Constructive comfort: accelerating change in the NHS – The Health Foundation – February 2015

Posted on February 27, 2015. Filed under: Health Mgmt Policy Planning | Tags: , , |

Constructive comfort: accelerating change in the NHS – The Health Foundation – February 2015

How can the NHS become better at change? – news release – The Health Foundation – February 2015

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White Paper: The new era of thinking and practice in change and transformation – NHS Improving Quality – 4 July 2014

Posted on August 8, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

White Paper: The new era of thinking and practice in change and transformation – NHS Improving Quality – 4 July 2014

“This new White Paper from NHS Improving Quality examines leading trends in change and transformation from multiple industries across the world.

As leaders of health and care we operate in a world where change needs to happen at a faster rate and become more disruptive – our thinking and actions need to challenge the status quo, which will not serve us for the future.

Many of the ways we go about improving health and care (in the NHS and elsewhere) were designed in a different mindset for a different set of circumstances. Given the radical and complex nature of our transformational challenge, these ‘tried and tested’ methods increasingly won’t deliver what we need to deliver for patients.

In this White Paper, we identify the profound implications and opportunities for leaders of health and care. They include a fundamental rethink about what organisational and system change means, including:

Who does it (many change agents, not just a few)
Where it happens (increasingly ‘at the edge’ of organisations and systems)
The skills and mindsets that change agents need.”

… continues on the site

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Future organisational models for the NHS: Perspectives for the Dalton review – The King’s Fund – 1 July 2014

Posted on July 4, 2014. Filed under: Health Mgmt Policy Planning | Tags: , |

Future organisational models for the NHS: Perspectives for the Dalton review – The King’s Fund – 1 July 2014

“With a growing number of health care providers in deficit and others placed in special measures because of concerns about the quality of their care, the search is on to find ways in which they could be supported. Sir David Dalton’s forthcoming review provides a timely opportunity to explore the range of organisational models that providers could use to meet their current strategic and financial challenges.

This publication explores some of the organisational options available, including how high-performing NHS organisations might support providers in difficulty. It provides an evidence review and a range of individual perspectives on some of those new organisational arrangements, in health and other sectors, nationally and internationally – in a bid to inform the work of the Dalton review. The individual contributions highlight the benefits and challenges of different organisational models.”

… continues on the site

 

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A Diagnostic Tool for Assessing Organisational Readiness for Complex Change – Australian and New Zealand School of Government – 2013

Posted on March 26, 2014. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: |

A Diagnostic Tool for Assessing Organisational Readiness for Complex Change – Australian and New Zealand School of Government – 2013

Blackman, D., O’Flynn, J. and Ugyel, L. (2013) “A Diagnostic Tool for Assessing Organisational Readiness for Complex Change”, paper presented to the Australian and New Zealand Academy of Management conference, Hobart, 4-6 December

“Abstract
Much is made of the best way to manage change, including a large body of work that argues that there is no point in undertaking such programs unless the organisation is actually ready and able to adopt these new ways of working. In this paper we focus, in particular, on the issue of organisations working together in more ‘joined-up’ ways across government – an example of complex change. We contribute to this literature, arguing that in cases of complex change, not only does there need to be readiness in terms of the change itself, but that there also needs to be readiness in the capacity of the organisation to work together, both within and across organisations. The paper outlines the development of a new diagnostic tool that combines macro and micro levels of analysis in order to enable organisations to gauge their preparedness for complex change.”

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Innovillage tools for sustainable change – National Institute for Health and Welfare [Finland] – 2014

Posted on March 25, 2014. Filed under: Health Systems Improvement | Tags: , |

Innovillage tools for sustainable change – National Institute for Health and Welfare [Finland] – 2014

Juha Koivisto, Kristel Englund, Merja Lyytikäinen, Niina Peränen, Niina Pitkänen, Pasi Pohjola & Kati Virtanen. Innovillage tools for sustainable change. National Institute for Health and Welfare (THL). Discussion paper 5/2004. 32 pages. Helsinki, Finland 2014. ISBN 978-952-302-128-0 (printed); ISBN 978-952-302-129-7 (online publication)

“This report presents an open, national innovation environment, called Innovillage, developed in the welfare and health field in Finland. The report starts with a short development history of Innovillage and then presents and discusses the innovation model of Innovillage. The co-development tools of Innovillage are then presented and their workability discussed. Finally, the further development of Innovillage and matters related to the scaling of its innovation culture are considered.

