Readiness to change in NHS organisations

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The context facing organisations in the English NHS is hugely challenging – this much is obvious. The state of NHS finances is parlous, care delivery targets are increasingly missed, and there is recognition of – but not yet action to address – the need to integrate systems to deliver care.

Combined with increasing demands on the health care system, these multiple pressures require NHS organisations to change, adapt and innovate on a scale that would make Apple and Microsoft catch their breath.

This requires not simply tinkering with organisational change, but transforming the way health and care are delivered to ensure long-term sustainability. And this can only be achieved with the involvement, engagement and commitment of leadership and staff throughout the NHS and in other organisations and sectors. It requires changing cultures both within and across organisations.

But the challenge is this: how can these changes be achieved in organisations with cultures, structures and processes created for quite different ways of working, some of which are largely resistant to innovation? There is little to disagree with in the proposals for change being implemented at national level, but achieving such change will not simply be the result of advocacy and enthusiasm. This is easy enough to say, but how can it be addressed?

At The King’s Fund we are working to answer this question through our Ready to make change programme, supported by The Health Foundation. Making change at the level required to meet the current demands on the NHS will require new ways of working at every level: the adoption of new technologies by staff and patients; more research and development; and a major shift in the capacity of organisations to develop and adopt good practice. That will only be achieved if the organisational conditions are in place.

As part of our Ready to make change work we are focusing on three areas: first, understanding what these conditions are; second, how to assess them in terms of relative strengths and development needs in every organisation; and finally, how to promote the development of these enabling conditions at pace and scale. The project focuses on how to organise in order to ensure innovation and transformation – it will develop a self-assessment method so that NHS organisations can determine their own readiness for improvement.

We are currently in the process of identifying what needs to be in place for organisations to achieve this. Themes include leaders ensuring that they have an appropriate strategy and vision for innovation; that they have a culture and leadership that fosters innovation; that diversity and the participation of all stakeholder groups is encouraged to stimulate and sustain innovation; and that the systems, processes and resources are in place to ensure that innovation can be successfully implemented and supported.

Our aim in this project is to offer a helpful framework for those faced with the task of developing capabilities for innovation in NHS organisations. We will be working with NHS organisations to test the approaches we’re developing, and our plan is to consult on and share our learning across the NHS. It is relatively easy to describe the challenges NHS organisations face and the changes they must make, but it is only by transforming their established ways of working that they will be able to really implement what is demanded. It is for the sake of the people in their communities, not the system leaders and politicians, that these challenges must be met.


Iain Stewart

Comment date
19 August 2016
I am keen to find out more information about the "ready to make change" work programme. I had a browse and a search of your website but can't find information. How can I find out more about it?

Catherine Armshaw

Managing Director,
Armshaw Associates
Comment date
06 May 2016
Michael this blog aligns neatly with one that I wrote last week entitled: 'Location, location, location: re-branding to break down healthcare barriers'

I have also created a presentation to suggest my idea:

It would be great to catch up to discuss how the two ideas could align.

Pearl Baker

Independent Mental Health Advocate and Advisor/Carer/ Trust Governor,
Comment date
02 May 2016
The culture of the NHS social services and related agencies have to realize to be successful you have to accept 'we are all in it 'together'. 'Integration cannot ever happen' if those considered NOT part of the 'Professional' system, while at he same time they are 'struggling' to cope in their caring role, because of finance, emergency contacts, 'safeguarding' issues, then it will NOT happen in my lifetime.

Bus Passes have been withdrawn from All those suffering from a Mental Illness, what are the 'Professionals' doing to put right the 'injustice' of this? this is total DISCRIMINATION, inequality' we the Voluntary sector are left yet again to campaign on behalf of ALL your clients and our loved ones!

Umesh Prabhu

Medical Director,
Wrightington Wigan and Leigh FT
Comment date
01 May 2016
Dear Michael,

Nothing will change in NHS unless we get the basics right. No doctor can be a good doctor if he/she doesn't get the basics right. Same is true for NHS leaders. Sad reality is NHS Board has 80% non-clinical leaders and only 20% are clinical leaders (MD and ND) and both are not trained in leadership! NHS is also financially challenged and target driven organisation and hence in such a culture finance and targets dominate and patients and staff suffer!

This is not a criticism of any individuals as most Board and CCG leaders try their best to do a good job but sadly as they are not trained in leadership nor appointed for values and as most of them have not worked in the NHS before (I am talking about NEDs) they do not realise the importance of caring for staff nor the complexity of NHS system, process, team dynamics and so on.

Sadly NHS has a culture of bullying, naming, shaming, discipline, harassment, victimisation, racism and so on. In such a culture patients and staff always suffer.

Unless we appoint values based leaders and managers from top to bottom of NHS who focus on culture, values, value based leadership, good governance and accountability for leaders and get staff and patient engagement right nothing will transform our NHS. All we can have is more and more gimmicks and in reality nothing really changes.

NHS is the easiest organisation to lead provided we get leadership right. We need leaders who are kind, caring, compassionate but also courageous to say 'enough is enough'.

NHS language has to change from one of inspection, regulation, blame, humiliation, punishment to one of staff support, staff engagement, values based leadership, learning and supportive culture and culture of accountability and excellent medical/clinical leadership and medical/clinical engagement.

This is what has transformed Wrightington, Wigan and Leigh FT where today patient harm has been reduced by 90% and 450 less patients die and for staff feedback we are the second best Trust in the country from being bottom 20% in 2011! Today we have diversity in medical leadership with 50% medical leaders from BME background and 20% are women! All of them were appointed for their values and not for ethnicity or gender!

Of course we are not perfect and still lot more to do. But we are on the right track with our values, culture, governance, staff and patient engagement. It is our 4500 wonderful staff who have made us so successful and the Board has played huge role in promoting excellent culture and values.

Trish stewart

Head of Safeguarding,
Comment date
30 April 2016
Currently studying on Elizabeth Garrett Anderson NHS Leadership course & Kings Fund information very relevant

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