Transformational change in health and social care

The health and care system in the United Kingdom is facing unprecedented financial and service pressures. There is widespread recognition that there needs to be transformational change in the way in which organisations work individually and together if the sector is to meet the challenges it faces from the needs of an ageing population, the availability of more expensive treatment options and the increasing prevalence of long-term conditions.

Considerable effort has already been invested in new ways to deliver more integrated care, including work under way in new care models, vanguards and sustainability and transformation partnerships. While these initiatives are starting to deliver results, they have focused on changing organisational structures and forms, and there is little understanding or research into the effect this transformational change can have on the individuals involved. This research project helped us to understand better how transformational change programmes are experienced by individuals in the NHS and other health services and highlighted some key considerations for those involved in future health and care transformation.

What is transformational change?

What we did

The project consisted of a literature review and interviews in four provider organisations that have demonstrated excellence in leading and implementing a transformational change initiative, exploring the experiences of individuals from across these organisations to understand the circumstances that triggered the change initiatives, as well as the barriers and enablers.
 
Our focus was on understanding personal experiences of and reflections on being involved with the transformational change process.

Our interviews sought the perspectives of a range of individuals, including those who have experienced change as:
•    leader – responsible for the day-to-day running of the change project
•    sponsor – enabling the project to be delivered by supporting the change leader
•    participant – helping to design, deliver and oversee the project
•    recipient – service user or patient who has experienced the change 
•    bystander – observing the transformation taking place but not directly involved in delivering it.

We explored questions such as: What were individuals’ motivations for being involved in such transformational projects? What problems were they trying to solve? How did it feel to be part of this process? What factors acted as enablers and what hindered progress? What is the lived experience of staff who are involved in or who lead this type of change?

The four organisations were selected to cover the community, primary, acute and mental health sectors, both within and outside England.