Innovillage began in 2007 at a time when similar observations were being made by different stakeholders in the social and health field in Finland. The ageing population, the threatened availability of skilful professionals, and a recession within the public sector are challenging the existing modes of service production. New models and solutions are needed to meet these challenges. The Ministry of Social Affairs and Health and the other authorities in the field have funded numerous development projects over the recent decades, but the models and solutions developed have only seen limited scaling-up within the sector, with very little development activities working across the sectors. Separate development projects have developed similar solutions over and over, without knowing of each other. New tools and practices are needed for co-development and for boundary-crossing that would strengthen the scaling-up and implementation of new models and solutions. Earlier the key organizations in the field, such as the National Research and Development Centre for Health and Welfare, the Association of Finnish Local and Regional Authorities, and different third-sector organizations, each developed their own databases for ‘good practices’. They were typically ‘passive’ systems, where the developers described the models and/or the local practices developed in their projects. A unified and more interactive platform enabling and supporting real time co-development processes was recognised as necessary in the sector.

According to the Innovillage innovation model, innovation activity is an open, transparent, and collaborative activity that adopts and adapts models already developed by someone else or develops totally new solutions and models. The innovation model consists of three iterative and mutually constitutive sections: Stimulate, Incubate, and Enact. Each section should be worked on to achieve successful solutions and sustainable change in a local site. The sections are not phases that should be worked through in a linear order; they rather include different development tasks that are performed simultaneously and interactively; a change in one thing may generate change in another thing. In addition, the innovation model includes an activity for generalising from a local solution to arrive at a general enactment model that can be applied in
any other innovation activity.

The tools for co-development within Innovillage consist of both web-based tools and face-to-face tools, where actors meet in person. The tools are as follows: Networks Tool for the different networks to collaborate; a Project Database to design and report on development projects; a Development Environment to carry out development activities; Innoworkshops to co-develop face-to-face; Events, to offer a meeting point for the developers (peers), a place where ideas, practices and models can be discussed, marketed and scaled-up; and finally the Innotutor training for developers to practice the innovation culture and learn how to use the Innovillage tools.

One of the key tasks of Innovillage in the near future is to scale-up the Innovillage-like development culture to other sectors. Different sectors typically develop their solutions and models in silos, though often a good solution would entail co-development and collaboration between different actors and practitioners across sectors and organizations.”

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Leading the Way to Healthcare Improvement in Quebec: Three CFHI-Funded Healthcare Transformation and Coordination Approaches Realize Results – Canadian Foundation for Healthcare Improvement – 14 March 2013

Posted on March 26, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , |

Leading the Way to Healthcare Improvement in Quebec: Three CFHI-Funded Healthcare Transformation and Coordination Approaches Realize Results – Canadian Foundation for Healthcare Improvement – 14 March 2013

“Three Quebec-led teams are accelerating the transformation of healthcare and seeing positive change, as a result of having applied innovative project and change-management processes to the healthcare challenges in their regions.

The findings are revealed in three reports funded by the Canadian Foundation for Healthcare Improvement (CFHI) released today. They include:

Strategic Community (SC): An Approach for Developing Interorganizational Collaboration by the members of the Work Organization Studies Chair, Université de Sherbrooke, led by Dr. Mario Roy and Madeleine Audet

Innovative Strategy in Organizational Transformation: Creating and Implementing a Transition Support Office within a University Health Centre led by Mélanie Lavoie-Tremblay, Associate Professor, Ingram School of Nursing, McGill University and Marie Claire Richer, Director Transition Support Office (TSO)
In 2008, the McGill University Health Centre (MUHC) set up the Transition Support Office (TSO) to guide the implementation of its large scale redevelopment project which is still underway. Once complete in 2015, the care and services now provided at six hospital sites will be absorbed into three. More than 10,000 staff and thousands of clients will be impacted by the redevelopment. The TSO’s goal is to ensure consistency around the harmonization of clinical practices, team consolidation and process optimization.

Knowledge in Action: Healthcare Management and Governance Innovation Lab, led by Dr. Denis A. Roy, Vice-president of Scientific Affairs, National Institute of Public Health, Quebec”

… continues on the site

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Large-System Transformation in Health Care: A Realist Review – Milbank Quarterly 2012

Posted on September 27, 2012. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: , , |

Large-System Transformation in Health Care: A Realist Review – Milbank Quarterly 2012
Allan Best et al

“Context: An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait lists. The aims of the review were to analyze examples of successful and less successful transformation initiatives, to synthesize knowledge of the underlying  mechanisms, to clarify the role of government, and to outline options for evaluation.

Methods: We used realist review, whose working assumption is that a particular intervention triggers particular mechanisms of change. Mechanisms may be more or less effective in producing their intended outcomes, depending on their interaction with various contextual factors. We explain the variations in outcome as the interplay between context and mechanisms. We nested this analytic approach in a macro framing of complex adaptive systems (CAS).

