Exploring the status of change agency in the NHS

How we can better support NHS staff trying to deliver effective change and improvement?

It’s a question that demands data and evidence on the current state of change agency in the NHS, to adequately respond.

Sensemaker © provides an innovative way to gather data that is different to other surveys you may be used to.

We are using Sensemaker © to understand the status of change agency in the NHS. Sensemaker allows us to do this from a different mind-set: change agents are initiating improvements in complex environments where several variables interact and linear cause-effect impact is often impossible to unravel.

Complex systems are different, as Diane explains here.

Conclusions that are drawn from evidence based on cause-effect linear models of impact, can also have unintended consequences. For example, the removal of the Meals on Wheels service by many UK councils was influenced by evidence that “Getting outdoors offers physical, sociological and psychological benefits for older people”. In Australia, the Meals on Wheels service was retained, because, despite the evidence, the will of the elderly is often to stay in the house.

Annabel Davidson-Knight, Head of Practice at Collaborate, said: “Complex problems require collaborative solutions and increasing numbers of funders — across the public and voluntary spheres — are experimenting with new ways of sharing power. Many are stepping into the role of broker, convening stakeholders across the complex environments in which they operate, seeing the maintenance of ‘system health’ as a crucial part of their role.” (Davidson-Knight, Lowe, Brossard & Wilson, 2017)

Six principles for complex environments were outlined by Braithwaite (2018). The first and sixth principles are particularly relevant to our project looking at how we can better support NHS staff trying to deliver effective change and improvement.

1. Pay more attention to how care is delivered at the coalface.

6. Adopt a new mental model that appreciates the complexity of care systems and understands that change is always unpredictable, hard won, and takes time, it is often tortuous, and always needs to be tailored to the setting

We will be capturing the day-to-day experiences of NHS staff trying to initiate change and improvement over the coming months. In addition to our aim to capture vast quantities of data, we are asking participants to then categorise their own experiences, rather than using the policy maker or researcher’s perspective to draw out the conclusions and key themes (here’s why).

Its useful to do this in a complex system because, with a truer understanding of the barriers and enablers, based on the experiences of those leading change and improvement, we can tailor our support for them better. We don’t know yet what is going to occur but we do know that the School for Change Agents has attracted vast and growing numbers of change leaders in healthcare systems from around the world over the years. The need is there, how can we meet it even better?

Sign up for The School for Change Agents - be part of a 15,000 strong global community! This year's series of live webinars starts on 16 May.

Braithwaite, J. (2018) Changing how we think about Healthcare Improvement BMJ 2018; 361

Davidson-Knight, A., Lowe, T., Brossard & Wilson, (2017) A Whole New World https://collaboratecic.com/a-whole-new-world-funding-and-commissioning-in-complexity-12b6bdc2abd8