Transformational change process
Any transformation programme needs to start with a roadmap for change consisting of a clear vision, leaders who will drive the change and buy-in from a coalition of stakeholders who will deliver change on the ground.
A local vision
Everyone must understand the purpose of the change and the desired outcomes. A compelling narrative will help engage people in the change, ideally connecting with them emotionally and intellectually.
Your local narrative should speak to your stakeholders and describe how the project will benefit them. (See stakeholder analysis below.)
Defined leadership and sponsorship
For the change to be successful you will need to build a team who can lead it. This team will ultimately report to sponsors and SROs for the transformation.
Ideally, this team should include people with credibility who are recognised by members of the wider community whose practice will be affected as the new ways of working are implemented.
Building a guiding coalition
Your stakeholder analysis should help you assemble the most appropriate team and identify how the team interacts and relates to other stakeholders like sponsors and services users. Consider the size, both in terms of population served and numbers of constituent organisations, and complexity, of your local health and care system when building your team.
Planning the change programme
Any transformation planning must answer the following fundamental questions, as a minimum:
1. Where are we now, what is the “as is” state?
2. Where are we trying to get to, what is the “to be” state?
3. How are we going to get there?
The transformation project should deliver a range of positive outcomes for service users, avoid negative outcomes, and provide a better experience for both service users and the professionals who care for them. You should agree the best outcomes that reflect baseline levels and population needs, that are realistic and achievable, and that are owned by leaders and teams to ensure outcomes are delivered.
Stakeholder analysis
The stakeholder analysis will also help you identify the people you need to actively engage with to make your project successful. Successful stakeholder engagement ensures an effective and strong guiding coalition who are willing to work collaboratively. Stakeholder analysis at the start of the project will help you in writing your business case. The three main groups to consider are:
- Senior support to secure funding, resources, strategic fit and promote engagement
- Health and social care professionals to understand and deliver the change
- People who use services, carers, voluntary sector
Benefits planning and evaluation
There is a strong metrics culture in health policy and practice so you will also want to think about the quantitative data you use to demonstrate the benefits of your project.
Developing a business case
It is best practice for any project to be justified in terms of a business case balancing the investment required against the planned outcomes.
Taking stock
Stocktakes are essential to transformation as they engage everyone involved to create a shared vision of the ‘to be’ aspiration. The stocktake consists of a deep dive into your organisation, assessing your practices and processes, relationships and connections, information, and systems. This will involve your system vendors and technical infrastructure support colleagues as well as other stakeholders. You may need to revise your project assumptions based on one or more cycles of taking stock.
What are the features of a good a stocktake?
- Provides a vehicle for telling people about your transformation objective and gives them a chance to get on board with the ideas.
- Enables you to check your understanding of the ‘problem’ you might be trying to fix and to better appreciate how your sense of the situation is different from the views other stakeholders might have based on their different knowledge and experience, for example as point-of-care professionals.
- Offers an opportunity to bring representatives from different stakeholder and professional groups together to collectively reflect on what they have in common, how they are different in their approaches, culture, and language, and how they can work towards a shared objective.
- Designed to reflect that the implementation of the PRSB Standards is a people-based cultural endeavour and cannot succeed without the hearts, minds and professional expertise of all your stakeholders.
Engaging stakeholders
Stakeholder engagement and people development are key elements of successful culture change, arguably one of the hardest elements of any transformation initiative. It is important to have clear plans as to how to achieve buy-in, acknowledge that the workforce already use systems, have workarounds, vary in their attitudes to technology and are mostly time-poor when it comes to ‘non-clinical’ activities.
Developing people is key to successful implementation of standards.
Discussion-based interdisciplinary group workshops are a proven method that achieves the desired end goals.
How people learn and work informs and influences the format you use to present information, design workshops and activities and even the language you use to communicate in discussions.
Stakeholder engagement and learning models help maintain momentum to embed PRSB standards.
Additional reading
• Action Learning Sets
• Communities of Practice
• Coaching/Mentoring
Completing the transformation process
If transformational change is to be fully embedded in your systems, it requires an iterative approach. In order to understand how progress is being made on all fronts, the project team will need to review, evaluate and iterate continually throughout the process. Iteration until completion at each stage will result in you ‘completing the transformation process’.
The PRSB are developing a series of implementation toolkits to help you through the adoption of the various PRSB information standards as part of meeting the broader digital transformation agenda. The toolkits will help to improve the delivery of care through the sharing and receiving of standardised health and care information.
The implementation toolkits have six sections which take you through the different stages of service transformation as shown here. The six stage cycle can be repeated any number of times until the required change is in place.
The toolkits include detailed resources to assist you with specific aspects of the change and transformation required to implement the PRSB Standards. Using these resources will help you plan, build support and engage effectively with key stakeholders as you implement the standards to provide high-quality and personalised care, and improve the experience for the patient, their carer, and their families.
