Published: 05/05/2005, Volume II5, No. 5954 Page 29

Getting staff on board is key to changing your organisation, writes Phyllis Shelton

Change is about employee engagement. In trying to introduce innovation and new planning and review techniques to healthcare, it is essential to encourage individuals to perform beyond the usually expected level rather than adhere to the simple urge to remain in their jobs.

This is what the Central Norfolk health and social care economy found in 2004 when it launched a new transformation programme designed to promote homebased and cross-boundary care.

The change programme includes new structures, 35 improvement objectives, a co-ordinated and planned communications strategy, a fast-track invest-to-save incentive scheme, and a new approach to organisational development.

It also includes a series of training days designed to help participants articulate, generate and buy in to solutions to problems. A by-product of the training days are action plans to help Central Norfolk meet its local goals and national targets.

The ideas and action plans are fed into workstreams - multi-agency working groups set up to determine methodology for achieving the improvement objective and patient care pathway, and testing out these ideas with local people.

The most important goal of the training days is to ensure planning and review techniques are used back in the real world. This is supported by a team of 13 transformation facilitators from different levels within organisations.

Planning is faster and more precise, with clearer systems of accountability.

Improvements have been made in emergency access, delayed discharges, reductions in lengths of stay and reduced cancellations. At the same time, Central Norfolk has identified financial savings in its non-clinical services and successfully introduced its new model of care, Better Care for Norfold, following successful public consultation.

Most encouraging is the apparent cultural transformation (see graph), which suggests the prospective outlook for maintaining change is strong. And the NHS Leadership Centre is monitoring the programme as a pilot for other trusts.

Phyllis Shelton is director of performance improvement and organisational development for Central Norfolk health and social care economy.

Examples of local NHS goals

Reduce the level of emergency admissions to 2003-04 levels by the end of March 2005.

Reduce average length of stay in diabetes services through targeted use of nurse facilitators by April 2005.

Design a new model of palliative care by end of December 2004.

Reduce number of delayed discharges and transfers by 50 per cent by the end of March 2005.

Reduce average length of stay in acute services for new tracheotomy patients by nine days by March 2005.

Reduce cancellations by 25 per cent by December 2004.