How to make changes

The Health Foundation has published a wide range of resources to help services, teams, and individual health professionals to improve systems and processes. 

Free for download from the Health Foundation.

We have also learnt a lot from the Co-creating Health programme about how teams can work together specifically to implement systems and processes that support people to self-manage.

Our learning includes:

  • Think about when is the right time to start service improvement work
    Different teams are at different stages in their understanding of and commitment to self-management support.  Training health professionals and the wider team in the ethos of self-management support and in the skills, tools and techniques of supporting people to self-manage may be a good starting point.  People can then develop ideas about how the service needs to change to enable them to better support people to self-manage.
     
  • Ensure leadership at the right level
    Leadership at the right level means the person can influence change and culture within the team and the work will be given the priority it needs. On the ‘flip side’, service leaders also need to ‘buy in’ to enable teams to make the changes that are needed.
     
  • Ensure there is support and expertise available to help the team
    The team needs to be able to draw on skills and knowledge about service improvement and care pathway development, including how to monitor and evaluate changes.  The Health Foundation’s Co-creating Health programme found that teams made the most impact when they had access to consistent support and advice to help them. 
     
  • Consider what resourcing might be needed
    As part of the work in Torbay on the Health Foundation’s Co-creating Health programme, the site developed a Locally Enhanced Service (LES) for five GP practices to include collecting data and doing PDSA cycles. This allowed the teams and individuals to consistently test out their ideas and overcome one of the objections of lack of resources. The ideas and results were shared with each practice and learning documented.  This resulted in practices trying out things together.
     
  • Recognise that service improvement is a team sport
    The benefits of working together as a team include:

    -  Team members provide a contribution from their perspective, enriching the approach and also leading to a better understanding of individual roles and how the team works together.
    -  It can help to work with the key stakeholders, including GPs, practice nurses, intermediate care teams, consultants, specialist nurses and local patient groups, to strengthen the relationships between them.
    -  When the whole team have worked together on a particular tool or process it is more likely to be used consistently by all team members.
    -  There are wider benefits to team learning and functioning, including a greater sense team cohesiveness and a wider culture change.

    Sites working on the Health Foundation’s Co-creating Health programme reported that as a result of their work on self-management support they also developed improved team working and a more patient-focused service.  Some also started to undertake wider service improvement work to identify and address other areas their service could improve.
     
  • Ensure people with long-term conditions are part of the team
    People with long term conditions have the best knowledge of the challenges they experience and the support that would be most helpful in enabling them to self-manage.
     
  • Involve people beyond the team
    For example, when the team in Ayrshire and Arran decided to re-design the training for patients they involved representatives from other departments including Learning & Development and other organisations including the voluntary sector.  In Calderdale & Huddersfield the training for health professionals combined self-management support, effective care planning and consultation skills. It was designed in collaboration with the local PCT and Hospital and Diabetes Year of Care.
  • Create a shared understanding of what you are trying to achieve
    In the early stages, check that members of the team have a shared understanding and provide training and support on what system change and care pathway development might include and require.
     
  • Start by looking at the whole patient journey from the patient’s perspective
    Understanding the whole patient journey means service improvement resources and activity can be targetted on the places or steps on the journey where changes will have the most impact in terms of supporting clinicians’ practice or patients’ behaviour.
    As one senior manager put it:

    “Step back – don’t make changes. Look at what gets in the way of patients having a collaborative relationship with their clinician. Identify the barriers.”

    Process mapping and other approaches can help teams to identify where to focus. Read guidance on process mapping from the NHS Institute for Innovation and Improvement.
     
  • Create a baseline for how you’re doing
    Another approach is for the team to work through the Assessment of Primary Care Resources and Supports for Chronic Disease Self-management. Although designed to for primary care teams, it is relevant to other services, and enables teams to assess how well they are supporting people with long term conditions to self-manage and to identify actions they can take to further support this.
     
  • Think about how the areas identified might link or relate to broader work or objectives within the service or organisation.
    This can help to build support for the work and ensure that it is implemented and sustained.
     
  • Make small changes and evaluate their impact
    Having clear goals, encouraging small changes, evaluating the impact of changes and making tweaks to processes as often as necessary before widespread implementation is important. There are a number of different quality improvement tools to support this, such as the Plan, Do, Study, Act cycle.