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Introducing the NHS Change Model - A shared approach to leading

Helen Bevan, chief of service transformation at the NHS Institute for Innovation and Improvement, introduces the newlylaunched NHS Change Model.

The NHS Change Model has been launched. This is a dynamic framework for change that pulls together everything we know about delivering successful improvement – it’s about improving improvement and has been designed to help healthcare commissioners, providers and NHS partners to deliver NHS goals for quality and value.

Whilst there have been significant improvements in the NHS over the last ten years, the rate at which the NHS will need to transform in future is outpacing the current speed of change. The NHS Change Model seeks to build on the knowledge and experience of large scale change that we have already gained to create a common approach. It offers a framework to achieve better, quicker change outcomes for patients and communities by:

• Creating shared ways of thinking about change and a common language for change;
• Helping ignite the energy and brainpower of the NHS workforce, people who use NHS services and NHS partners in leading change;
• Linking and connecting change activities across the whole health system.

The NHS Change Model’s development has involved more than 500 leaders, who were asked to contribute and share their ideas and experiences. People got involved because they recognise that if we want the best outcomes for the people we serve in a time of considerable financial constraints, we need to work in ways that give us the greatest potential for change.

The NHS Change Model brings together the collective improvement knowledge, evidence and experience of change from across the NHS into eight components (see diagram).

There are a number of key principles in using the NHS Change Model:

- You should start with ‘shared purpose’ but after that it is flexible and there is no prescribed linear order for the other components.

- It’s important to use the model to check if all eight components are present but it’s more important to focus on whether the connections have been made between them and that they are aligned. You should also consider the u n i n t e n d e d consequences of an over dominance of one or more of the components on the others. For example, the negative impact that an over-emphasis on rigorous delivery – a change approach that is driven by performance management – might have on our ability to create the conditions where innovation can flourish – spread of innovation.

- The model should be used to build on what you are already doing. It isn’t designed to be an alternative to the existing ways that NHS teams and organisations are going about change. Its aim is to add components and emphasis that can help to make change faster and more sustainable. Previous experience of change models in the NHS suggests that they work best when teams take the essence of the approach and make it their own, to fit their context, their priorities and their patients or community.

- The aim is to build commitment to, not compliance with, the NHS Change Model. History suggests that in order to build and sustain large-scale change, connections should be made with the intrinsic motivation that people have to get involved in, and build energy for, change. The NHS Change Model seeks to do this through connection to shared purpose, engaging to mobilise and leadership for change. At the same time, the recent experience of the NHS has demonstrated the importance of drivers of extrinsic motivation including transparent measurement, incentivising payment systems, effective performance management systems and holding leaders to account to deliver change outcomes. Most leaders of change tend to favour one side or the other (intrinsic/extrinsic) in their approach to change. The power of the NHS Change Model is that the strengths of BOTH are necessary to improve the way the NHS improves itself.

The NHS Change Model represents leading edge thinking about how to improve improvement in the NHS and has the potential to play a significant role in transforming the relationship between quality and cost and ensuring the sustainability of NHS services.

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