The-Story-of-Change-Day (1)

www.changeday.nhs.uk
By Kate B. Hilton & Chris Lawrence-Pietroni
Leaders Everywhere
The story of
NHS Change Day
A learning report 2013
NHS Change Day is supported and coordinated by NHS Improving Quality.
NHS CHANGE DAY
Do something better together
#NHSChangeDay

2 Leaders Everywhere The Story of NHS Change Day
PURPOSE, DESIGN & AUTHORS OF THE LEARNING REPORT
The purpose of this report is to explore what can be learned from NHS
Change Day 2013. Its intent is to summarize the lessons described by
those who took part in NHS Change Day; it is not a formal or independent
evaluation. The report offers a narrative of what happened, explores the
ways in which people led and pledged their support of NHS Change Day,
highlights lessons learned, and discusses the strengths and challenges of
this approach. The report draws on interviews with core leaders, clinical
and non-clinical staff, the NHS Change Day website and a catalogue of
materials. It describes the immediate and ongoing impact of NHS Change
Day through examples and stories that raise strategic questions for those
involved in future Change Days and similar efforts.
Kate B. Hilton and Christopher Lawrence-Pietroni authored this report. In
2010-11, Kate and Chris supported the QIPP workstream team on
mobilising for cost and quality by developing distributed leadership skills
and adapting a community organizing framework to the NHS (resulting in
Call to Action: Delivering QIPP and achieving common purpose through
shared values and commitment). Having been mentored for years by long-
time organiser, Marshall Ganz, Kate and Chris consult with organisations
and voluntary multi-stakeholder groups to achieve shared purpose around
health transformation. Their biographies are attached as appendices to
this report. Kate and Chris wish to express their gratitute for the
opportunity to learn alongside those participating in NHS Change Day,
and thank all those who kindly volunteered their time to share their
insights, experiences and stories.
Front cover: Picture taken on NHS Change Day 2013 at Healthcare Innovation Expo.

CONTENTS
EXECUTIVE SUMMARY 4
INTRODUCTION & ORGANISATION OF THE LEARNING REPORT 7
CHAPTER 1: THE NATIONAL STORY 11
1.1 A Time of Enormous Challenge 11
1.2 The Birth of NHS Change Day 12
1.3 From Zero to 189,000 Pledges 14
1.4 Summary of Quantitative Research and Results 16
CHAPTER 2: THE PLEDGE MAKERS’ STORY 19
2.1 The Story of NHS Arden Commissioning Support 19
2.2.The Story of Open Minds Alliance CIC 22
2.3 The Story of Derbyshire Community Health Services Trust 24
2.4 The Story of Steve Fairman, NHS England 28
CHAPTER 3: LEARNING FROM NHS CHANGE DAY 2013 31
3.1 ‘Impact’ or ‘Design and Outcomes’? 31
3.2 Design: NHS Change Day, Social Movements and Hierarchy 33
3.3 Outcomes: Distributed Leadership 33
3.4 Outcomes: Relationships 36
3.5 Outcomes: Weak & Strong Ties 38
3.6 Outcomes: Voluntary Action 39
3.7 Outcomes: Mobilisation around Shared Values 40
3.8 Outcomes: Collective Action 41
3.9 Outcomes: Social Media 42
3.10 Outcomes: A Special Kind of Grasstops Leadership 44
3.11 Outcomes: A ‘Dual Operating System’ 47
CONCLUSION: LEADERS EVERYWHERE 49
RECOMMENDATIONS 51
REFERENCES 55
APPENDICES 57
Appendix A: The Story of Barking, Havering and Redbridge
University Hospitals NHS Trust 57
Appendix B: The Story of Birmingham Children’s Hospital 63
Appendix C: The Story of Jonathan Griffiths 66
Appendix D: Authors’ Biographies 70
3Leaders Everywhere The Story of NHS Change Day

