Readiness to change in NHS organisations

The context facing organisations in the English NHS is hugely challenging – this much is obvious. The state of NHS finances is parlous, care delivery targets are increasingly missed, and there is recognition of – but not yet action to address – the need to integrate systems to deliver care. Combined with increasing demands on the health care system, these multiple pressures require NHS organisations to change, adapt and innovate on a scale that would make Apple and Microsoft catch their breath.

This requires not simply tinkering with organisational change, but transforming the way health and care are delivered to ensure long-term sustainability. And this can only be achieved with the involvement, engagement and commitment of leadership and staff throughout the NHS and in other organisations and sectors. It requires changing cultures both within and across organisations.

But the challenge is this: how can these changes be achieved in organisations with cultures, structures and processes created for quite different ways of working, some of which are largely resistant to innovation? There is little to disagree with in the proposals for change being implemented at national level, but achieving such change will not simply be the result of advocacy and enthusiasm. This is easy enough to say, but how can it be addressed?

At The King’s Fund we are working to answer this question through our Ready to make change programme, supported by the Health Foundation. Making change at the level required to meet the current demands on the NHS will require new ways of working at every level: the adoption of new technologies by staff and patients; more research and development; and a major shift in the capacity of organisations to develop and adopt good practice. That will only be achieved if the organisational conditions are in place.

As part of our Ready to make change work we are focusing on three areas: first, understanding what these conditions are; second, how to assess them in terms of relative strengths and development needs in every organisation; and finally, how to promote the development of these enabling conditions at pace and scale. The project focuses on how to organise in order to ensure innovation and transformation – it will develop a self-assessment method so that NHS organisations can determine their own readiness for improvement.

We are currently in the process of identifying what needs to be in place for organisations to achieve this. Themes include leaders ensuring that they have an appropriate strategy and vision for innovation; that they have a culture and leadership that fosters innovation; that diversity and the participation of all stakeholder groups is encouraged to stimulate and sustain innovation; and that the systems, processes and resources are in place to ensure that innovation can be successfully implemented and supported.

Our aim in this project is to offer a helpful framework for those faced with the task of developing capabilities for innovation in NHS organisations. We will be working with NHS organisations to test the approaches we’re developing, and our plan is to consult on and share our learning across the NHS. It is relatively easy to describe the challenges NHS organisations face and the changes they must make, but it is only by transforming their established ways of working that they will be able to really implement what is demanded. It is for the sake of the people in their communities, not the system leaders and politicians, that these challenges must be met. 

Michael West is Head of Thought Leadership at The King’s Fund http://www.kingsfund.org.uk/about-us/whos-who/michael-west