Delivering an improved level of quality in patient care through change management is certainly achievable, but the vision and the process must be visible and understood at all levels of your organisation, say Marie-Clare Mendham and Seraphim Patel.

The NHS is incorporating and enacting a continual regimen of modernisation. Although this creates tensions for those employed in the service, it provides opportunities for those wanting to advance their knowledge in delivering change.

Achieving simple goals in healthcare often implies complex underlying patterns of change. The increased demand placed on public health to maximise performance and improve health outcomes with reduced funding simply cannot be achieved under the current system.

Structural reform across the entire organisation is required to satisfy these heightened expectations. A paradigm shift in leadership mindset, teamwork and corporate culture are urgently required. This is no mean feat.

The planned changes to the NHS architecture require leadership development support for new roles with new responsibilities for both provider and commissioner organisations.  There will be an increased developmental leadership focus for clinicians, specifically in line with the emerging GP leaders of the clinical commissioning groups.

However, many NHS departments are yet to embrace transformational change based on quality improvements. The NHS has often changed in line with two models:

  • An evolutionary model which views change as both gradual and incremental that adapts to its local internal and external environments;
  • A punctuated equilibrium model which depicts long periods of stability, punctuated by short bursts of radical reform.

Transformational change is brought about by an organisation-wide commitment to progress, coupled with a continuous series of specific quality improvement projects. Leadership is crucial to achievement this.

If we are to successfully navigate these treacherous seas of change then the fundamental questions NHS departments need to ask are: “How transformational is our management?” and “Where is the driver for change, inside-out or outside-in?”

Paul Tarplett states that the “transforming approach simultaneously impacts the personal development and corporate productivity of all involved”. The basis of this approach is the notion of both instilling and inspiring a vision, communicated in a way that motivates people to give extra effort and therefore achieving extraordinary results, often under very demanding circumstances.

It highlights four main factors in effective leadership, namely that it should be: charismatic, inspirational, intellectually stimulating and individually considered. While this may sound highly individualistic, the notion has progressed in the past decade, embracing a sense of distributed leadership, as well as recognising the importance of good management.

In this respect it emphasises the need for outcomes as well as processes, values, task, experimentation and continuous learning within both the team and the individual. This is supported by research which has shown that transformational leadership has a significantly greater impact than transactional leadership on a variety of subjective and objective outcome measures, including job satisfaction, motivation and overall performance, as well as lower levels of stress and burnout among staff.

So, what can trusts do to engage both staff and patients, reassuring the wider public that NHS staff are both competent and well-motivated and that the treatments they receive will result in a positive outcome?

The answer is to make sure that their staff are competent and well-motivated, goal focused and dedicated to the quality of care of their patients and importantly not distracted by current or impending changes to the NHS system.

The key to achieving this is clear effective communications from top to bottom, and, more importantly, from bottom to top. Without an effective communications strategy along with the systems and resources to deliver it, a trust can’t even create the key values among their staff that will result in a focus on quality of care, let alone manage the changes to operating procedures, resources and organisational culture that are being demanded as we enter the daring new world of clinical commissioning.

Without appropriate training in effective leadership, communication skills, change management, communication skills and effective media management and interview skills, trusts will always struggle to deliver the right care quality culture, to motivate their teams to deliver change, to tell their stakeholders internally or externally what is expected, intended and delivered. 

A useful model is change management guru John Kotter’s eight-step change model:

Establishing a sense of urgency

  • Examine market and competitive realities
  • Identify and discuss crises, potential crises or major opportunities

 Creating the guiding coalition

  • Assemble a group with enough power to lead the change effort
  • Encourage the group to work as a team
  • Developing a change vision
  • Create a vision to help direct the change effort
  • Develop strategies for achieving that vision

Communicating the vision for buy-in

  • Use every vehicle possible to communicate the new vision and strategies
  • Teach new behaviors by the example of the guiding coalition

 Empowering broad-based action

  • Remove obstacles to change
  • Change systems or structures that seriously undermine the vision
  • Encourage the risk-taking and nontraditional ideas, activities, and actions

 Generating short-term wins

  • Plan for visible performance improvements
  • Create those improvements
  • Recognise and reward employees involved in the improvement

Never letting up 

  • Use increased credibility to change systems, structures and policies that don’t fit the vision
  • Hire, promote, and develop employees who can implement the vision
  • Reinvigorate the process with new projects, themes, and change agents

 Incorporating changes into the culture 

  • Articulate the connections between the new behaviors and organisational success
  • Develop the means to ensure leadership development and succession

To make any change stick, it should become part of the core of your organisation. Your corporate culture often determines what gets done, so the values behind your vision must show in day-to-day work.

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