EXECUTIVE SUMMARY
NHS Change Day 2013 was the biggest day of collective action for
improvement in the history of the NHS. A countrywide event in England,
NHS Change Day was a grassroots initiative devised and driven by a small
group of emerging clinicians and improvement leaders. Their idea was to
create a mass movement of National Health Service (NHS) staff
demonstrating the difference they can make by one simple act, proving
that large-scale improvement is possible.
The NHS Change Day core leadership team applied and adapted social
movement theory, skills and practices associated with community
organising and made use of social media to secure voluntary pledges from
NHS staff and patients to take a specific improvement or innovation action
on or around 13 March 2013. The Change Day team set themselves the
goal of securing 65,000 pledges, 1000 for each year of the NHS. Over
189,000 pledges were secured on the online pledge-wall alone.
Change Day occurred in a context in which the NHS was under great
financial, organisational and reputational strain. This combination of
factors created a climate in which NHS staff were under internal pressure
and negative external scrutiny. NHS Change Day 2013 connected with
that moment, providing an opportunity to transform anger or frustration
into constructive action.
This learning report was commissioned to tell the story and capture the
learning from NHS Change Day 2013. It draws on interviews with core
leaders, clinical and non-clinical staff, the NHS Change Day website and a
catalogue of materials. It describes the immediate and ongoing impact of
NHS Change Day through examples and stories that raise strategic
questions for those involved in future Change Days and similar efforts.
Learning from NHS Change Day 2013
The most significant learning from NHS Change Day is that change of
this kind is possible; the most significant impact is that tens of thousands
of staff have now had the experience of taking part in collective action for
change.
NHS Change Day was an entirely voluntary effort that invited staff to
take action on something that they were passionate about. It intentionally
drew on shared values, and in doing so, it unlocked willing commitment
to act rather than hierarchical compliance.
Putting shared values at the heart of the Change Day provided an
authentic ‘call to action’ to which others with a similar outlook
responded. It made Change Day not only an opportunity to do something
that would be of benefit to others, but also to express support for the NHS
as an institution and the shared values that it represents.
NHS Change Day created a sense of urgency by focusing on a single day
of collective action. In many cases Change Day provided the necessary
prompt to galvanise and amplify activity that was already planned.
Narrative skills were used to heighten and maintain this urgency and to
sustain motivation.
NHS Change Day had a low threshold for participation encouraging
pledge-makers to identify their own action rather than sign up to a single
national initiative. This reinforced the model of distributed leadership
intentionally applied by the NHS Change Day team, designed to support
the development of ‘leaders everywhere.’ The design of NHS Change
Day was unique precisely because it drew together networks of

grassroots leaders while also enabling leaders with positional authority
to role model change leadership in a new way.
No permission was sought or given for NHS Change Day to take place; it
arose from the initiative of those motivated to take part. In a traditionally
hierarchical environment like the NHS this modelled a profound shift in
thinking and behaviour.
NHS Change Day was designed to be relational, which is one of the
reasons it was so successful. Off-line teams made commitments to each
other supported by the online pledges made on the Change Day website.
The social media presence supported the development of a community
through one-to-one communication via Twitter, shared YouTube videos
and other interactions.
The relational nature of Change Day extended to many of the pledges
themselves. A key insight arising from this experience is the importance of
face-to-face human interaction not only in relation to patient care but
also feedback and communication between the NHS and the public and
amongst NHS staff.
Because NHS Change Day was relational it developed new social capital.
These new relationships have an intrinsic value for the people involved,
offer a wider benefit for other NHS objectives, and provide new
resources on which NHS Change Day 2014 can draw.
As with many social movements, young leaders played a particularly
important role in providing the energy that initiated NHS Change Day.
However, NHS Change Day was simultaneously built on a foundation of
learning about social movements and the application and adaptation of
community organising skills in a healthcare setting amongst
improvement leaders over many years.
In September 2013, NHS Change Day was a winner in the Harvard
Business Review / McKinsey Leaders Everywhere Challenge.
Conclusion
NHS Change Day offers an example of how new leadership can be
developed and deployed in healthcare. This model enables distributed
leadership to flourish while not ignoring the realities of hierarchical
structures and processes. There is often a tension between the
commitment-driven volunteerism of a collective day of action – which can
be unpredictable – and the temptation by senior leaders to require
certainty, specified results or perceived success. In learning to embrace this
tension, and to resist the pull towards more familiar behaviours and
processes, the possibility emerges for a new kind of organisation that has
at its disposal both the standardising potential of hierarchy and the
relational potential of networks.

