Published: 03/11/2005 Volume 115 No. 5980 Page 29

The NHS is scaling mountains of change that will potentially transform services for patients. But it is high-risk change with high stakes. Change gurus and researchers tell us that up to 75 per cent of change initiatives fail to achieve their objectives. The more things change, the more they stay the same.

The reality of most large-scale initiatives in the NHS is that every leader has a different set of experiences and ideas about critical success factors. Our leaders tackle many change priorities simultaneously in different ways. We do not necessarily make best use of available resources, skills and knowledge.

Change experts offer a plethora of recipes for success. Last month, Harold Sirkin and colleagues published their model in Harvard Business Review. It is based on evidence from more than 1,000 global change initiatives. Four common denominators are said to determine the outcomes of any transformation initiative better than any other factors.

The first is duration. An underpinning belief in many NHS change programmes is that we need to execute change quickly. Not necessarily so, say the authors. What really matters is having formal, senior management-led review processes. A long project that is reviewed frequently and effectively is more likely to succeed than a short project that is not reviewed.

The second factor is performance integrity. This means selecting the right mix of team members to deliver the change.

The third is commitment. The authors focus on two critical categories. There must be active, visible backing for change from the most influential senior leaders.

They say that if, as a senior leader, you feel you are talking up the change initiative at least three times as much as you need to, your organisation will feel you are backing the transformation.

In addition, the change is unlikely to succeed if it is not enthusiastically supported by staff.

The final factor is effort. There is a tendency in the NHS to launch major improvement initiatives without taking account of the extra time that will be required on top of busy operational jobs. The authors assert that if anyone's workload increases by more than 10 per cent as a result of an initiative, it is likely to run into problems.

Organisations need to create the space for change to happen.

The authors offer a framework for organisations to score their current change efforts and predict the likelihood of a successful outcome using the four factors.

Models such as Sirkin's help leaders to understand their state of change readiness and take actions early in an initiative to get better outcomes.

Clinical colleagues particularly appreciate this robust, evidence-based approach to change. Scores can be recalculated over time at different stages in a project's lifecycle. Most importantly, using one of these models enables a better dialogue about what needs to be done.

So how would the overall NHS reform process score by the four criteria? Are effective review processes built in at both local and national levels? Do people leading the change have the appropriate skills to execute improvement? Have our staff bought into the opportunities of a patient-led NHS? Can the increased effort that is required to implement the reform process be contained within existing workloads?

We need to ask these questions and act on the answers.

Helen Bevan is director of service transformation at the NHS Institute for Innovation and Improvement. For details of the NIII's predictive models and change readiness tools visit www. institute. nhs. uk