What are the key activities involved in change?
The key activities are known as the Change Activities – Define, Design, Deliver.
In the Guide these change activities are set out for you to follow in a step-by-step manner. You may need to review your plans and remain flexible to what is emerging and new possibilities. This is the nature of change in a complex system such as health and social care. We have also provided some additional templates aimed at working with Service Users, Families, Citizens, Communities and Staff.
Identify shared purpose
Be clear about the purpose of the change from the start. Engage early to help people focus on a shared ambition. Provide clarity on why change is needed and create a sense of energy for the change. Work with senior leaders to get their commitment and the resources for the change. Agree how best to keep all key stakeholders involved and informed of progress.
Understand current services
Develop a shared understanding of how services currently work. This will help you to identify what needs to change and why. Collect data to help you measure the current situation and to track progress. Take time to engage with stakeholders to understand the current culture and values. Work out readiness and capacity for change at team, service and organisational level (see templates in the Change Guide that will assist you with this). Identify what might help you to build energy for change, e.g. supportive relationships, feedback from service users and staff, learning from previous experiences of change.
Agree better outcomes
Work together with the service users, staff and people affected by the change to design better results for the service. Create a compelling ‘story’ of the service’s future that connects with people in a meaningful way and that helps build commitment. Agree clear objectives and outcomes with all key stakeholders. Good outcomes are person-centred, look towards the future, are evidence informed, are capable of being resourced and implemented, and are joined up. These outcomes will be the basis for your Action Plan for the change.
Measure for success
Design your measurement plan at the start of the change – how will you know you are making progress? Use existing data to describe the starting point before change. Choose measures that reflect the results you want for the improved service. Share this information with key people, and use the measurement results to help you plan the next steps.
Make the case for change
Take time to ‘make the case for change’ and document it as a ‘business case’. This will help you with communicating and tracking progress. Agree responsibility to make sure you have leadership support and the authority for the change. You will need to set up a change management team to oversee and guide the process. The team members should be representative of key stakeholders and should have clear roles. Identify what resources you will need and include these in your proposal for change.
Template 6.2.1: SWOT Analysis (Strengths, Weaknesses, Opportunities and Threats/Challenges)
Template 6.2.2: Context for Change – Why What How Method
Template 6.2.3: Description of the Current Situation (Service Operational Model)
Template 6.2.4: Guidance on Defining your Personal Values
Template 6.2.5: Cultural Web Exercise
Template 6.2.6: Personal Readiness for Change
Template 6.2.7: Team Diagnostic
Template 6.2.8: People and Culture Change Platform – Readiness Factors
Template 6.2.9: Developing a Vision for the Future
Template 6.2.10: Clarifying Measures
Template 6.2.11: Project Initiation Document (PID)
Define – Resources
Design – Resources
Deliver – Resources
Agree to co-design
Co-design is a joint approach to service design. It involves service users, families, frontline staff and other key people designing the new service in partnership. It places people’s needs at the centre of decision-making, recognising that people are best placed to describe their own needs based on their experiences. Use the ‘key service design principles’ in the Change Guide to help you make decisions about the service design.
Design the Service Operational Model
Use the information you gathered on service user needs as a starting point to design the improved Service Operational Model. Make a list of design options and think about the choices available, working together to best reflect the service users’ needs. Examine the options carefully and agree the preferred option. Then work out the detail, i.e. the elements of the service that make up the Service Operational Model.
Test and refine
Test the change in the ‘real world’ using an approach such as Plan-Do-Study-Act. Refine the design based on what you learned from the testing phase. Then identify the gaps between where you are now and where you want to be. Consider how these ‘gaps’ can be addressed and what action is needed to bring about the change. Assess the impact of the change on the people involved. Also consider the change’s impact on policy, systems and resources.
Agree an Action Plan
An Action Plan sets out the sequence of actions needed to get to the agreed future service. Be clear about who is responsible for action and timelines. Decide on the key indicators of performance that will measure your success in delivering the agreed outcomes. Identify any risks to the delivery of the plan and decide how to manage those risks. Consider any events or activity on which the success of the plan depends and decide how to manage these.
Communicate the Action Plan
Involve key stakeholders in signing off the Action Plan. Give dedicated time to communicate the Action Plan to all involved. Consider using many different approaches, but prioritise face-to-face communication.
Template 6.3.1: Service Design – Option Generation and Appraisal
Template 6.3.2: Detailed Design of the Service Operational Model
Template 6.3.3: Service Design – Gap and Impact Analysis
Template 6.3.4: Action Plan
Implementing the Action Plan is the combination of all your work to date. It tests the design of the ‘new service’ or the part of the service you want to improve. Everyone involved needs time and support to move to new ways of working. Track the progress towards the expected results. You will need to continue delivering current services while implementing the change. Support and encourage leaders, especially frontline leaders, and clinicians to promote the change. Go back over all the elements of the People and Culture Change Platform to check how well you are practising collective leadership, modelling shared values and supporting behaviour change. Increase engagement and communication with all stakeholders.
Support all involved in implementation
Intensify individual and team supports and focus on managing the uncertainty associated with change. Pay particular attention to how inter-teams/services and inter-agencies are working, and ask for the support of colleagues to manage issues that arise. Continue the engagement with service users, staff, Trade Unions and other key partners.
Measure and monitor progress by using current data to track performance and identify risks. Help people to understand the measures. Test the reliability of the results and keep the focus on honest communication about progress. Adapt to emerging local needs, learning from what happens and take action if needed to change or improve your plan. Keep the focus on how well you are delivering an improved service to meet the needs of service users.
Celebrate success or ‘wins’ along the way in a meaningful manner. This will help motivate people and sustain their interest and energy for the change. Acknowledge people’s personal effort and investment in the change. Recognise and acknowledge individual and team development, improved capacity, better working relationships, organisational learning from the change and the wider value for the public. Mark key milestones using creative approaches, and help teams to showcase their work.
Sustaining improvement needs focus and energy. Balance staying faithful to the new service design with adaptability to local need. Build in review/learning points, keep monitoring, and support the new skills and practices. Have good ways to check and share learning. Scale-up innovations that work, with the help of ‘change activists’ and incentives for taking up new practices. Continue to involve service users and frontline staff in reviewing progress. Their input will keep you grounded and support you to continue the progress towards a better future for all.
Template 6.4.1: Factors to Monitor During Implementation
Template 6.4.2: Personal Checklist for Change
Template 6.4.3: Working with Emotional Reactions to Change
Template 6.4.4: People Indicators to Support Behaviour Change