Summary Recommendations
Engaging with existing NHS processes: NHS Change Day 2014 should
remain outside the formal NHS communication, improvement, training or
management structures.
Senior Leaders: Senior leaders should be encouraged to pledge as part of
NHS Change Day 2014 and should take the opportunity to model the
value of enabling others to lead using their positional authority to hold up
the successes and stories of pledge-makers.
Structure: NHS Change Day 2014 should develop a more intentional
structure of distributed leadership that allows teams throughout the
country to take responsibility for particular aspects of the overall strategy
(based on geography, professional groups, particular pledges, necessary
functions or some combination). Their roles should be clearly defined and
the core leadership team should in part be drawn from them.
Skills and capacity: Planning for NHS Change Day 2014 should make the
most of new skills that have been developed by creating opportunities for
them to be passed on to others through trainings, webinars, online skills
sharing, printed and online resources etc.
Emerging leaders: The growth strategy for NHS Change Day 2014
should include a focus on identifying and recruiting young leaders from all
parts of the NHS.
Patients and their families: The strategy for NHS Change Day 2014
should consider what resources patients, their families and citizens in
general can contribute to the overall effort, as well as its leadership.
Integrate online and offline strategies: The strategy for NHS Change
Day 2014 should include an online/offline element that draws inspiration
from contemporary campaigns and social movements.
Build on successes: NHS Change Day 2014 should build on the
successful pledges in 2013, particularly those that mobilised large
numbers of people within a particular organisation or locality.
Campaign approach: An annual campaign to hit a target number of
pledges on a particular day each year is central to the Change Day design.
While making room for new thinking, leadership and learning, a longer-
term ten-year strategy for Change Day can help guide its growth with
year-round activity.
Goals and metrics: NHS Change Day 2014 should set an even more
ambitious goal for the number of pledges secured. Additional metrics
should be considered including: impact measures directly from pledges,
impact measures of effects of pledges on involved patients and staff, and
metrics around NHS Change Day design elements.
Opportunities for research: Change Day leadership, pledge-makers and
researchers should come together to pursue research partnerships,
particularly around demonstrating impact from pledges and pledge-
makers involved in Change Day.
Global movement: The NHS should invite others to join them in a world-
wide “Change Day” with no one particular organisational affiliation, but
the same approach and objectives.

INTRODUCTION & ORGANISATION OF THE LEARNING REPORT
NHS Change Day was a grassroots initiative devised and driven by a
small group of improvement leaders and young and emergent trainee
clinicians. Their idea was to create a mass movement of NHS staff
that large-scale improvement is possible. The effort was designed to
engage the frontline in individual and team pledges to improve patient
experiences or clinical outcomes by spreading and adopting best
practices and championing innovation. The aim was for 65,000 pledges
to be made, 65 being the number of years the NHS has been in
existence. Over 189,000 pledges were made.
This report explores some of the learning from this inspiring effort. It is
organized into three chapters: (1) narrative of Change Day; (2) learning
from pledges, and (3) lessons from the approach. In Chapter One, we
offer a narrative of Change Day by describing the challenges facing the
NHS at the time, the birth of Change Day as an idea, the leadership that
took it forward, their strategy to reach their goal, and a summary of
quantitative results. In Chapter Two, we offer the qualitative examples of
four pledges to learn what Change Day meant to pledge-makers, and
what pledge-makers meant to Change Day. In Chapter Three, we
explore our learning about this approach to change by examining its
design elements and considering the range of outcomes that flowed
from them, the challenges and limitations that emerged, and
opportunities for development in the future. We conclude this report
with a brief summary of what we view as our greatest takeaways from
NHS Change Day and its implication for health care organisations the
world over.
HOW TO READ THIS REPORT
NHS Change Day was a grassroots initiative devised and driven by a
small group of improvement leaders and young and emergent trainee
clinicians. Their idea was to create a mass movement of NHS staff
that large-scale improvement is possible. In September 2013 NHS
Change Day was a winner in the Harvard Business Review/McKinsey
Leaders Everywhere Challenge.
The effort was designed to engage frontline staff in individual and team
pledges to improve patient experiences or clinical outcomes by spreading
and adopting best practices and championing innovation. The aim was
for 65,000 pledges, 65 being the number of years the NHS has been in
existence. In the event over 189,000 pledges were made.
Chapter 1: The National Story
Stories are at the heart of all successful social movements; they are used
to call others to action, to sustain motivation in difficult times and to
celebrate what has been achieved. In Chapter 1, we tell the story of NHS
Change Day from the perspective of the national leadership team that
brought it into being. How and why did it happen? How did this team
come together? How did they come up with the idea? How did they
work together? What challenges did they face? How did they overcome
them? What have they learned and what would they do differently? If
these questions are of interest, you’ll find answers in sections 1.1-1.3.
Quantitative results of NHS Change Day 2013 can be found in section 1.4.

