It's all action stations for the biggest, boldest NHS Change Day yet

You know that the initiative has become mainstream – and is not just a Twitter phenomenon any more – when NHS England chief executive Simon Stevens decides to throw his weight behind it and participate.

NHS Change Day, which began as an online conversation, is getting bigger and bolder.

The annual event, now in its third year, has been about individual members of staff publicly making a pledge on a single day to improve care in their field or area of expertise.   

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Change from within

The idea first started when a group of medical professionals started to discuss the frustrations of bringing about change from within.

“I am going to lead the drive across the NHS to change the services people with learning disabilities receive”

The conversation then moved on to Twitter, where it soon snowballed into a virtual movement, garnering massive support from young staff and emerging leaders.

In a relatively short span of time, NHS Change Day has managed to mobilise employees, especially at grassroots level, to make a commitment, however small or big, towards making a difference.

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Making this year’s first pledge at Department of Health headquarters at Skipton House in London, Mr Stevens said: “My action this year is that I am going to lead the drive across the NHS to change the services people with learning disabilities receive and to end the scandal of people being stuck in unsuitable long stay inpatient care.

“Change Day represents the NHS as a social movement, not just as a care and repair service”

“The reason I am backing NHS Change Day across the whole country is because Change Day represents the NHS as a social movement, not just as a care and repair service.

“If you walk around any GP surgery or any hospital ward and talk to a ward sister, a junior doctor, a patient or a visitor, they will tell you instantly of the many possibilities for how we can do things better, and often, it feels as if people succeed despite the system not because of it.”

Viral infection

The optimism that Change Day inspires can be infectious. In 2013, it recorded 182,000 pledges – nearly three times the original target of 65,000. In 2014, the number was more than 500,000.

Jackie Lynton, head of transformation at NHS Improving Quality and one of the main organisers, ascribes its success to bottom up change drive.

“Three years ago a few people had the audacity to think we could create a movement of people inside a hierarchy, who simply valued doing something better together to make a difference.

‘It is something that people can do for themselves, which is what gives it the impact that it does’

“By enabling frontline staff, and working together with senior leaders, carers and people who use our services, it’s our opportunity to come together and harness our collective energy, creativity and ideas to make a change”, she says.

Change Day has indeed been successful in attracting people from all levels: nurses, junior doctors, consultants, managers, emerging leaders, healthcare assistants, staff from mental health and community trusts, clinical commissioning groups, social care professionals, third sector organisations, patients, service users, carers and many others.

And the pledges differ in their breadth and diversity (box, below).

In the past, the campaign has attracted criticism for being simplistic and not having any real, tangible impact. Aware of that or perhaps because of that, this year, it is promoting the concept of “taking action” instead of “making a pledge”.

Ms Lynton explains: “It’s not for one day, it’s an everyday change to make lasting change that is been encouraged.

“It’s a call to action and a platform to share what you are doing to improve care for people, inspire others and make a difference, everyday. No one is invited but everyone is welcome,” she says.

‘How do we measure what we’ve actually achieved through the initiative over the years?’

While most applaud Change Day’s intent and reach, there is clearly room for improvement.

Anne Cooper, clinical nursing informatics adviser, emphasises the need for evaluation.  

“What I’m interested in is the impact of Change Day. How do we measure what we’ve actually achieved through the initiative over the years?

“So for me it would be really good if we can do some evaluation after the event.”

Polar opposites

Others differ in their approach on how to take the initiative forward.

When HSJ’s video team asked senior NHS leaders their views about Change Day at a recent event, several of the health service’s top guns had not even heard of it, indicating a demographic and hierarchical divide.  

‘It’s a call to action and a platform to share what you are doing to improve care for people’

While managers viewed it as a “frontline-led” initiative, doctors, nurses and other frontline staff felt that more managers and senior leaders should be involved.

Claire Flatt, staff nurse at Heart of England Foundation Trust, praises the “bottom up approach” but reckons it can be more inclusive.

“I think it is something that people can do for themselves, which is what gives it the impact that it does have year on year.

“However, I’d like to see more people involved who are not on social media. It would be great to see more people involved on a local level – reaching out to local trusts, local communities, local workplaces that do not necessarily have social media presence.”

Virtual impact

On the other hand, some of the online media enthusiasts call for an even bigger digital footprint.

WeNurse founder Teresa Chinn says: “They should have more of a voice within social media.”

Tim Kelsey, national director for patients and information at NHS England, believes Change Day is “one of the most important highlights of the NHS calendar”.  

‘We should make it bigger. This is something that should reach out beyond the NHS’

However, he makes a case for taking it beyond the health service to make it a citizens’ movement.

“I think we should make it bigger. This is something that should reach out beyond the NHS.

“I wonder whether we should be promoting this as a civil society priority… there are lots and lots of citizens who won’t know about Change Day who’d want to involved in it and make their contribution to the NHS,” he concludes.

At a time when the health service is dogged by patient safety scandals and complex financial, regulatory and performance pressures, the simple action of an individual pledging and inspiring others can be something to cheer about.  

You can make a pledge at www.changeday.nhs.uk. A 12-hour “Changeathon” will be taking place online from 7am to 7pm on Change Day, 11 March, featuring live broadcast of inspirational change stories and change day events from across the country.