Research was undertaken with the buyers to establish what it was about the system that they saw as unacceptable, and sought for ways to restructure the implementation so that it delivered the benefits claimed.

It became clear that the implementation was regarded by the buyers as debasing their self-worth, as they saw themselves as relationship managers, experts in the ways of the suppliers they dealt with, and as negotiators, people who made deals; not – as they described it – as data entry clerks.

Working closely with HR and the business unit managers, the training and the remuneration packages were redesigned. The value of good MI was emphasised and motivated by performance-related pay being associated with good record keeping (a recognised weakness in the earlier systems) and a re-emphasis on the gaining and utilisation of business intelligence on the suppliers.

Focus on corporate behaviour was strengthened with the buyers becoming a vocal force in the use and deployment of business intelligence to further the ambitions of the retailer.

One of the factors identified in the report that contributed to the poor level of care in Stafford Hospital was the constant upheaval the NHS is in.

The CIPD/simplyhealth 2011 absence management survey (get report from CIPD) gives the average number of days absence for public services as 9.1 days per year.  Although this is a half-day reduction on the previous year, it is significantly higher than the private sector.  A particular challenge identified in the public sector is the sheer amount of major change and restructuring, and it is suggested this could be the root cause for the relatively high level of absence.

In analysing the report, the BBC make the following three observations, that are worth highlighting (BBC insight):

1. The inquiry report said Stafford was “not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated”.
2. To move forward, the report called for a “fundamental change” in culture whereby patients were put first.
3. This would require a commitment from all those working and connected to the health service to make sure they put this at the heart of everything they do.

This poses many real challenges for the various trusts in the NHS, which is where most of the changes need to be made, as the recommendation is that any necessary changes are done within the existing NHS structure.  Should the change be driven bottom-up, from the perspective of the individual patient, who typically wants a local service, within a general, national  framework?  If so, what would be the implications on change management skills within the local trusts?  Also, the need for successful delivery through projects and programmes is fundamental, given the number of reported unsuccessful change implementations in the public sector.

How will the NHS cope, given that successfully changing a culture is arguably the biggest change challenge.  But is there just one culture to change?

Things to consider

1. Have you established a clear, shared vision for the change among all interested parties?
2. Does the communications strategy cover the ‘breadth’ (involve all relevant areas) and the ‘depth’ (involve all relevant levels) necessary for long term commitment?
3. Are you looking out for previously unidentified individuals and groups who need to be ‘on board’?
4. Do you know how to communicate with each individual or group and how often?
5. Are those impacted by the change empowered to contribute to the change?
6. Does the communication feedback tell you what you need to know about how individuals and groups feel about the change? Is their commitment steady, rising or falling?

Emergencies, opportunities and externally imposed mandates will, despite strategic intent, all play a role in altering corporate priorities for change and can destabilise the portfolio.  Even worse, this creates the impression of a lack of clarity of purpose and inconsistency in senior management behaviour to the staff who are involved in the changes.  There is little worse for morale and motivation than the perception that an organisation’s leadership is prone to erratic, short-term behaviours – especially when this is not really the case!

The real question, therefore, is how do we deliver strategic change objectives and structure a consistent portfolio, while maintaining the capability to respond to short-term tactical priorities?

Things to consider

Have you discussed and agreed:

1. the relative priority of work within the portfolio and the level of resource commitment that the work requires?
2. the organisation and mechanisms that accept unplanned work into the portfolio and how this will be communicated?
3. the value system that is being used to drive the portfolio?

And are you considering:

1. a ‘practical’ level of planned resource utilisation for the current and foreseeable circumstances?
2. making explicit the rationale for accepting any unplanned work, particularly in terms of the impact on the overall portfolio?

Things to consider

1. Is the organisational value of the change clear?  Have the benefits, costs and risks been fully reviewed and validated by all who will contribute?
2. Have the implications of operating the change been made explicit to those expected to own the change within business-as-usual?
3. Identify challenges, threats and risks that may prevent realisation of the benefits in day-to-day operations and set out a strategy to address them.
4. Ensure that changes to roles, accountabilities, reporting and performance management are understood and agreed at all levels within the business.
5. Make sure that the required on-going support for the change products is in place.

With significant change, where benefits will be realised across many functions, the change owner must be in the upper layers of the business, and have significant political influence.  Where ownership responsibilities are delegated, these will probably mirror line management structures, and there will be a need for coordinated activities by the senior managers involved.  Without careful attention, effective business ownership may not happen.  Consequently, the ownership of each change must be clearly visible and communicated to all.

Things to consider

1. Is business ownership of each change product clear and accepted?
2. Is accountability for the benefits clear and accepted?
3. Is the change ownership role assigned to the appropriate individual?
4. Are the risks of any shared change ownership being appropriately addressed?
5. Is the ownership of the change apparent to the adopters of the change?

An organisational-wide change arises from the sum of all the individuals’ change behaviours – and there lies a challenge. There is generally not a single, completely shared change journey, but multiple transformations, and so there is no single motivation or change process that will work.

It has been said that running a programme is like herding cats; shepherding individuals and groups and pushing them forward is difficult.  Of course, if you want the cats to behave ‘rationally’, the best way is to put ‘treats’ where you want them to go, and wait.  What then count as ‘treats’ for those who need to change?

Things to consider

1. Have you identified what counts as ‘achievement‘ in the vision of the new world and any ‘natural’ rewards in the outcomes?
2. Has the change initiative developed sign-post Key Performance Indicators (KPIs) for use during the transition period?
3. Have you modelled rewards in terms of pay, promotion and praise (non-financial reward? (Each ‘p’ has a major contribution to play in developing and embedding behaviours)
4. Are the value systems of the groups that are to change identified and understood?

And are you considering

1. linking jobs and roles to recognisably valuable outcomes
2. replacing the KPIs for the change with operational ones after the transition – defining a profile over time that recognises the occurrence of learning?
3. involving the adopters in the design of any new processes.