Transforming Care: Building clinical commissioning group capability for large scale change Jo Godman, Senior Associate and Mark Jennings, Senior Associate - 26 March 2014 Presentation from Commissioning Live 2014, London: Transforming Care programme for CCGs. The programme offers supported learning for CCG and partner organisations to address large scale change. Developed by NHS Improving Quality and NHS England’s commissioning development directorate, the Transforming Care programme is designed to empower commissioners to lead change across boundaries and improve outcomes for patients. So far, the programme has been taken up by more than 50% of CCGs.

1. Transforming Care:
Building clinical commissioning group
capability for large scale change
Jo Godman
Senior Associate
Mark Jennings
Senior Associate
26 March 2014

2.  Introduce NHS Improving Quality
 Explore the complex challenges faced by
CCGs
 Describe NHS Improving Quality’s experience
of working with CCGs to apply large scale
change techniques that seek to use a social
movement approach to change through
commitment rather than compliance
 Facilitate a discussion about the opportunities
and issues raised
Objectives

3. Improving health outcomes across England by
providing improvement and change expertise
The driving force for improvement
across the NHS in England

4. Building capability capacity
The How and The What
P
r
o
g
r
a
m
m
e
s

6. CCG

7. Complex Complicated
Chaotic Simple
Emergent practice Good practice
Best practiceNovel practice
Snowden D & Benford RD. The Cynefin Framework.
Cause & effect relationships exist, are
obvious to most people &
predictable & repeatable. Can be
known in advance.
Cause & effect relationships exist, but
not obvious, so require
analysis/investigation +/- expert
knowledge.
Cause & effect only obvious in
hindsight, with unpredictable,
emergent outcomes.
No cause & effect relationships can
be determined.
Probe. Sense. Respond. Sense. Analyse. Respond.
Sense. Categorise. Respond.Act. Sense. Respond.
Disorder
Better
processes
More
time/resource
for analysis
Bring in lots of
perspectives
Do what you’re
told!

8. www.changemodel.nhs.uk
NHS Change
Model

9. Three dimensions of large scale
(transformational) change
Depth
of change vis-à-vis
current ways of thinking
and doing; a.k.a
cognitive-behavioural or
paradigm shift
Pervasiveness
of change; does it affect whole or
only portion
of the system?
Size
of system experiencing change; e.g.
geography, numbers of people
Refs: Mohrman A. et. al. Large-Scale
Organizational Change. Jossey-Bass, 1989
and Levy A. Second-order planned change:
definitions and conceptualizations. Org.
Dynamics. Summer 1986, 15:5-20

11. Our model of LSC
Identifying
need for
change
Framing/
reframing
the issues
Engaging/
connecting
others
Making
pragmatic
change in
multiple
processes
Attracting
further interest
After some
time
Settling in
Possible outcomes
1. sustainable norm
2. plateau
3. run out of energy
Living with
results and
consequences
Maybe later
Repeats
many
times in
hard to
predict
ways
Time delay

12. Our findings…..
Work with partners
Commitment v. compliance
Impact of shared purpose
Loose – tight properties
Learning through doing

13. Transforming Care Programme

14. Framework for transformational change
The first four workshops are about building effective foundations for change.
These seek to provide and support confident use of new frameworks for
undertaking improvement, building an improvement culture, deepening
partnerships and ensuring clarity of shared purpose.
They cover six key components of successful large scale change:
Purpose Vision NarrativeCultureStrategy Measure

15. How can we help here ?
1. Help you develop your vision for transforming care
2. Help you develop a statement of Your Shared Purpose
3. Help you outline a change plan to support your vision and
purpose
4. Help you collaborate to agree and begin to implement a
strategy and specific interventions
5. Guide you in the choice and use of metrics to promote
change and improvement
6. Help you be clear about the narrative you use in engaging
others, and think about how culture might need to
change.
with further support if you want it …. engagement, patient
involvement, process mapping, modelling, demand / capacity

16. CCG transformational change
challenges
Urgent care
Primary care
7 day working
Mental health
Children's services
Maternity
Safety and quality
Integrated care

17. Heat map

18. Thank you
Contact:
London – Mark Jennings mark.Jennings@NHSIQ.nhs.uk
Midlands and East – Mani Dhesi mani.dhesi@NHSIQ.nhs.uk
North – Neil Simpson neil.simpson@NHSIQ.nhs.uk
South – Elaine Latham Elaine.latham@NHSIQ.nhs.uk