Chapter 2: The Pledge-Makers’ Story
Stories are endlessly variable and can be retold in many ways. In Chapter
2, we tell the story of NHS Change Day from the perspective of the
people who made it happen on the ground – the pledge-makers. To do
this, we dive into four case studies, each of which illustrates a different
kind of pledge with diverse challenges, choices, outcomes and learning.
In section 2.1 the Story of NHS Arden Commissioning Support
explores the unexpected benefits of participating in Change Day from a
group that did not initially connect with its approach, and the
surprisingly powerful impact of a pledge that engaged staff and citizens
in face-to-face relationships.
In section 2.2 the Story of Open Minds Alliance Community Interest
Company reveals how a single pledge led to over 50,000 supporters,
and how Change Day enabled an organisation outside the NHS to build
thousands of relationships inside the NHS, each of which has the
potential to improve the health and wellbeing of some of the most
vulnerable people in England.
In section 2.3 the Story of Derbyshire Community Health Service
Trust illustrates how Change Day was used as a catalyst to amplify work
that is already underway, how the creativity of staff was unleashed (look
out for the Harlem Shuffle), and how supporting pledges at a local level
helped to ensure sustainable impact.
In section 2.4 the Story of Steve Fairman, NHS England shows how
action by a single pledge-maker had unpredictable knock-on effect that
led to a chain of new insights and relationships, and the impact of a
pledge that at its simplest involved spending time in someone else’s
shoes.
Three additional case studies can be found in Appendices A-C.
• In Appendix A the Story of Barking, Havering and Redbridge
University Hospitals NHS Trust explores the pledges of three
different leaders and how they worked to enable others to exercise
leadership.
• In Appendix B the Story of Birmingham Children’s Hospital
illustrates the impact that a single enthusiastic individual can have by
motivating others, and how an institution like a hospital can replicate
the Change Day model locally, generating hundreds of pledges and
sustained change.
• In Appendix C the Story of Jonathan Griffiths shows how social
media played a role in raising awareness of Change Day and building
a national community of collective actors, as a GP spent the day in a
wheelchair in order to better understand one subset of patients.
We have drawn extensively on lessons and examples from the appended
case studies in Chapter 3 of this report and included them in full as an
additional resource.

