ARTICLE


CHANGE MANAGEMENT


How to improve service without increasing cost


In the first of a series of articles, Susie Peachey looks at examples of effective change to facilitate improvements in quality.


NHS Improving Quality (NHSIQ) was set up from 1 April 2013, bringing together approximately 150 staff from improvement programmes across the NHS, including the National Cancer Action Team, National End of Life Care Programme, NHS Diabetes and Kidney Care, NHS Improvement, and the NHS Institute for Innovation and Improvement. NHSIQ provides improvement and change expertise to support improved health outcomes, supporting the entire NHS by developing partnerships across sectors. This new organisation will use the NHS Change Model to deliver improvement programmes (www.changemodel.nhs.uk). The NHS Change Model brings together collective improvement knowledge and experience from across the NHS into eight key components, which, applied together, make change happen. Continuous quality improvement techniques support the capability to deliver through the new NHS Change Model.


While the NHS Change Model predates the pathology service improvement programme, the methodology of choice selected by the diagnostics team of NHS Improvement to make the transformations across the pathology disciplines over the past four years was the use of Lean principles. Lean is an evidence-based improvement methodology using A3 thinking and ‘Plan, Do, Study, Act’ (PDSA) cycles to test changes. The ‘productive’ series, which was used in wards, theatres, primary care and mental health services, also uses Lean CQI principles to deliver improvements in quality, increased safety, reduced turnaround times, increased efficiency and productivity, improved staff morale and reduced costs. Many of the other basic Lean principles


reinforce the NHS Change Model, which include:  respect, challenge and grow your people and create ‘leaders’ is one of the Lean 4Ps


708 THE BIOMEDICAL SCIENTIST


Leadership for change


Do all our leaders have the skills to create transformational change?


Engagement to mobilise


Are we engaging and mobilising all the right people?


Spread of innovation


Are we designing for the active spread of innovation from the start?


shared purpose


Our


System drivers


Are our processes, incentives and systems aligned to enable change?


Does this improvement meet our shared NHS purpose?


Rigorous delivery


Transparent measurement


and ensures leaders have the skills to create transformational change


Do we have an effective approach for delivery of change and monitoring of progress towards our planned objectives?


Are we measuring the outcome of the change continuously and transparently?


 Lean ‘philosophy’ is interchangeable with ‘shared purpose’, linking purpose, vision and values to processes and problems


 Lean Six Sigma is data-focused, ensuring a change is an improvement (eg statistical process control [SPC]) and so links to ‘transparent measurement’ of the change process, using PDSA cycles to ‘test’ changes and ensure the change is an improvement  rigorous delivery is ensured by following a


The NHS Change Model.


Improvement methodology


Are we using an evidence-based improvement methodology?


standard process with internal monitoring of


progress towards goals and measures.


In addition, the diagnostics team supported leadership training in CQI for histopathology junior doctors in the East Midlands and Mersey deaneries of The Royal College of Pathologists, as well supporting training for national clinical advisors in their role to ensure that changes in health and social services are reflected in training and education. There was also a bespoke course for 50 senior pathology leaders (managers and clinicians)


DECEMBER 2013


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