in the NHS

1 ManagingChangein the NHSM aking InformedDecisions on ChangeKEY POINTS FOR HEALTH CARE MANAGERS AND PROFESSIONALS What is it for?The booklet aims to encourage managers andclinical professionals to reflect on, and share,learning and experience of what helps andhinders successful change in pursuit of qualityhealth services. Drawing on a focused summary of selectedmodels, it explores what has been learned so far about the successful management of change. In particular, it considers: What findings are of most practical use to those delivering and organising health servicesand to those receiving those services?

2 Where can these lessons be found?The NHS Plan (DOH, 2000) made it clear thatfar-reaching change is needed if the healthservice is to deliver the standards that patientsexpect and staff want to provide. This bookletsupports the work needed at local levels tomake the plan a is it for?The booklet offers findings of practical interest to all those attempting to bring about change for the benefit of patients. Health professionals,managers and educators at many different levelshelped to develop the material; as didrepresentatives from patient, community anduser InformedDecisions on ChangeThis is a practicallearning resourcefor all thoseplanning andmanaging change in the the wheel?

3 As a manager or a healthprofessional, where can youstart in planning and puttinginto practice effective changeinitiatives?4 What works?What can you do to helpmake sure that yourmanagement of change isbased on sound evidenceand best practice? 5 Thinking about change: a rough guideThe sheer size and scope ofthe literature on changemanagement can make ithard for practitioners to findtheir way around. Thissection offers: signposts through the forest insights into the real-life experiences of managersand professionals as theybring about change. 6 Change, in practice In practice, what are the mainfactors affecting the waymanagers and professionalsapproach change?

4 19 Thinking aheadWhere can you look forevidence, further information,help? Should you be thinkingabout people, publishedresources, learning networks?21 References 23 Acknowledgements24 Where does it come from?The NHS Service Delivery and Organisation(SDO) National R & D Programme was launchedin March 2000. The remit of the Programme isto produce, and promote the use of, researchevidence about how the organisation anddelivery of services can be improved to increasethe quality of patient care, ensure better patientoutcomes, and contribute to improved health inthe wider community.

5 As one of our first activities, we carried out anational listening exercise which broughttogether a wide range of people includingservice users, health care professionals, healthservice managers and researchers. One area of common concern was theimplementation and management of concern on the ground chimed with therequirement for change in pursuit of quality setout in the White Paper, A First Class Service(DOH, 1998).In response to the specific needs identified, we have developed this publication and a longerreview, Organisational Change, under the seriestitle, Managing Change in the NHS.

6 See backcoverfor more below for link to page requiredWhat changes all thetime but stays the same?According to an influential articlepublished three years ago, there is oneshort answer to the question, Whatchanges all the time but stays thesame? That answer is, The NHS . The NHS is 50 years old. Everygovernment since 1948 has re-invoked its founding principles,but there is less agreement abouthow services based on theseprinciples should be remarkable stability in theespoused purpose of the NHS therehas been almost constant structuralchange. [..] There is a papermountain of advice on reforms,restructuring and managing many behaviours do not puzzle is why the NHS has beenso unchanging, given the barrage ofattempts to reform (1998)Some of those who use, work in andcare deeply about the health serviceagree with this insight about behavioursremaining the same.

7 Others point tothe significant changes in clinicalinterventions that are constantly takingplace and argue that substantialchange is already a feature of the NHS and that patients across the countryare benefiting as a is little disagreement on a coreissue. That, whatever its record onchange so far, the health service needsto transform itself further so that moreand more people have improvedaccess to more effective services and feel better about the way they aretreated by the health s agreement on something elsetoo. That managers, professionals andstaff in the NHS show a growinginterest in understanding how they candevelop the skills and attitudesnecessary for the kind of continuouschange and learning required in amodern health sense of thepressures for change.

8 When asked to describe what changemeans for them, managers andprofessionals often talk about: multiple priorities competing for time changing external pressures challenging demands on staff. All these factors may seem to have anadverse impact on patient care. Many managers and professionals feela need to bring together disconnectedexternal initiatives and internalrequirements into one coherent,manageable approach.. and planning your next movesSo, as a manager or a healthprofessional, where can you start inplanning and putting into practice aneffective change initiative?

9 Are you .. about to implement a change in your unit or organisation and wouldlike to review the range ofapproaches you might take? .. in the middle of a change initiative and want to take a little time to reflecton how things are going? .. keen to encourage other people in your organisation to do their best toensure that the way they managechange is based on sound theoryand good practice?Whatever the focus of your currentconcerns, you re likely to find it usefulto think about the following questions: What do I know about effective change management? What don t I know?

10 What do I need to know in order to initiate and sustain effective change? Where can I look for evidence, furtherinformation, help? For example,should I be thinking about people,published resources, learningnetworks?Reinventing the wheel?4 Why is the search for evidence important?Many readers will be seeking ananswer to the question Does it work? in relation to individual models ofchange management. It is important tobear in mind that neither question noranswer is simple or straightforward. NCCSDO has been working closely withcolleagues across the NHS and outsideto explore the nature of evidence in thefield of change management.