Chapter 3: Learning from NHS Change Day 2013
This report aims to tell the story of NHS Change Day 2013 and to extract
the learning from that story. In Chapter 3 we draw the learning together.
Section 3.1 ‘Impact’ or ‘Design and Outcomes’? looks at the thorny
issue of how to measure the success of NHS Change Day 2013. What
was its short, medium and long-term impact, and what are the best
metrics for judging it? Is it possible to measure traditional improvement
impacts and how valuable would it be to measure new capacity for
action? What metrics should NHS Change Day 2014 adopt?
Section 3.2 Design: NHS Change Day, Social Movements and
Hierarchy considers what effect the application of social movement
theory had on the design of NHS Change Day, how this was adapted for
use in a vast hierarchical organisation, and what effect this had on the
kinds of outcomes that NHS Change Day can enable.
Section 3.3 Outcomes: Distributed Leadership explores the model of
leadership used and developed by NHS Change Day, the extent to which
this is valuable within the NHS and the challenges this poses.
Section 3.4 Outcomes: Relationships looks at the importance of off-
line relationships in building and sustaining NHS Change Day, recruiting
new leadership to it and the legacy of these relationships in terms of
new social capital.
Section 3.5 Outcomes: Weak & Strong Ties digs a little deeper into
the nature of the relationships formed through NHS Change Day, the
particular value these added to the effort and the value they could add
to the NHS in future.
Section 3.6 Outcomes: Voluntary Action investigates a fundamental
principle that underpinned Change Day, what difference it made to
outcomes and the challenges of sustaining this within the NHS.
Section 3.7 Outcomes: Mobilisation around Shared Values looks at
the positive vision of NHS Change Day and how this was used as a way
of motivating others to take action through narrative and stories.
Section 3.8 Outcomes: Collective Action shares learning from pledge-
makers and others about the experience of participating in a single day
of action and the effect that this had.
Section 3.9 Outcomes: Social Media draws together insights on the
extraordinary role that a range of social media and online technology
played in enabling Change Day to happen, how the potential of social
media was actively exploited at all levels and what else might be done in
future.
Section 3.10 Outcomes: A Special Kind of Grasstops Leadership
focuses on what NHS Change Day tells us about the role of senior
leaders in mobilisation efforts and the implications that this has for the
kind of leadership that they may need to offer day-in day-out.
Section 3.11 Outcomes: A ‘Dual Operating System’ extends learning
about leadership into the kinds of formal and informal structures that
were used by NHS Change Day and what this suggests about the value
for the NHS of more intentionally operating through hierarchy and
networks simultaneously.

Conclusion: Leaders Everywhere
Our conclusion is not only that NHS Change Day was an extraordinary
event which created significant new capacity but also that it helped to
model the development of distributed leadership that makes the most of
the standardising potential of hierarchy and the relational potential of
networks.
Recommendations
We include twelve recommendations that draw on the learning from
NHS Change Day 2012. These are intended as a contribution to NHS
Change Day 2014 and to assist others around the world interested in
applying a Change Day approach.
Stuart Sutton – GP, Becton Surgery, East London
Core leadership team
Originator of the first tweet with Helen Bevan

CHAPTER 1: THE NATIONAL STORY
1.1 A Time of Enormous Challenge
Change Day occurred in a context in which the NHS was under great
financial, organisational and reputational strain. Although the government
had protected NHS funding, the service as a whole was looking to achieve
£20bn in efficiency savings by 2015. At the same time, the 2011 Health
and Social Care Act had ushered in a period of restructuring intended to
shift resources towards primary care by giving responsibility for
commissioning most services to Clinical Commissioning Groups led by
GPs. Amidst these financial and structural challenges, NHS staff – like
other public service employees – were facing the consequences of the
government’s austerity programme in the form of an agreement to a two-
year pay freeze in order to avoid compulsory redundancies.
Concern about patient safety and the standard of care provided the
constant background to this period of challenge for the NHS with regular
media coverage of perceived failings and shortcomings. The long-running
series of inquiries into major failings at Mid-Staffordshire NHS Foundation
Trust exemplified this concern and published a series of damning reports
with wide-ranging recommendations.1
The inquiry was due to issue its
final report in February 2013 – one month before NHS Change Day.
This combination of factors created a climate in which NHS staff were
under considerable internal pressure and frequently negative external
scrutiny. In the midst of this reality, many cynics dismissed the Change Day
effort. Some felt that “committing” to a pledge was another way for line
managers to get people to comply with improvement measures by
dressing it up as applying ‘social movement theory.’ Others argued, “It is
already our job to improve the NHS; why should I treat this day differently
from any other?” Still others worried that it was a politically charged effort
and wished to remain neutral. Some were too exhausted by their day
jobs, admitting that they didn’t want one more thing to have to do. And
others felt that the effort would not produce measurable impact, citing
pledges as “insignificant.” These cynics watched from the sidelines as an
explosion of energy and commitment from frontline staff created a
different reality. Jackie Lynton from the NHS Change Day core leadership
team stated: “At the end of it, onlookers shook their heads and asked
‘How on earth did this happen?’”
It was as though NHS Change Day 2013 connected with a certain mood
amongst those facing financial pressures, reorganisation and the imminent
publication of the final Francis Report into the failings at Mid-Staffordshire
NHS Foundation Trust. The timing suggests the importance of the ‘sense of
urgency’ that surrounded NHS Change Day, as it provided an opportunity to
transform people’s anger or frustration into constructive action.
The British people undoubtedly have a special relationship with the NHS.
In a recent national survey, people said they cherish the NHS more than
the Royal Family or the
armed forces (Katwala,
2013). Politician Nigel
Lawson famously
described the NHS as
“the closest thing the
English have to a
national religion”
(Katwala, 2011).” It is
difficult to imagine any
other country that
1
The inquiry was led by Robert Francis QC, and the reports are referred to as ‘the Francis report.’
NHS featured in the Olympics 2012