Findings: Our rapid realist review identified five “simple rules” of LST that were likely to enhance the success of the target initiatives: (1) blend designated leadership with distributed leadership; (2) establish feedback loops; (3) attend to history; (4) engage physicians; and (5) include patients and families. These principles play out differently in different contexts affecting human behavior (and thereby contributing to change) through a wide range of different mechanisms.

Conclusions: Realist review methodology can be applied in combination with a complex system lens on published literature to produce a knowledge synthesis that informs a prospective change effort in large-system transformation. A collaborative process engaging both research producers and research users contributes to local applications of universal principles and mid-range theories, as well as to a more robust knowledge base for applied research. We conclude with suggestions for the future development of synthesis and evaluation methods.”

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Evidence-Informed Change Management in Canadian Healthcare Organizations – Canadian Health Services Research Foundation (CHSRF) – 29 June 2012

Posted on August 28, 2012. Filed under: Health Mgmt Policy Planning | Tags: , |

Evidence-Informed Change Management in Canadian Healthcare Organizations – Canadian Health Services Research Foundation (CHSRF) – 29 June 2012

“Key Messages

  • Recent developments within the Canadian health sector highlight a perpetually shifting landscape, coupled with an increasing demand for practical approaches to implementing effective change.
  • The purpose of this project was to identify a suite of evidence-informed approaches to support change in small and large systems that are applicable to a variety of contexts within the Canadian health system.
  • Key issues that leaders and managers face in responding to and initiating change were used to identify evidence-informed approaches.
  • A variety of theories, models, approaches, tools, techniques and instruments that decision makers can effectively use to oversee change exist; these approaches need to be deliberately chosen, with attention to stage of change and context, so as to have maximum utility and impact.
  •  More attention to change readiness and change capacity prior to initiating change would contribute to better understanding about what strategies and approaches would help to initiate and support change effectively.
  • More formal learning regarding change in the four key areas of preparing for change, implementing change, spreading change, and sustaining change would be of benefit to decision makers.
  • Developers of university credit and non-credit professional development programs for leaders and managers should be encouraged to make the study of change a prominent feature in their curricula.
  • National and provincial agencies should be encouraged to develop a support platform devoted to leadership development in support of change in the Canadian health system (online access to tools and direct access to expertise).
  • While using approaches to change may be useful, increased attention to conceptualizing the change process would likely lead to more effective implementation and results.”
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NHS Change Model – launched July 2012

Posted on July 6, 2012. Filed under: Health Mgmt Policy Planning | Tags: , |

NHS Change Model – launched July 2012

“The model has been created to support the NHS to adopt a shared approach to leading change and transformation.  We hope to build this website further and add practical information, tools and support over the coming months.  Please tell us what you think to help us shape this model and the ongoing future work using the chat room facility.

Why do we need a change model?
Building on what we collectively know about successful change the ‘NHS Change Model’ has been developed with hundreds of our senior leaders, clinicians, commissioners, providers and improvement activists who want to get involved in building the energy for change across the NHS by adopting a systematic and sustainable approach to improving quality of care.

What does the model do?
The model brings together collective improvement knowledge and experience from across the NHS into eight key components. Through applying all eight components change can happen. This means no matter whom or wherever you are in the NHS you can use the approach to fit your own context as a way of making sense at every level of the ‘how and why’ for delivering improvement, to consistently make a bigger difference.”

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We have to stop meeting like this: what works in health and local government partnerships? – University of Birmingham School of Social Policy – 13 March 2012

Posted on March 22, 2012. Filed under: Health Mgmt Policy Planning | Tags: |

We have to stop meeting like this: what works in health and local government partnerships? – University of Birmingham School of Social Policy – 13 March 2012

“New Health and Wellbeing Boards proposed as a key part of the Coalition’s reform package for the NHS must focus on patient outcomes rather than developing unnecessary processes and structures according to a new policy paper from the University of Birmingham’s leading health research unit the Health Services Management Centre.

