How successfully are you delivering change? - 1 -

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1 How successfully are you delivering change? - 1 -

2 Introducing the Roadmap for Transformational Change (RTC) The challenge Successfully delivering change that makes a real difference to value and productivity requires radical thinking about new ways to design and deliver services. It requires an approach that recognises and deals with complexity, constraints and conflict. It needs leaders with a clear, compelling and shared vision, a drive to realise benefits and a renewed focus on transformational change. What is transformational change? Transformational change is radical in nature, it is also difficult to achieve It requires a shift in assumptions made by the organisation and its members. Transformation can result in an organisation that differs significantly in terms of structure, processes, culture and strategy. (NHS SDO publication of May 2001). ISIP s core proposition is that integrated service improvement drives transformational change. How does the ISIP RTC help? ISIP s Roadmap for Transformational Change (RTC) provides a framework to support people who are leading and managing integrated service improvement as a way to achieve effective and successful transformational change

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4 What is the RTC? A framework for change The RTC is a framework that enables health and social care organisations to design, plan and deliver integrated and transformational change that is both successful and sustainable. The primary purpose of the RTC is to stimulate and guide local decisions. It is NOT a prescriptive method, nor is it mandatory: however, because of its focus on transformational change and the use of systematic techniques, it requires active support from chief executives and senior clinical leaders. For commissioners and providers The RTC is relevant to both commissioners and providers and can be used across a Local Health / Social Care Community (LHC/LHSCC), a clinical network and an individual trust or organisation. Based on recognised good practice The RTC is based on recognised good practice, research and experience including, for example, the Office of Government Commerce (OGC) approach to Managing Successful Programmes (MSP) and Cranfield University s approach to Benefits Management

5 Phases, Strands and Activity Maps The ISIP RTC describes a journey through five phases starting with LHC-wide strategic planning and ending with the implementation of change and the realisation of benefits. Each phase is supported by an Activity Map that identifies a balanced and interconnected set of activities across four strands. The activities provide access to additional guidance, tools and techniques. As change programmes are implemented, the RTC will be populated with further content including case studies and will eventually become a key source of knowledge for integrated and transformational change in health and social care

6 Phases: Describing the journey of change The RTC is set out as an iterative journey through five phases: however, change leaders and change agents can choose to start at any phase and should be guided in doing so by their priorities and by what it is feasible for them to achieve. If, for example, an organisation, network or community starts by using the RTC to improve the way they specify and plan projects, and to ensure these are focused on the realisation of benefits, they may want later to consider both the integrated change programmes to which their projects (should) contribute and the strategy that sets the direction for change. Where phases are used in sequence, each phase will: validate and use output from the previous phase build ownership and sponsorship and secure commitment to move to the next phase. Phase I Initiation and strategic planning Phase II High-level design and benefits planning Phase III Detailed analysis and design Phase IV Developing, testing and training Phase V Implementing, tracking and improving - 6 -

7 Strands: Ensuring focus and balance The purpose of the four strands is to ensure that, as the focus of activity changes through the five phases, an essential balance is maintained between the key aspects of the integrated and transformational change that is being designed, planned and delivered. Governance & Management Strategy & Benefits ensuring decision-making and control maintaining a focus on benefits realisation People, Process & Technology Change Stakeholder Engagement & Communication designing and delivering all aspects of change ensuring stakeholder participation and commitment - 7 -

8 Activity Maps: Guiding local change Phase V: Implement, Track and Improve (This phase is undertaken separately for each project and co-ordinated across the portfolio of projects within each integrated change programme) Governance & Management Manage project plans Manage programmes Undertake Post Formally close for implementation to ensure continuous Project Review / project / and transition improvement Programme Review programme April 2006 Each phase of the RTC is supported by an Activity Map that identifies a balanced and interconnected set of activities across the four strands. The map for each phase is shown later in this booklet. Strategy & Governance & Benefits Management People, Process Strategy Governance & and Technology & Benefits Management Change Strategy & Benefits Phase III: Detailed Analysis and Design People, Process and Technology Change Stakeholder Engagement & Communication Realise, measure and review benefits (This phase is undertaken separately for each project and co-ordinated across the portfolio of projects within each integrated change programme) Confirm project governance structure Agree objectives for project Undertake final benefits review Set up and deliver support for all aspects of change Reaffirm costs and Maintain PID, Create and approve priorities across all Programme Definition PID (for new projects) Continue programmes to improve within Implement and ISI Plan workflows and the use the ISI Plan Changes of technology, equipment and facilities Continue to update and deliver training Define and plan and education Produce project outcomes, benefits benefits realisation and measures plan Set-up ongoing Celebrate Update feedback new state Create specifications communications plan mechanisms for required technology and equipment Analyse and design Design workforce workflows for projects changes required for including care future state pathways Design and plan required changes to facilities and estates Design and deliver Obtain organisation Update and continue to Complete impact stakeholder management implement assessment transformational skills commitment to communications plans training stretch targets April 2006 A systematic approach to integrated change will require at least the consideration of all of the activities in the relevant phase(s). The sequence of these activities and the extent to which they are followed, should be based on local conditions and requirements and on an assessment of likely costs and benefits. People, Stakeholder Process and Engagement & Technology Communication Change Stakeholder Engagement & Communication Individual activities and the RTC as a whole should be used alongside other complementary approaches, for example those that are recommended by the NHS Institute for Innovation and Improvement

9 Activities: Accessing guidance, tools & techniques Clicking on any area of a phase brings up an activity map Clicking on any activity brings up a page which describes the activity, its triggers, inputs, tasks, outputs and links to supporting material including guidance, case studies, tools & techniques and other sources of useful guidance -9-