would, without irony, celebrate its health service in front of the world at
the Opening Ceremony of the Olympic Games. NHS Change Day
harnessed its people’s pride and passion for a system designed to take
care of its own.
The NHS is also the biggest health system in the world, serving the needs
of a population of 54 million people.2
The sixth biggest employer in the
world, only the U.S. Department of Defense, the People’s Liberation Army
of China, Walmart, and McDonald’s have more people (Alexander, 2012).
Everyday a million patients use the services of the NHS. It is a massive
complex system – and as such, not easy to change. Yet NHS Change Day
marked the single biggest improvement event in any organisation in the
world. Why? Each and every one of its workforce of 1.7 million employees
were treated as potential leaders of change.
1.2 The Birth of NHS Change Day
The story begins in 2012 when a conversation began on Twitter between
a GP and healthcare improvement thought leader. GP Stuart Sutton had
just attended Helen Bevan’s talk on “Building Contagious Commitment to
Change” as part of the learning programme run for Darzi Fellows by the
King’s Fund. Helen had worked for years to apply social movement
principles to improving health care, in part as a response to some existing
change initiatives using Lean, Six Sigma and other industry approaches.
Trained in community organizing methods, Helen encouraged others in
the NHS to learn from leaders of great social movements, people who had
few resources, no hierarchical and positional power, but who delivered
results by building power through collective action.
During her presentation, Helen asked the audience to describe the projects
that they were working on. 70 percent described cost-benefit efficiency
projects; and 30 percent described projects focused on quality, patient
care or the safety-experience. Helen then challenged her audience to
consider how the design of projects generates commitment from others.
Was anyone up for doing something differently?
Helen’s provocation got Stuart thinking, and after the training he and
Helen exchanged Tweets. They agreed to meet and talk more about what
“mobilising young clinicians” across the NHS might look like. Paediatric
trainee, Damian Roland, joined the conversation; and Helen encouraged
Stuart and Damian to take seriously their passion to make a difference for
patients. Even though emerging clinicians like Stuart and Damian might be
perceived as powerless and at the bottom of the NHS hierarchy, Helen
understood that young people historically drive change, and that effective
leadership comes from within a constituency, not outside it. In fact, in
1948, it was the new generation of doctors who lived through the war
that were instrumental in overthrowing the established order and securing
the establishment of the NHS in the first place.
Stuart and Damian recruited other emerging clinical leaders to explore
ideas over the course of two conference calls. The make-up of this group
reflected the engagement of Generation Y, who in previous years had
been focused on completing their clinical training and kick-starting their
careers. This growing cadre of younger leaders were active on social
media, ready to engage in change, and passionate about making a
difference for patients.
1
The inquiry was led by Robert Francis QC, and the reports are referred to as ‘the Francis report.’

