Transformational change in the NHS provides new insight for business leaders seeking to deliver system-wide change through periods of uncertainty.
In 2009, the UK government outlined a strategy to transform the way primary care services are commissioned in the National Health Service (NHS). From April 2013, commissioning was to be led by clinicians located in a wide range of new organisations rather than by managers based in the Primary Care Trusts (PCTs).
This was a significant transformation. In London alone, the NHS employs 5,500 management staff across the Strategic Health Authority, the London Deanery and six PCT clusters. As part of the government’s transformation plans, these bodies were to be abolished and staff moved to a total of 75 new organisations. During the transition, over 600 buildings and 11,000 service contracts were to be reviewed.
A major complication for all the organisations involved was that the entire system was undergoing transformation. The NHS is a highly interconnected system, so each organisation undergoing this change was having an impact on the organisations surrounding it. PA worked with a number of PCT clusters to deliver this complex transformation, supporting the closure of the PCTs and setting up the new organisations.
Our experience of managing this transformation highlights three key learning points for managing through uncertainty:
Understand the wider system and the impact of transformation on connected organisations and stakeholder groups
Even in an environment where pace is critical, it is important to understand all the organisations and stakeholders involved in the change across the system, the transformation they are undergoing and how their plans and influence will affect your delivery approach. For example, to manage the emergence of the new Commissioning Support Services organisations successfully, we also needed to understand the objectives, plans and influence of the new Clinical Commissioning Groups and the NHS Commissioning Board as well as of the old PCTs.
Agree the end outcome and interim targets but be prepared to be flexible in your transformation planning
Where uncertainty is significant, it is difficult to plan out the whole programme in detail. For example, during the transition programme for NHS London, national guidance was still emerging even while the transformation was taking place. So we used flexible planning methods to enable us to adapt to inevitable changes in direction.
We found it useful to identify key programme-level targets that everyone could understand and therefore commit to. This included, for example, agreeing the date when a shadow operation would begin or when key leaders would be in post by. This focused people’s thinking on what needed to be done to achieve these outcomes while they waited for national guidance to set longer-term targets. As more information became available and other stakeholder organisations evolved, we reviewed our plans and activities continually to ensure they remained appropriate for achieving the desired outcomes.
Keep key stakeholders on side – and accept that you cannot plan for every eventuality
It is vital to keep everyone informed about the transformation, and particularly to make sure that key stakeholders understand the plan and remain on side throughout the transition. We recognised that it was not possible to account for every single eventuality resulting from system-wide change. However, we did acknowledge important issues as they arose and aimed to make informed decisions without deviating from the core purpose and scope of the transformation programme. We had to base our decisions on information that might change at a later date, but taking these decisions on the basis of best-available information resulted in a focused plan with clearly defined boundaries and targets.
To find out how PA can support your organisation in managing transformational change through uncertainty, contact us now.