The talk about NHS change we can act on

A little over a month ago, the change challenge was launched as a partnership between HSJ, Nursing Times and NHS Improving Quality. We set up the campaign because, in the era of the NHS 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.

‘I was blown away by just how much effort people who responded put in’

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.

The way that people have responded to the challenge has exceeded our expectations. 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 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, hundreds of ideas and discussions have been evaluated and collated, and something remarkable has emerged: the first socially constructed theory of change for the NHS.

Theory test

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 widescale 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.

‘We want to make this real, relevant and impactful’

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 identify any potential to strengthen the building blocks, as well as avoiding or tackling the barriers.

The next stage

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.

‘There is a massive reservoir of untapped energy for positive change in our system’

They have demonstrated their commitment and passion for change, as well as a desire to get involved in change that results in better experiences and outcomes for patients and better use of resources. And they have shown that there is a massive reservoir of latent, untapped energy for positive change 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 don’t get evaluated; fewer control based management processes that suck the energy out of good ideas and new initiatives; and a social movement of change agents, with many individuals capable of leading change from the grassroots.

I hope you will find inspiration and ideas from the Change Challenge and learn from the people who participated in it.

Helen Bevan is chief transformation officer at NHS Improving Quality. Follow her on Twitter: @HelenBevan