Blog: Change starts with activists

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

HSJ, 26th January 2015

https://theedge.nhsiq.nhs.uk/

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; when the request for ideas went out in the HSJ and The Nursing Times, there were more than 7,500 responses and interactions, 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.

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 be 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.

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 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, 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.

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