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‘Everything we know about successful change in one place”

The Change Model (also called the NHS Change Model) was created to inspire and guide the planning and leadership of larger scale change programmes. It draws together a wide body of evidence and experience in the factors for turning good ideas into sustainable success. 

Each of the elements can in itself drive progress. They work better when they are all aligned (‘pulling in the same direction’) and when the movement has our shared purpose at its heart. 

The Change Model was developed originally at the NHS Institute for Innovation and Improvement and has been adopted by NHS England as the core methodology for transformation in the NHS. More resources are at www.england.nhs.uk/sustainableimprovement/change-model/

Developing and agreeing a shared purpose is the foundation for successful change. Being clear about our shared identity (who we are) and values (what we believe in achieving) helps us to clarify WHY we are working together for shared aims.

To ensure that the changes we plan get delivered, we must have ways of making sure that the change is happening, the expected results are being achieved and any risks or unexpected outcomes are being actively detected and managed.

To ensure that the changes we plan get delivered, we must have ways of making sure that the change is happening, the expected results are being achieved and any risks or unexpected outcomes are being actively detected and managed.

Measurement is essential for us to know if the changes we implement are an improvement – otherwise, they may just be ‘change for change’s sake’. Measurement can be used to inspire,
stimulate curiosity and evaluate – and most large scale change programmes will need plans for how to do all of these. Measuring as close to real-time as possible enables more effective feedback and reinforcement for staff and allows problems to be dealt with quicker. The way we measure should obviously support our shared purpose.

The NHS is a complex system with many different parts interacting. Key aspects of the system which can impact a change programme are the resources available (eg skills, equipment, workforce numbers), the incentives (eg payment or recognition) and the sanctions (eg standards and penalties). These drivers can impact individuals, teams, organisations and whole systems.

Whatever the scale, most changes in the NHS rely on individual people to choose to act, for example by working in a different way. Successful change is often dependent on large numbers of staff and others (including patients, carers and other stakeholders) recognising the value of engaging positively with the change and committing to it. People are more likely to commit where they have contributed, so co-designing change is a powerful enabler for success. In a complex social system like the NHS, it is people themselves who are often the most effective channel for spreading change and mobilising others to take action.

Successful change is led, not just planned. Leadership which highlights values and mobilises people around a shared purpose is an essential component of change at any level. This usually requires leadership commitment and behaviours throughout the system – it is not enough for this to come from people with power or position. We need to share leadership widely, including through empowering patients and the public as leaders and partners for change.

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