Transformational change process

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.  

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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  
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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.
Stocktake image graphic

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.

Additional reading

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.

Toolkit cycle process image

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”