In a paper entitled ‘We have to stop meeting like this: what works in health and local government partnerships?’, the authors argue that previous attempts to create partnership structures have tended to focus too much on issues of process and structure. If the new Boards are to avoid this trap they need to understand three key issues:

The importance of values and culture
The limits of relying on large-scale structural changes
The need to focus on outcomes for patients”

… continues

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A Framework and Toolkit for Managing eHealth Change: People and Processes – Canada Health Infoway – October 2011

Posted on October 19, 2011. Filed under: Health Informatics | Tags: , |

A Framework and Toolkit for Managing eHealth Change: People and Processes – Canada Health Infoway – October 2011

“The Pan-Canadian Change Management Network has concluded that ICT for health projects should incorporate the following six core change management elements:

Governance & Leadership
Stakeholder Engagement
Communications
Workflow Analysis & Integration
Training & Education
Monitoring & Evaluation”

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Delivery System Reform Tracking: A Framework for Understanding Change – Commonwealth Fund – 2 June 2011

Posted on June 29, 2011. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: , , , |

L. Tollen, A. Enthoven, F. J. Crosson et al., Delivery System Reform Tracking: A Framework for Understanding Change, The Commonwealth Fund, June 2011.

“Overview
The health care delivery system is changing rapidly, with providers forming patient-centered medical homes and exploring the creation of accountable care organizations. Enactment of the Affordable Care Act will likely accelerate these changes. Significant delivery system reforms will simultaneously affect the structures, capabilities, incentives, and outcomes of the delivery system. With so many changes taking place at once, there is a need for a new tool to track progress at the community level. Many of the necessary data elements for a delivery system reform tracking tool are already being collected in various places and by different stakeholders. The authors propose that all elements be brought together in a unified whole to create a detailed picture of delivery system change. This brief provides a rationale for creating such a tool and presents a framework for doing so.”

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Transforming community services transformational guides – Department of Health [UK] – 8 February 2011

Posted on February 9, 2011. Filed under: Community Services, Health Systems Improvement | Tags: , |

Transforming community services transformational guides – Department of Health [UK] – 8 February 2011

“The six transforming community service reference guides were co-produced with clinicians. They utilise up to date evidence-based research from the Health Services Management Centre (HSMC), and experiential knowledge from clinical innovation in practice. The guides relate to 6 key specific areas of practice, namely: health and well being; children, young people and families; acute care closer to home; long term conditions; rehabilitation and end of life care.

These guides are for use by frontline clinicians, commissioners and providers and are based around a framework of ambition, action and achievement:

Clearly setting out your ambition Taking action to deliver the ambition using the best available evidence (high impact changes) Demonstrating and measuring achievement (using quality indicators)The guidance also includes six transformational attributes which practitioners and teams need to demonstrate in order to meet the requirements of the high performing practitioner-partner-leader roles.”

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Organizational readiness to change assessment (ORCA) – article – 14 July 2009

Posted on July 14, 2009. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: , |

Research article: Organizational readiness to change assessment (ORCA): Development of an instrument based on the Promoting Action on Research in Health Services (PARiHS) framework
Christian D Helfrich email, Yu-Fang Li email, Nancy D Sharp email and Anne E Sales email
Implementation Science 2009, 4:38doi: 10.1186/1748-5908-4-38
Published:     14 July 2009

Abstract (provisional)

Background
The Promoting Action on Research Implementation in Health Services, or PARIHS, framework is a theoretical framework widely promoted as a guide to implement evidence-based clinical practices. However, it has as yet no pool of validated measurement instruments that operationalize the constructs defined in the framework. The present article introduces an Organizational Readiness to Change Assessment instrument (ORCA), derived from the core elements and sub-elements of the PARIHS framework, and reports on initial validation.

Method
We conducted scale reliability and factor analyses on cross-sectional, secondary data from three quality improvement projects (n = 80) conducted in the Veterans Health Administration. In each project, identical 77-item ORCA instruments were administered to one or more staff from each facility involved in quality improvement projects. Items were organized into 19 subscales and three primary scales corresponding to the core elements of the PARIHS framework: (1) Strength and extent of evidence for the clinical practice changes represented by the QI program, assessed with four subscales, (2) Quality of the organizational context for the QI program, assessed with six subscales, and (3) Capacity for internal facilitation of the QI program, assessed with nine subscales.

Results
Cronbach’s alpha for scale reliability were 0.74, 0.85 and 0.95 for the evidence, context and facilitation scales, respectively. The evidence scale and its three constituent subscales failed to meet the conventional threshold of 0.80 for reliability, and three individual items were eliminated from evidence subscales following reliability testing. In exploratory factor analysis, three factors were retained. Seven of the nine facilitation subscales loaded onto the first factor; five of the six context subscales loaded onto the second factor; and the three evidence subscales loaded on the third factor. Two subscales failed to load significantly on any factor. One measured resources in general (from the context scale), and one clinical champion role (from the facilitation scale).

Conclusions
We find general support for the reliability and factor structure of the ORCA. Discrepant results included poor reliability among measures of evidence, and factor analysis results for measures of general resources and clinical champion role did not conform to the PARIHS framework. Additional validation is needed, including criterion validation.

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