Only a third of change programmes succeed, research suggests, so how do we navigate this tricky terrain successfully?

Professor Stephen Eames, Independent Chair for the Humber, Coast and Vale Health and Care Partnership

So we have a new government with a strong mandate making bold commitments about improving health and care services. Sound familiar?

I have no doubt that this is well intended and this time around we do have a coherent long-term plan for the NHS that signals major change over the coming years.

In Humber, Coast and Vale we spent much of last year engaging with partners, stakeholders, patients, staff and members of the public to help us develop our Partnership Long Term Plan. These commitments and plans signal major change and a complete redesign of the way we plan, provide and access health and care services.

Twenty-five years ago, John Kotter published Leading Change, which is still seen by many as the bible of change management. He revealed only 30% of change programmes succeed. More recently, a global survey by McKinsey showed only one in three major transformation programmes succeed. This is not easy terrain to navigate!

Classically, change management entails thoughtful planning, sensitive implementation and the involvement of the people most affected by the change. Without this, the default position is that problems arise. Time needs to be taken so that the people affected can understand and cope with change.

The trouble is we often don’t always have the luxury of time because taking too much of it might mean your plans become outdated. Paradoxically, making changes too quickly usually leads to poor implementation and negligible impact.

So, I modestly offer some top tips for minimising risk and increasing the chances of success:

  • Dynamic environments require dynamic people and flexible processes and systems, so put them in place and support them.
  • Plan the long term in brushstrokes: what really matters is a granular plan for establishing and measuring the delivery of immediate actions that can continuously inform your medium-to-long-term plans.
  • Communicate incessantly with those people who can assist in making change happen and be prepared to change course.
  • Drive decision making at local level and delegate the responsibility to go with it.
  • Try to avoid autocratic interference but hold people to account.
  • Encourage and develop capable people who share the vision and agree to champion the change strategy.
  • Focus on using technology to provide critical information to aid decision making and teamwork.
  • Be mindful that the chief insecurity of most staff is change itself. Senior people responsible for managing change do not, as a rule, fear change – they generally thrive on it.

I don’t believe anyone argues against the fact that the NHS must undergo fundamental change over the life of this Parliament and in the next decade. Nor can anyone argue that the NHS has coped with a continuing cycle of political and environmental change over past decades, while sustaining a broadly positive image in the minds of patients and the public.

What is really at stake this time though is the opportunity to deliver a radical and long lasting transformation. The choices are not easy and will be testing in the short term but let’s hear it for the management of change – it is the only way forward!

Across the Partnership we have countless change processes under way at both a macro and micro level. For example, our Local Maternity System is undertaking a significant change process to put in place a new workforce model for midwives and other professionals to enable us to deliver continuity of carer for local women.

This is a significant change to the way in which our professionals have worked but is already having a positive impact for those using maternity services as well as those providing them – you can hear what some of our midwives think in this video.

Our LMS team has received some encouraging feedback from colleagues in Scunthorpe where a midwife-buddy rota system has been introduced.

In a nutshell, two midwives are ‘paired’ together for the entirety 0f a four-week rota pattern, with one midwife spending the first two weeks working in the community, while the other works at hospital. They then swap roles for the second two-week period. This aims to deliver excellent continuity of carer for the women in their care.

The feedback from the midwives in Scunthorpe has been encouraging. This rotational way of working provides the midwives with better work-life balance and increases their opportunity of caring for women they have already established relationships.

Leo Stevens

Author Leo Stevens

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