How to create sustainable change in health and care

On top of the significant challenges of staff shortages, declining staff wellbeing, long waiting lists and managing patient flow, staff are facing a large amount of organisational change.

Many are experiencing the impact of national and local restructures in NHS England and integrated care systems (ICS), with the merger of several national bodies and the rationalisation of multiple CCG functions coming together into ICSs with a different focus. The forthcoming Hewitt review is likely to compound things even further.

From personal experience, I know that change is hard. I have gone through numerous restructures, worked on the development and implementation of national policy changes, spent time researching what successful NHS change looks like, and worked with clinical teams to deliver change.

And at Kaleidoscope as a team we also have the research, experience and expertise to know what it takes to navigate change successfully.

As an organisation, we spend the vast majority of our time supporting clients to deliver transformational change that creates sustainable improvement. But despite the variety of the work we do with clients – whether it is with providers, systems, charities or national bodies – when it comes to creating change that sticks in difficult times, some universal truths hold.

Effective change starts where people are

Effective change starts where people are, not where we might want them to be. Many people bring the scars of  previous poorly executed change programmes and can approach any change with a healthy dose of scepticism. We recognise that reality when supporting organisations to develop impactful strategies.

We take a pretty low view of the large number of strategies written in ivory towers. They rarely feel meaningful to anyone outside a few, very invested, leaders.

Producing a glossy document without real representation or insight and then it from the outside is only going to meet with resistance.

Building collective ownership

We meet our partners where they are, taking a highly participative approach to engaging staff, patients and other stakeholders. We help them to work together to identify the areas for action, and build collective ownership for the change and its implementation.

This is the approach we have successfully taken when working with many organisations, including Bromley Healthcare, South London and Maudsley NHS Foundation Trust and Oxleas NHS Foundation Trust.

Change that lasts is always collaborative

It is only by empowering the people affected by change in a shared process of development, that health and care improves. We specialise in helping individuals and organisations to build effective collaborations with the structure and purpose to thrive.

Collaboration is all about creating value together but it doesn’t happen by accident – to be meaningful, it needs to be planned and conducted with rigour.

Tangible improvements

We have supported the development of multiple collaborations including our HSJ award winning work in Cambridgeshire and Peterborough ICS. This enabled primary, community and local authority providers to come together to design and implement a digital first type 2 diabetes pathway, creating tangible improvements for patients and staff.

What made a difference to this project was not only looking at the digital tools and data, but bringing that together with the people who needed to use them, and working with them to decide what would have the greatest impact.

Effective change is many tiny snapshots, not a big bang

Enabling clients to become better leaders, teams, organisations and systems is about achieving small shifts in daily practice by many people. We often encourage our clients to think about committing to micro actions – the impact of these taken repeatedly, over long periods of time, really adds up.

Of course, there is more to it than that. We use evidence and insights from different industries, drawn together into a set of practical frameworks and support for clients to galvanise action and improvement.

Manageable actions

But in practice, by implementing smaller manageable actions, we’ve been able to make tangible, positive changes at an individual, team and directorate level that leads to sustained improvement.

The impact of this approach is shown in the work we have done with South East London ICS, supporting a year-long programme across a directorate to realise its potential through the transition to an integrated care system.

And it can also be seen in our work supporting the Macmillan partnerships and engagement team for the North of England, to come together to work more collaboratively, strategically and with a shared purpose.

Participative evaluation generates learning for effective change

What sets us apart from other more traditional consultancies who do research and evaluation is how we bring people together to share wisdom. Our approach is based on co-production, building the case for change as a group, and delivering the best possible value from it as a learning experience.

The result is that research and evaluation generates the impact data we need and, importantly, has the added benefit of providing an opportunity for collaborative learning and improvement too.

We’ve seen this in our evaluation of NHS England’s palliative and end of life care programme, and our work with Barts Health NHS Trust to evaluate their culture change model.

At Barts, the team learned that they could trust the data that they had gathered, and so knew how they should test the impact on culture and inclusivity going forward.

Impact and joy

We feel privileged to partner with people with whom our mission and values resonate. We share what we know; provide advice and support that leaves our clients with the tools for long term improvement; and help make change happen that is full of both impact and joy.

That’s why it’s so lovely to get feedback that doing things this way really works.

“It was a fantastic experience and has left us in a much better place as a directorate, with the ability to contribute effectively to our integrated care system.”  – Sarah Cottingham, Executive Director of Planning, South East London Integrated Care System

“The quality of Kaleidoscope’s work was good, as expected, but the programme management and collaboration was especially valuable, professional and enjoyable.” – Henry Ireland, Programme Manager, Barts Health NHS Trust

“It gave us the platform, energy and momentum to build great foundations for our collective efforts, and we have taken that forward as the team has grown in size and ambition.” – Heather McLean, Head of Partnerships for Macmillan Cancer Support North of England

“This project has been a game changer. There has been a real improvement in the care of patients with diabetes thanks to the combination of support to create consistent processes that free up clinical staff time; facilitating us to come together and engage as a group of practices within the PCN; and training in digital tools that give us real time information to identify gaps in care.” – Dr Mandeep Sira, GP at North Brink Practice and Clinical Director for Wisbech PCN

If you are working in health and care and need support to create sustainable change, transformation and improvement, please get in touch for a conversation – we’d love to hear from you and see how we can help.