Making informed decisions on change: key points for health care managers and professionals (original) (raw)
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Anticipating the challenges of change within the NHS
2017
Background: An opportunity arose to understand the dynamics and challenges of change in complex systems by examining a portfolio of different NHS improvement projects, brought together under the ACE Programme, an initiative focused on improving early diagnosis of cancer. Method: A thematic analysis of 16 semi-structured interviews from eight projects active over the period 2015/2016 was conducted using the Framework Method. The analytical framework combined codes pre-defined based on Senge’s ‘dance of change’ framework1 with codes derived from ‘open coding’ of the data. Results and conclusions: The processes depicted in the ‘dance of change’ framework as working for and against change were evident in all eight projects. The constancy of this dynamic suggests that leaders of change could be more successful more quickly if they used the framework to anticipate and diffuse challenges whilst simultaneously paying attention to the factors that help change flourish. In particular, leaders...
The Journal of Applied Behavioral Science, 2007
A team of practitioners, university researchers, and health care policy makers has been working to develop and apply "design sciences" thinking within the challenging context of a national system aiming to bring about a "revolution in health care." As members of that team, the authors share that thinking and early findings with those interested in the concept, theory, and practice of design as an approach to large-scale organizational change. The article builds on what to date has been a somewhat abstract debate around the design sciences, its aim being to forge stronger links between the concept and the practice of design. Using empirical data from the English National Health Service as a case study, the article seeks to demonstrate how design sciences may first, expand our thinking around organizational theory and practice and second, offer organization development some new methods, approaches, and processes around the "doing" of large-scale change. ) where neither the results nor initial goals are fully met (at least not consistently across the board) during implementationsummed up in that wonderful phrase of Richard Pascale (1990) that "the results of change programs are often seriously underwhelming." In essence, although change interventions, including those in the NHS, often aim at systemwide secondorder change, in many cases they may result in only piecemeal, small, first-order improvements-the "implementation gap."
In the UK healthcare sector structural change has become increasingly frequent and there are few employees in the NHS who have not experienced this in some form. Anecdotally, many of those affected report negative consequences that have potentially adverse effects on service delivery. The purpose of this research is to evaluate the effectiveness of the management of change in one specific healthcare setting, the Public Health Laboratory Service. It also seeks to make recommendations for managing organisational change that are applicable elsewhere and to consider the validity of existing change management models. This research is set in the context of the creation of a new Special Health Authority (the Health Protection Agency, HPA) and other related changes as outlined in the Chief Medical Officer's strategy document Getting Ahead of the Curve (Department of . The research seeks to analyse this change programme from the perspective of one group of affected individuals, employees of the Public Health Laboratory Service. Recommendations for future management of change at the HPA and elsewhere are made, with observations about the validity of existing change management models. The core contribution of this research is that it has added to the general body of knowledge about organisational change and its management. This is of value to those working in the UK healthcare and wider public sector. Specific recommendations for future research are made.
Journal of Healthcare Leadership
Background: The increasing prioritisation of healthcare quality across the six domains of efficiency, safety, patient-centredness, effectiveness, timeliness and accessibility has given rise to accelerated change both in the uptake of initiatives and the realisation of their outcomes to meet external targets. Whilst a multitude of change management methodologies exist, their application in complex healthcare contexts remains unclear. Our review sought to establish the methodologies applied, and the nature and effectiveness of their application in the context of healthcare. Methods: A systematic review and narrative synthesis was undertaken. Two reviewers independently screened the titles and abstracts followed by the full-text articles that were potentially relevant against the inclusion criteria. An appraisal of methodological and reporting quality of the included studies was also conducted by two further reviewers. Results: Thirty-eight studies were included that reported the use of 12 change management methodologies in healthcare contexts across 10 countries. The most commonly applied methodologies were Kotter's Model (19 studies) and Lewin's Model (11 studies). Change management methodologies were applied in projects at local ward or unit level (14), institutional level (12) and system or multi-system (6) levels. The remainder of the studies provided commentary on the success of change efforts that had not utilised a change methodology with reference to change management approaches. Conclusion: Change management methodologies were often used as guiding principle to underpin a change in complex healthcare contexts. The lack of prescription application of the change management methodologies was identified. Change management methodologies were valued for providing guiding principles for change that are well suited to enable methodologies to be applied in the context of complex and unique healthcare contexts, and to be used in synergy with implementation and improvement methodologies.
Sociology of Health and Illness, 1996
Ahstract Using the implementation of the Griffiths Report as an example, this paper examines the way in which sociologists and others have examined the process of managing change within the NHS. Several studies of Griffiths have documented a number of unintended consequences of its implementation but it is argued that none of these have adequately theorised these unintended outcomes of the policy implementation process. It is suggested that the process-sociological approach of Norbert Elias, and in particular his game models, enable us better to understand the complex interweaving of planned and unplanned processes which is involved in all processes of managed change.
Change management in the NHS: distributed leadership
British Journal of Healthcare Management, 2019
The ongoing changes in UK health policies have aimed to promote competition, provide enhanced performance and deliver improved care to patients. To engage with these ongoing changes, the health service has had to become even more adaptable. This article explores the opportunity to apply distributed leadership across the healthcare environment in order to apply policy changes easily across the health service.
Change capacity: the route to service improvement in primary care
Quality in Primary Care, 2008
Source: PubMed CITATIONS 7 READS 30 3 authors: Some of the authors of this publication are also working on these related projects: lfhe sponsored projects on higher education View project starting to write a new co authored book on management knowledge in English health care organizations View project