10 What can the RTC do for you? Your organisation, network or community can use the RTC to share experience and build a skilled and recognised community of change leaders, including clinicians and managers, to deliver successful transformational change. It provides your change leaders with organised access to guidance, tools, techniques that support: collaborative decision-making and control over a portfolio of integrated change programmes design and implementation of benefits-led integrated change people, process and technology changes through the integration of national enablers the involvement of all stakeholders including patients, service users and staff. ISIP s vision for the RTC is that it will become an evolving source of knowledge used and maintained by enthusiastic change leaders, including clinicians and managers, working with patients and staff to achieve transformational change. ISIP recognises that achieving its vision for the RTC is itself likely to require transformational change. Publishing the RTC in its current form as a proof of concept is the first step in this journey

11 ISIP s vision for the RTC The RTC is an evolving source of knowledge used and maintained by enthusiastic change leaders, including clinicians and managers, working with patients and staff to achieve transformational change. organise & manage RTC is an evolving source of knowledge ISIP Support use own & maintain research & advise Community of change leaders including clinicians and managers Is perceived to be Relevant, useful & proven The agreed way we do things around here Supported by patients, service users and staff Part of all leadership training by

12 Phase I: Initiation and Strategic Planning Purpose: To agree and gain commitment from leaders of all organisations in the LHC on the portfolio of integrated change programmes that contribute to their shared vision for health and social care across the LHC and address the case for change. Key Output: Integrated Service Improvement Plan (ISI Plan) and a comprehensive Communications Plan. Success Criteria: A clear case for collaborative cross-community change and an agreed plan to deliver the change through a portfolio of integrated change programmes which is accepted by the leaders of the LHC, including clinicians

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14 Phase II: High-level Design and Benefits Planning Purpose: To work with staff and patient representatives to design an integrated change programme that delivers transformational change and realises quality and value benefits. (This phase is carried out for each integrated change programme and co-ordinated across the portfolio of programmes in the ISI Plan.) Key Output: Programme Definition that includes a business case, a description of high-level process changes and a Programme Benefit Realisation Plan (BRP) with high-level estimates of costs and benefits. Success Criteria: A high level design for a benefits-led integrated change programme that clearly articulates the current state and scopes specific projects that are required to deliver the future state. Agreement from executive teams, including clinicians, of all relevant organisations in the LHC to move forward to detailed design and analysis

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16 Phase III: Detailed Analysis and Design Purpose: To carry out detailed analysis and design for a project and ensure that each organisation within the LHC understands the implications of implementing the programme. (This phase is carried out for each project and co-ordinated across the portfolio of projects within each integrated change programme.) Key Output: Success Criteria: Detailed specification of all aspects of the design. Project Initiation Documents including, where required, a Project Benefit Realisation Plan. Local managers and clinicians in organisations responsible for delivering the project give their unequivocal commitment (in terms of sponsorship, dedicated resources and funding) to move forward to development, testing and training. A detailed design for a project which integrates relevant changes to workforce, processes, technology, facilities and estates the benefits of which are understood and fully accepted by staff and patient representatives

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18 Phase IV: Develop, Test and Train Purpose: To develop the changes specified during detailed design and analysis, test these with the people affected by the change and to provide training. (This phase is carried out for each project and co-ordinated across the portfolio of projects within each integrated change programme.) Key Output: Comprehensive training in the new tested workflows; new systems, facilities and associated policies and procedures ready for implementation; confirmed baseline measurements for all benefits; detailed plans for implementation and transition. Success Criteria: All proposed changes have been successfully piloted and staff are confident that they can work in the new environment. Senior management and clinicians declare that they are ready to go ahead with the required changes and to move forward to implementation

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20 Phase V: Implement, Track and Improve Purpose: To implement all of the changes that have been designed, developed and tested, ensuring that the actions needed to deliver the benefits are completed, the benefits realised are measured and a plan for continuous improvement is agreed. (This phase is carried out for each project and co-ordinated across the portfolio of projects within each integrated change programme.) Key Output: Final Benefits Review and plans for continuous improvement. Success Criteria: New responsibilities, new ways of working and/or new information systems are operational across the LHC and employees fully trained. Patients, service users and staff are realising measured benefits and are keen to celebrate and share the success of the change

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22 What now, what next? The RTC can be accessed through the ISIP website:. Encourage change leaders, including clinicians and managers, within your organisation to visit the website, use the RTC and provide us with feedback. Our aim is to ensure that the RTC becomes the framework that you need to deliver successful transformational change. We are particularly looking for: evidence of your success in delivering transformational change to inform and populate the RTC your help to identify change leaders from within your organisation for whom the RTC could become a valuable resource. You can contact us via on [email protected] or by calling Alternatively you can find out more via your SHA ISIP Lead (details of your local contact can be found on our website at )

23 Are you ready to deliver successful transformational change? Does your LHC have a shared vision for health and social care? Is your LHC designing benefits-led change that exploits national enablers? Is your LHC managing change so that patients and staff fully appreciate its value? Is there clarity, co-ordination and control across all change taking place within your LHC? Does your LHC have leaders who are committed to delivering transformational change? Is your LHC using the right processes, tools and skills to deliver transformational change? The ISIP Roadmap for Transformational Change helping Local Health Communities deliver successful change

24 NHS Integrated Service Improvement Programme 7 th Floor New Kings Beam House 22 Upper Ground London SE1 9BW Further information website: [email protected] tel: Version 3 released November 2006 Crown Copyright 2006 Working in partnership with the Department of Health, the Office of Government Commerce and the NHS Institute for Innovation and Improvement