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?

Properly structured change initiatives, involving programmes and projects, are designed to avoid this but, too often, insufficient thought and planning is put into how the impacted business units will adopt multiple ‘waves’ of change. Effective portfolio and change management disciplines are good at addressing planned change, driven by the strategy, but not always adequate at coping with additional significant ‘must do’ changes.

Things to consider

1. Has your organisation an overarching corporate portfolio view of change?
2. Have you discussed and agreed with affected business units:
   • The type, rate and volume of change being introduced into their areas?
   • How much change they are trying to introduce themselves and how much is coming from external initiatives?
   • How any concerns and issues can be overcome?
   • Where ‘hot-spots’ will arise and what strategies and tactics will be used to address these?
   • What must be sacrificed to ensure that the operational business units will not be overwhelmed?

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?