Today we are releasing a summary of our research findings into what drives poorer outcomes for patients and service users.
I have spent a significant part of my year implementing a large adult social care transformation programme in partnership with a local authority in London. I’ve learned many things about implementing change through this project and wanted to share five of them here. These are in no particular order, but are all critical to delivering change in a high-profile, high pressure local authority service under financial pressure:
1) Ensuring that the objective of the change programme is clearly communicated is crucial for everyone involved. Although the programme objective is likely to be driven by finances, exchanging this into the currency of the service is critical. For example, achieving a level of independence for an agreed number of people per month will mean much more to social workers than meeting a particular savings target. Communicating this is vital in successful change management.
2) Reframing the boundaries of influence to better understand what can be influenced is essential in major change. No service is an island, and understanding which other services and partners influence you, and that you in turn can influence, is vital. At the same time, making sure the boundaries are realistic is also critical. It may not be possible to change national policy, but it is possible to help shape a change in the local CCG policy, and working out how this could be achieved is the key.
3) Having the right people in place. It seems obvious, but the importance of having the right people in place is critical – both in your delivery team and in your service. The delivery team need the right balance of skills, experience and expertise to deliver a programme that will range from training social workers to designing processes, and from developing finance and performance targets to undertaking monitoring. The service will require management and well-honed people skills to take their staff on a change journey. And of course, both sides will need a lot of…
4) Resilience. Change programmes are successful when front line staff apply appropriate decision-making and behaviours to every interaction, day-in, day-out. Success is not driven by how slick a presentation is at programme board, but by hundreds of decisions by front line staff every day. Delivering this as a clear, shared objective requires resilience from everyone to persevere relentlessly, reinforce best practice, and making the right behaviours second nature. It is also the case that a programme of this nature will create a lot of worry and stress. Being able to ‘hold’ this stress by providing a place to hear staff concerns and proactively helping to alleviate them is a critical part of the programme team’s role, and one that also requires high levels of resilience.
5) Having a discovery mindset will promote flexibility and adaptability. No matter how well you plan, over the course of a large change programme things will be knocked off course, or will need to be adapted – whether because of the impact of new services, personnel changes or government policy. The critical thing is to be clear about your objective. Leaders must also create a safe space to trial new ideas and approaches, and shift resources to those that work most effectively. At IMPOWER, we say that such people have a ‘discovery mindset’.
There are probably another five or ten areas just as important as these, but they will have to wait for another INSIGHT article. If you’d like to learn more about our implementation delivery capability, or about our work in adult social care, please do get in touch.