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Transforming Care: Building clinical commissioning group capability for large scale change Jo Godman, Senior Associate and Mark Jennings, Senior Associate - 26 March 2014 Presentation from Commissioning Live 2014, London: Transforming Care programme for CCGs. The programme offers supported learning for CCG and partner organisations to address large scale change. Developed by NHS Improving Quality and NHS England’s commissioning development directorate, the Transforming Care programme is designed to empower commissioners to lead change across boundaries and improve outcomes for patients. So far, the programme has been taken up by more than 50% of CCGs.
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Transforming Care:Building clinical commissioning group capability for large scale change
Jo GodmanSenior AssociateMark Jennings Senior Associate26 March 2014
Introduce NHS Improving Quality
Explore the complex challenges faced by
CCGs
Describe NHS Improving Quality’s experience
of working with CCGs to apply large scale
change techniques that seek to use a social
movement approach to change through
commitment rather than compliance
Facilitate a discussion about the opportunities
and issues raised
Objectives
Improving health outcomes across England by
providing improvement and change expertise
The driving force for improvement
across the NHS in England
Building capability capacity
The How and The What
P
r
o
g
r
a
m
m
e
s
CCG
Complex Complicated
Chaotic Simple
Emergent practice Good practice
Best practiceNovel practiceSnowden D & Benford RD. The Cynefin Framework.
Cause & effect relationships exist, are obvious to most people &
predictable & repeatable. Can be known in advance.
Cause & effect relationships exist, but not obvious, so require
analysis/investigation +/- expert knowledge.
Cause & effect only obvious in hindsight, with unpredictable,
emergent outcomes.
No cause & effect relationships can be determined.
Probe. Sense. Respond. Sense. Analyse. Respond.
Sense. Categorise. Respond.Act. Sense. Respond.
Disorder
Better processes
More time/resource
for analysis
Bring in lots of perspectives
Do what you’re told!
www.changemodel.nhs.uk
NHS Change Model
Three dimensions of large scale (transformational) change
Depthof change vis-à-vis
current ways of thinking and doing; a.k.a
cognitive-behavioural or paradigm shift
Pervasivenessof change; does it affect whole or
only portionof the system?
Sizeof system experiencing change; e.g.
geography, numbers of people
Refs: Mohrman A. et. al. Large-Scale Organizational Change. Jossey-Bass, 1989 and Levy A. Second-order planned change: definitions and conceptualizations. Org. Dynamics. Summer 1986, 15:5-20
Our model of LSC
Identifying need for change
Framing/ reframing the issues
Engaging/ connecting
others
Making pragmatic change in multiple
processesAttracting
further interest
After some time
Settling inPossible outcomes1. sustainable norm 2. plateau3. run out of energy
Living with results and
consequences
Maybe later
Repeats many times in hard to predict ways
Time delay
Our findings…..
Work with partners
Commitment v. compliance
Impact of shared purpose
Loose – tight properties
Learning through doing
Transforming Care Programme
Framework for transformational change
The first four workshops are about building effective foundations for change.
These seek to provide and support confident use of new frameworks for undertaking improvement, building an improvement culture, deepening partnerships and ensuring clarity of shared purpose.
They cover six key components of successful large scale change:
Purpose Vision NarrativeCultureStrategy Measure
How can we help here ?
1. Help you develop your vision for transforming care2. Help you develop a statement of Your Shared Purpose3. Help you outline a change plan to support your vision and
purpose 4. Help you collaborate to agree and begin to implement a
strategy and specific interventions5. Guide you in the choice and use of metrics to promote
change and improvement 6. Help you be clear about the narrative you use in engaging
others, and think about how culture might need to change.
with further support if you want it …. engagement, patient involvement, process mapping, modelling, demand / capacity
CCG transformational change challenges
Urgent care
Primary care
7 day working
Mental health
Children's services
Maternity
Safety and quality
Integrated care
Heat map
Thank you
Contact:
London – Mark Jennings [email protected]
Midlands and East – Mani Dhesi [email protected]
North – Neil Simpson [email protected]
South – Elaine Latham [email protected]
