Rising to the challenge of large scale change

The Health Foundation has invested for many years in developing the skills of individuals as leaders and we remain committed to these highly effective programmes. But the stark reality is that supporting and improving the skills of individuals is just the starting point for addressing a much bigger challenge.

Leaders don’t work in isolation – they work within teams, departments and organisations, as well as in multiple partnerships across the whole health economy.

Furthermore, while we’ve gained a reasonable understanding of how to go about implementing new approaches at a local level within a team or department, scaling up and getting change accepted and embedded organisation-wide is much more problematic and we have much to learn. And the size of the challenge multiplies exponentially when attempting change at a whole health economy level.

Jo Bibby, the Health Foundation’s Director of Improvement Programmes says: ‘To make large scale healthcare improvements happen we need to develop the skills of individuals and help them to put these into practice. We also need to understand the context in which they work because existing systems, structures and workplace cultures are not always conducive to change.’

Key strands in our 'Organising for quality' work

In 2012 we will be exploring how we can help people to understand, manage and if necessary change the systems, structures and cultures that shape healthcare working environments. Our planned work has four key strands:

Supporting leaders

We will support leaders, who are in a position to influence large scale change, by sharing learning and insight. For example we will be disseminating an evidence review, scheduled for later this year, of organisational context and its impact on the ability to deliver better healthcare.

Organisation-wide strategies

We will demonstrate effective strategies that can be used at an organisation-wide level. Our Shared Purpose programme, for example, will demonstrate how corporate support services can support clinical teams to achieve large scale quality improvements. Successful applicants from eight sites will be announced in April.

The programme will evaluate the impact on quality of new approaches from services such as finance, informatics, human resources and estates – and explore how to bring about greater day-to-day alignment between the goals of these support functions and those of clinical teams.

We will also be paying particular attention to the organisational context needed to support high quality patient experience through the Family and Patient-centred Care programme with The King’s Fund.

Exploring health economies

Recognising that truly patient centred care needs all parts of the system to work together effectively, we are scoping a major piece of work to develop relationships with long term partners, exploring how health economies can come together to bring about lasting change in the shape and quality of service provision.

Supporting networks

We believe that healthcare networks have the potential to make a major contribution towards implementing large scale change and our Supporting Networks programme will offer practical support to around 30 existing networks to develop and share insight into what makes networks effective.

And it’s business as usual with our established leadership development programmes, GenerationQ and the Quality Improvement Fellowships which will continue throughout the year.