They ultimately took their inspiration for Change Day from Earth Hour, a
worldwide event organized by the World Wide Fund for Nature (WWF),
that encourages households and businesses to turn off their non-essential
lights for more than one hour to raise awareness about the need for
action on climate change. The first event took place at the end of March
2007, when 2.2 million residents of Sydney participated by turning off all
non-essential lights. Following Sydney’s lead, many other cities around the
world adopted the event. By 2012, it was taking place in more than 7000
cities and towns across 152 countries and territories.
The emerging clinical leaders’ initial questions were about what the NHS
could do that was equivalent to turning the lights off. They asked
themselves, “What should we use as our goal? Should we identify a
specific action that we want everyone to take, or should we leave it to
people to take action that is meaningful to them? How will we measure
outcomes? Who owns Change Day, and how do we allow it to be led –
and remain led – by the grassroots?”
The main difference between Earth Hour and NHS Change Day is that
Earth Hour is an umbrella movement that brings many organisations and
activists together in a common cause. NHS Change Day is a movement
largely inside – and alongside – a hierarchical system.
Jackie Lynton played a special leadership role in bringing this about. As
Lead Associate for Thought Leadership & Change Model at the then-NHS
Institute for Innovation and Improvement, Jackie sat in on an early
conference call among the emerging clinical leaders. She immediately
recognized their idea as a mobilisation project and saw its potential.
Jackie established a strong coaching relationship with Damian, who
initially wanted to give people a menu of two to three national pledges to
choose from, in part motivated by a desire to measure impact.
Based on her own experience as a former clinician, Jackie encouraged him
to consider the power of “not telling people what to do” but of giving
them the opportunity to decide for themselves. With her coaching, the
emerging clinical leaders together decided it was critical to maintain a
balance between igniting frontline engagement and using the leverage of
the hierarchy to make positive change happen as a voluntary grassroots
effort. They wanted to create “leaders everywhere.”
Out of their initial leadership grew a core leadership team that recruited
other members with particular technical and organisational expertise. The
role of the core leadership team was to organise and mobilise people and
put in place a range of channels, activities and platforms – particularly
through relationships and social media – to enable individuals amongst the
NHS and its supporters to join the effort.
Members of the core team included: Damian Roland (Paediatric Senior
Registrar), Stuart Sutton (GP), Pollyanna Jones (NHS Graduate
Management Trainee), Kat Trimble (PR and Communications), Jacqui
Fowler (Social Media and Knowledge Management), Joe McCrea (Social
Media Strategy), and a team of improvement leaders from the NHS
Institute including Helen Bevan, Rachel Douglas-Clark, Michaela Firth,
Stuart Hill, Jackie Lynton, and Alan Nobbs.
The ongoing coaching dynamic between the emerging clinical leaders and
improvement leaders played an important role. The improvement leaders
provoked the clinicians to take action, serve as role models, and act as
spokespersons. Meanwhile the improvement leaders helped the clinicians
develop leadership skills and a campaign structure. In turn, the clinicians
provided leadership ‘from within’ the frontlines of the NHS. They provided
the effort with real credibility among the clinical community.

Over the course of the next few months, the core leadership team worked
together in the following way: they had one half-day strategy session to agree
to the goal, shared purpose and campaign plan; a weekly 1-hour WebEx
meeting to agree to ongoing tactics and actions; hours of spontaneous
coaching and support across the team; calls to action to keep their energy up
and motivate each other; and support from an oversight group made up of
senior leaders. Here is what they did with that.
1.3 From Zero to 189,000 Pledges
The first challenge the team faced was to decide on a commitment-based
goal. In other words, they could not create “leaders everywhere” through
compliance; NHS Change day had to be underpinned by intrinsic
motivation around shared values, one that anyone could commit to.
Initially they thought of asking everyone to take part to develop an
improvement project inspired by some of the best practices approaches
that already existed. Some thought a target of 500 projects might be
aspirational but reasonable. Others thought they could be more ambitious.
At a strategy meeting, the goal of achieving 65,000 online pledges was
agreed – 1,000 for every year of the NHS. This was a nerve-wracking
choice. How would they secure that level of commitment? After
brainstorming various ways in which this could be brought about, they
developed the concept of a single day of action. They had six months to
get there.
This is the campaign chart that sets out the leadership team’s timeline for
NHS Change Day and the “mountain top goal” of 65,000 pledges.
The next challenge point came in December. According to Alan Nobbs, the
team was working furiously to answer strategic questions like “How do
we get the message out? How do we filter it down? How do we help
people focus on pledges that are important? How do we structure
leadership, and how do we practice leadership? How do we enable
others?” Stuart Hill adds, “We were also facing our own challenges and
uncertainty. With the restructuring of the NHS, many of us faced
redundancy and redeployment. I personally felt challenged in giving
Change Day the energy it needed in the midst of all that noise.”

