We explain how we identified the barriers to achieving change in the NHS - and the building blocks that are key to supporting it
Phase one of our Change Challenge campaign resulted in a list of 10 barriers and 11 building blocks for bottom-up change. Each one of them was informed by more than 7,500 contributions from people taking part.
Here is how we did it.
‘Imagine the months of work it would have taken to develop the same insight by running face to face workshops’
We assembled two independent research teams - one from HSJ and one from Clever Together. They worked separately, coordinated by a steering group made up of leaders from both organisations.
To analyse the words and votes of contributors, or “the crowd”, the teams deployed a research method developed by Clever Together and enabled through our technology, inspired by what the research trade calls a “grounded theory approach”.
The Clever Together team reviewed the first 4,000 contributions, looking for frequently occurring themes when people described the blocks to change. In doing so, they identified seven common “barriers to change”.
They then looked for frequently occurring themes in relating to factors that support bottom-up change. This revealed 16 common “building blocks”.
Making sense of the multitude
The steering group then presented these potential barriers and building blocks to the HSJ analysis team, who tested their validity by coding the ideas.
This second analysis idenfied the need to further sub-divide barriers. For example, the project management theme was separated into:
- selecting and funding projects; and
- managing projects.
Likewise, analysis revealed that some of the building blocks could be merged (for example, “collaboration inside and between organisations” became “peer collaboration”). Ultimately, the HSJ team suggested 11 common barriers and 13 building blocks.
As the data continued to flow in, the Clever Together and HSJ teams iterated this process during an online workshop.
Analysing the analysis
To ensure validity of the data, both within each analysis team and also between the two, the process allowed for the teams to work separately as well as together, so that they could challenge each other’s analyses.
Once all the data was analysed, the two teams arrived at the same conclusions regarding the crowd’s perceived existence of 10 barriers and 11 building blocks.
Clever Together then re-analysed the most supported contributions within each theme, both the barriers and building blocks, to enhance the draft definitions.
The themes and definitions were presented to an extended steering group, consisting of former front line staff and the “Horizons Team” from NHS England’s Improving Quality unit. Two workshops later, the definitions were either acceptesd or refined, based upon the direct comments of those who took part in the online workshop.
Although the analysis process was intensive and complex, our technology and methods enabled us to focus the energy and efforts of both teams on the work that really mattered. Imagine the months of work it would have taken to develop the same insight by running face to face workshops and collating 7,500 Post-it notes.
‘Voices from the front line have been heard; now we have to act’
Voices from the front line have been heard; now we have to act. The change challenge reopens today and we are now inviting everyone to share their ideas and examples of how we can overcome the barriers and better use the building blocks to create bottom-up change.
Pete Thomond is director of Clever Together