Making significant structural changes to large organisations is challenging and fraught with risk.

The radical proposals outlined in the July 2010 white paperEquity and Excellence: Liberating the NHS will challenge both the structure and culture of the NHS.

Add the wider impact of public sector spending cuts and it is clear, regardless of the final detail of the plan, that the NHS faces a complex and highly challenging process.

It is possible to achieve substantial positive results from restructuring organisations, but only if the reform process is carefully and transparently managed. If not, the consequences for productivity, quality and financial performance can be disastrous.

Poorly handled, the proposed changes to the NHS will cause disruption at every level. Employee uncertainty, reduced commitment, interrupted communications, higher staff turnover and absenteeism will result, at the very least, in a manifest failure to maintain adequate or “business as usual” levels of productivity and quality patient services.

The government’s proposals are intended to move decision making closer to the patient and improve patient care, which is potentially a very powerful motivator for NHS staff. But they will simultaneously change the way the NHS works and how those within it see the organisation.

To avoid systemic failure it is Deloitte’s view that clearly aligning these reforms with the identity and values of the NHS, in the eyes of NHS employees, will be critical. In other words, the NHS identity must be deployed, above and beyond old and new structures, to act as an anchor in a sea of uncertainty.

There needs to be a line of continuity between the particular values that each employee perceives in the NHS and the new structures.

The key point here is that most employees’ primary commitment is to the values of the NHS - for example,delivering high quality patient care - and their commitment to a particular part of the NHS is secondary. The overarching aims and the very foundations of the NHS are what people are buying into.

Understanding how to enlighten staff about the extent to which the new structures will enable them to do their job is paramount. What would this look like on the ground?

Engage everyone at all levels

Each professional group interprets the NHS’s values differently, so engage with those interpretations and use them to underpin the new structures through a genuine process of dialogue. These defining elements can be set out to practitioners as they begin to disengage with organisations that are due for closure. Communicate how the proposed changes will contribute to the NHS’s aim of providing the best patient outcomes and how they’ll be able to do their job better and use their skills to that end.

Manage people within and across organisational boundaries

Restructuring will challenge many individual and professional groups’ beliefs about how healthcare organisations should be structured and who should deliver what.

Understanding but also challenging professional identities and how they could innovatively play out within the overarching NHS values can be used as the frame through which leaders set out the vision and case for a truly integrated patient experience.

Clear management of the transition process

The NHS workforce is experiencing huge levels of uncertainty at present and this will have a negative impact on the patient experience. Clear objectives and timelines plainly communicated by leaders will help to alleviate some of this uncertainty. The road map and timelines will need to be flexible and this too can be communicated to the workforce, but the existence and communication of a road map is reassuring in itself.

Dean Arnold is head of Deloitte’s healthcare practice and Niamh Lennox-Chhugani is a manger in Deloitte’s organisation and change practice

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