A framework to support early planning of large-scale change programmes in health and care

Change programmes have often been used to drive improvement and service transformation at national level across health and care. They can be complex, multi-layered and resource heavy. While there is a move away from top-down approaches to generate change, and increasing emphasis on delivering results at local level within health and care, some large-scale programmes to create change are always likely to be needed. 

A large-scale change programme in health involves a complex set of interrelated interventions and activities, organised around a shared high-level goal or theme. Examples of these kinds of programmes include virtual wards and community diagnostic hubs.

If designed and planned well, these programmes can help deliver some of the transformational changes needed to improve patient care that are central to the 10-Year Health Plan. But large-scale programmes in health, as in many other sectors, are prone to underperformance in delivery, cost, schedule, outcomes and impact. It is also known that many of the challenges arise during the early planning stages of a programme. It’s at this ‘front end’ where things often start to go wrong – but policymakers and programme leaders lack bespoke guidance to support early planning of large-scale change programmes specifically in the health field.

To address this gap, we – a collaboration involving THIS Institute, IPSOS and the Health Foundation – are developing a framework to support senior leaders and teams leading the initial stages of change programmes. It’s based on analysis of research literature and guidance on large-scale programmes (sometimes known as ‘mega-projects’) across multiple sectors, the research literature on change programmes in health care, and interviews with leaders of previous NHS programmes.

This work has identified the importance of fundamental aspects of programme planning – such as the case for change, for example. We’ve also gained important insights into some of the complexities of working with multiple stakeholders – like understanding their motivations and how and why they make decisions, being able to influence effectively, being alert to the political landscape, and having credible leaders who can adapt to working within uncertain and ambiguous environments. We found that change programmes in health and care share many characteristics with other major government programmes, so are likely to benefit from techniques such as portfolio-based approaches and integrated programme management based on government guidance, while tailored for the specifics of the health context.

A beta-version of the framework is now available. Offering a series of guiding questions spanning three themes, it supports structured thinking about design and early planning of large-scale health and health care change programmes. It is intended to facilitate discussions and dialogue rather than serve as a checklist or tick-box exercise. And it is likely to be most useful when used as part of a team-based discussion covering:

• programme purpose and content
• programme management, costing and scheduling, governance and learning
• contexts, stakeholders and implementation strategy.

Lots of the questions in the provisional framework are also relevant to many initiatives in health and health care, even if they are not at national scale.

We’re keen to engage policymakers and programme leaders in refining the framework to make sure that it’s practical and useful. We’re currently carrying out an online consultation on Thiscovery to gather insights.

Once we have taken on board the feedback, we’ll test a refined version of the framework using a scenario-based table-top exercise. We’ll then publish the final version, making it freely available.

Large-scale programmes can be a powerful way to create a change in health and health care. We hope this framework will help to make design and early planning better, ultimately benefiting patients. 

Access the beta version of the framework and take part in the online consultation by 20 August.