Leading Large Scale Change: a practical guide: A guide to leading large scale change through complex health and social care environments

NHS England, January 2018

Leading Large Scale Change: a practical guide has been produced by the NHS England Sustainable Improvement Team and the Horizons Team, NHS England, to help all those involved in seeking to achieve transformational change in complex health and care environments. This guide has been fully revised from the original 2011 publication to reflect latest policy and practice. This guide has a number of different resources which can be used according to local needs and circumstances and has been designed to be interactive, offering many links to useful, external sources.

Click here to view the guide.

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Retaining your clinical staff: a practical improvement resource

NHS Improvement, December 2017

This improvement resource outlines key steps to improving retention of clinical staff. It has distilled our advice from interviews with trust HR directors, directors of nursing and medical directors.  It recognises that no one action will boost retention on its own – sustained action in several areas is needed. It also acknowledges that external factors like private sector wage growth, the strength of the pound and the increasing demands of a clinical role in the NHS all make it difficult to retain staff.  Despite this there are factors in trusts’ control and trusts are exploiting these in their efforts to improve retention. These factors are covered in this resource.

Click here to view the resource.

Good work, wellbeing and changes in performance outcomes: illustrating the effects of good people management practices with an analysis of the National Health Service

What Works Wellbeing, December 2017

This report illustrates the effect of good people management with an analysis of the National Health Service.  The report found Trusts that made the most extensive use of good people management practices were over three times more likely to have the lowest levels of staff sickness absence and at least four times more likely to have the most satisfied patients. They were also more than twice as likely to have staff with the highest levels of job satisfaction compared to NHS Trusts that made least use of these practices, and over three times more likely to have staff with the highest levels of engagement. No link was found between people management practices and patient mortality.

Click here to view the full report.

Falling short: Why the NHS is still struggling to make the most of new innovations

Nuffield Trust, December 2017

Nuffield Trust report on the slow adoption of innovations by the NHS that finds it is due to:

  • An overly supply-driven and top-down approach to innovation. Shifts towards the co-production of solutions between clinicians and industry are encouraging, but initiatives such as the Innovation and Technology Tariff (while useful in some regards) do little to move the NHS away from a supply-driven approach, which starts with products first.
  • Identifying the most pressing problems and looking for solutions is rarely built into anyone’s day job – least of all clinicians. This is further compounded by a lack of clarity around how far chief executives should be involved in adopting innovation. Chief innovation officers with board oversight of the innovation process could make a fundamental difference.
  • Evidence generation (and the bodies that support it such as NIHR) are often not conducive to assessing real-world innovations in a timely way – particularly where there is a focus on cost effectiveness (rather than cost benefit).
  • Too often procurement departments and organisations as a whole look to innovations to produce short-term cash-releasing savings, rather than identifying where innovations can transform care pathways and lead to more efficient services. This requires adaptive leadership that can work across boundaries.
  • There is a tension between the policy push towards large-scale organisations (such as accountable care systems) and the capacity of SMEs to fulfil the needs of large contracts.

Click here to view the full report.

Horizon scanning future health and care demand for workforce skills in England, UK: Noncommunicable disease and future skills implications

World Health Organization, December 2017

World Health Organization Horizon Scan of good practice on workforce planning in in the UK that finds:

  • Investigation of skills mix and future demand for the whole system can reveal new ways of thinking and planning.
  • Small annual changes in demand can add up to larger changes over time requiring major shifts in the skills and competencies of the health workforce.
  • It is important to understand the context of the system to be investigated, ensuring that the appropriate scope, level of enquiry and methods are selected.
  • It pays off to experiment with a range of techniques and approaches to accommodate variation in systems.
  • Ensure that stakeholders are involved at every stage of the workforce review, including modelling and validation of variables.

The Centre for Workforce Intelligence, mapped out necessary skills and competencies for the health and care workforce, investigated roles and responsibilities for different health and care workers, and outlined 6 scenarios for change in future demand.

Click here to view the briefing.

The 2,000 days project: Practical ideas for reforming health and care

Healthcare at Home, November 2017

An Industry Coalition Group of clinicians, senior leaders in hospitals, primary care, the central bodies, charities and the private sector met earlier this year to take on the challenge of re-energising the NHS approach to handling rising demand, hospital debt, slow technological innovation and growing public expectations.  This report from Healthcare at Home identifies many examples of new care provision,  but also that current reform struggles to deliver the change needed, and integrated care is not happening on the scale required.  This report identifies seven key principles for reform:

  • Person-centred care must be at the heart of every NHS decision and action.
  • Person-centred care means taking every opportunity to maximise our ability to manage our own health. The NHS needs to focus on what we can do, not just try to fix what we can’t.
  • NHS leaders need to see joy and fulfilment in the workplace as key to delivering person-centred care and nurturing innovation.
  • Care services must stop being health and safety police, and take a more balanced approach to risk, to empower staff and let people live the lives they want.
  • Clinicians and managers need to be taught how to think digitally so they develop their own solutions using consumer technology. Online and face-to-face services should be integrated.
  • Where possible there should be direct access, including digital access, to community services.
  • The costs, benefits and practicalities of developing care at home need to be understood and debated.

Click here to view the full report.