are real but the work in the Change Challenge has now been verified by another, independent, source.

Last month health secretary Jeremy Hunt spoke of his long-term vision for the NHS. As part of this, he published the final report of Lord Rose’s Better Leadership for Tomorrow: NHS Leadership Review, which he commissioned before the election. The parallels between the findings of Lord Rose and those of the Change Challenge are striking.

Lord Rose recognises the complexity of the NHS, the lack of a single, shared vision and, as he sees it, the unsustainably high pace of change. This leads to a situation in which “through no fault of their own, people are often ill-prepared or ill-equipped to implement the changes asked of them.” He sees that staff need to be better supported through their careers and moving people into leadership roles needs to be properly planned. People should be given consistent access to the development and experience they need.

He found an NHS suffering from “widespread change fatigue and an irritation that new changes are not given sufficient time to bed in”. He said: “None of these [recent] changes have been supported by the deliberate development of the [necessary] skills.”

In further parallels with the Change Challenge, Lord Rose talks of both the seeming inability of the NHS to identify and effectively share best practice and also the need to cut stifling bureaucracy - in particular overlapping requests for data from regulators. He calls for “clear and simple reporting that doesn’t distract staff from patient care.”

Finally, in terms of diagnosis, he says the NHS needs a value-based leadership culture. Instead of relying on a top-down command-and-control culture of intense scrutiny, where “too much is being done by numbers… people need to be, and feel, trusted beyond compliance”.

We know the answers: inspiring and supportive leadership; fostering an open culture; nurturing our people; collaborative working; autonomy and trust; smart use of resources; long-term thinking; flexibility and adaptability; challenging the status quo; thought diversity; a call to action. These are the 11 “building blocks for change” identified by you during the Change Challenge.

The recommendations Lord Rose sets out in his final report chime remarkably with the work you did on creating solutions from these building blocks earlier this year. Here are just a few examples:

● Inspiring and supportive leadership: Lord Rose found “some of the best leaders leave around 30% of their time unscheduled so they can walk around, listen and understand what they are driving.” The Change Challenge asked leaders to “get back to the shop floor” to listen to patient and staff stories, and take action to address problems. This also helped address other barriers, like undervaluing staff, over-controlling leadership and one-way communication.

● Collaborative working: Lord Rose says the NHS needs to “simplify, standardise and share best practice”. He recommends creating NHS-wide comment boards, websites and supporting technology to share best practice. In the Change Challenge it was suggested that an “Everybody’s ideas board” for a department, organisation or even the NHS, could unleash great frontline ideas to solve complex problems. This would also help tackle one-way communication and stifling ideas.

● Autonomy and trust: Lord Rose said: “People need to be, and feel, trusted beyond compliance”. One Change Challenge solution - supporting staff to make quick changes - addressed this head on. Frontline staff have great ideas all the time - a supportive “just do it” culture can make a difference for patients and ensure staff feel their leaders value them more. It also addresses over-controlling leadership, stifling ideas and playing it safe.

The Change Challenge was a real innovation to support change across the NHS; Lord Rose’s report means it’s a great time to back the solutions. Set a challenge for your workplace - can you make it a reality?

Steve Fairman

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