The parallels between Lord Rose’s findings and that of the Challenge Top-Down Change project are striking. Steve Fairman explains how the project’s 15 solutions can help support change in the NHS

Confusing strategies, over-controlling leadership, one way communication, poor workforce planning, undervaluing staff, stifling innovation, and an inhibiting environment.

Steve Fairman

Steve Fairman

You may recognise this as a list of some of the barriers to positive change, which HSJ and Nursing Times readers identified earlier this year in the Challenge Top-Down Change, a joint (and highly innovative) piece of crowdsourcing work in partnership with NHS Improving Quality. 

Although all of us who try to make change happen in the NHS know these barriers to be real, the change challenge work has now been confirmed through another, independent source. 

Last month health secretary Jeremy Hunt spoke of his long term vision for the NHS in a wide ranging address.

As part of this, he published the final report from Lord Rose, Better Leadership for Tomorrow: NHS Leadership Review, which he commissioned prior to the election. The parallels between Lord Rose’s findings and those of the change challenge are striking. 

Diagnosing the situation in the NHS

Lord Rose recognises the high complexity of the NHS, and talks in particular about the lack of a single shared vision and, as he sees it, the unsustainably high pace of change. This leads to a situation where “through no fault of their own, people are often ill-prepared or ill-equipped to implement the changes asked of them”.

He sees that staff need to be better supported through their careers and that the movement of people into leadership roles in this era of constant and radical change - whether they are clinicians or general managers - needs to be properly planned.  

Individuals should be given consistent access to the development and experience they need. 

‘Lord Rose recognises the high complexity of the NHS’

He found an NHS suffering from “widespread change fatigue and an irritation that new changes are not given sufficient time to bed in”. Over the last few years he says that “none of these [recent] changes have been supported by the deliberate development of the skills needed to deliver them”.  

In further parallels with the change challenge, Lord Rose talks of both the NHS’s seeming inability to identify and effectively share best practice, the need to cut stifling bureaucracy, and in particular overlapping requests for data from regulators.

He calls for “clear and simple reporting that does not distract staff from patient care”. 

Finally, in terms of diagnosis, Lord Rose identifies the NHS as needing a value based leadership culture but instead relying largely on a top-down “command and control” culture of intense scrutiny where “too much is being done by numbers”. He expresses the view that “people need to be and to feel trusted beyond compliance”. 

We already know the answers

Inspiring and supportive leadership, fostering an open culture, nurturing our people, collaborative working, autonomy and trust, smart use of resources, long term thinking, flexibility and adaptability, challenging the status quo, thought diversity, and a call to action. 

These are the 11 “building blocks for change” identified in the change challenge. 

I don’t think Lord Rose would dispute a single one of them, and the recommendations he sets out in his final report chime remarkably with the change challenge’s “solutions” from these building blocks earlier this year. 

Here are just a few examples:

Inspiring and supportive leadership

Lord Rose finds an NHS where “there is not enough management by walking about and listening”, but also that “some of the best leaders leave around 30 per cent of their time unscheduled so that they can walk around, listen and know and understand what they are driving.” 

This is precisely the change challenge solution where our leaders were asked to “get back to the shop floor” to listen to patient and staff stories and take action to address problems. This had knock-on benefits addressing other change barriers identified, such as undervaluing staff, over-controlling leadership and one way communication.

Collaborative working

The Rose review says the NHS needs to “simplify, standardise and share best practice”. One of his recommendations is to create an NHS-wide comment boards, websites and supporting technology designed and implemented to share best practice.

Again, this echoes the work in the change challenge where the solution of “everybody’s ideas board” for a department, organisation, or perhaps the NHS as a whole, could unleash great frontline ideas to solve complex problems. 

Again, an initiative such as this would have knock-on benefits of addressing barriers such as one way communication and stifling ideas.

Autonomy and trust

Lord Rose sees that “innovative care models depend on people to run them…” and that “people need to be and to feel trusted beyond compliance”. 

In the change challenge one of the solutions - “supporting staff to make quick changes” - addressed this head on. Frontline staff have great ideas all the time – a supportive “just do it” culture can make a real difference for patients, and at the same time increase the value felt by staff from their leaders. 

It also addresses wider barriers to successful change of over-controlling leadership, stifling ideas and playing it safe. 

Real innovation

The change challenge was a real innovation to support change across the NHS. 

With the publication of Lord Rose’s report, now is a great time to go back to those 15 solutions and set a challenge for your department/organisation – how many have you got in place and what could you do to make the rest a reality?

Steve Fairman is managing director at NHS Improving Quality

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