Damian Roland agrees. “We did struggle in December. We were hugely
behind schedule, we were revisiting the strategic direction, and
challenging personality dynamics began to emerge within the team.
Jackie Lynton, in particular, exercised leadership by renewing our
relationships, shared purpose, and values to forge a new level of trust.”
Jackie Lynton looked at her role as an improvement leader in a particular
way. “I saw my role as fending off internal and external resistance to
enable our young leaders to unleash their energy. It was about enabling
them – and all the members of our team – to do what they were good at.
It personified the whole effort. I was saying I am here to support you, I am
here to enable you, I will deal with the rubbish. That is what our pledge-
makers did too. Their pledges say the same thing to our patients.”
The New Year was a New Year. January marked the public launch of NHS
Change Day, and that in and of itself energized the team. Along with it
was the public release of the NHS Change Day video and website. The
team saw its own “story of us” personified in the urgent call to action
brought alive on camera and online. Stuart Sutton pointed out, “The
public launch was a breakthrough moment. We got our narrative right,
we made the connection to people on the frontlines real, and the film was
a brilliant recruitment tool. When I showed it to people, they got it!”
After the launch of Change Day, the number of pledges started slowly
rising. Although the core team had built a lot of relationships and asked
many organisations and individuals to make pledges before or on the day
itself, nothing could have prepared them for what happened. In the final
month before 13 March, Change Day took off.
The Francis Report was released on 6 February. It provided an urgent
challenge to call people to action. Feedback and requests for support
began to pour in from organisations and individuals. Social media
channels began to build traction and traffic. On 14 February, the total was
5,000. By 21 February it had grown to 43,000, and by t March it stood at
80,169 – breaking the target with two weeks still to go.
The 100,000-pledge mark was broken at lunchtime on Monday 11 March.
By the morning of Change Day itself, there were 130,000 pledges
registered on the website – double the target.
Liz Saunders from the healthcare policy think tank, the King’s Fund,
blogged and tweeted on the evening before NHS Change Day: “If ever
you’re losing faith that there is the energy to make a difference in the
NHS… there are more than 130,000 pledges on there, people actively
choosing to make a difference to the services they provide and to patient
care. It’s uplifting.”
Change Day pledges poured into the online site throughout the day.
The focus of NHS Change Day was England, but people caught the spirit
in Ireland and made over 13,000 pledges from there. By the end of
Change Day, 182,000 pledges had been received. Over 50,000 had come
in on the day itself. A further 1,000 were added the day afterward, and a
further 7,000 before the end of March – hitting a total of 189,000
pledges listed on the Pledge Wall. That does not account for those who
did not list their pledge, which is estimated at over 300,000.

The success of Change Day led well-known NHS commentator, Roy Lilley,
to declare: “Sometimes an event comes along that simply and
fundamentally changes things. They call it a ‘gamechanger.’ The dictionary
definition is ‘a newly introduced element or factor that changes an
existing situation or activity in a significant way.’ Well, I think we have a
new Gamechanger. It’s called NHS Change Day. It happened this week,
and it came from the NHS grassroots.”
1.4 Summary of Quantitative Research & Results
What did the effort result in? What can be gleaned from the patterns
within the pledges?
• The most profound finding was that ‘it can be done.’ NHS staff can be
mobilised to take action around shared values. Over 189,000 pledges
were submitted to the NHS Change Day website, and this total was a
fraction of the pledges made and carried out that day. As Joe McCrea,
the Social Lead of the core leadership team, quipped, “This thing could
have been a heroic failure in which case lots of the people who are now
saying that they were always supporters would have been pillorying the
core team!”
• Since March, a quantitative analysis of the pledges was conducted.
Survey research shows that the primary motivation for people to get
involved in Change Day was to improve patient care, closely followed
by “I wanted to make a difference,” and “I wanted to learn from
others.” In contrast, the two least motivating factors to get involved in
Change Day were “because I was told to” and “because I was asked
to.” This finding demonstrates that intrinsic motivation around share
values was critical to Change Day’s success, not strategies based on
compulsion, compliance or exhortation.
• 54 percent of pledges on the website involved action taken by a single
individual; 71 percent involved fewer than nine people; and 94 percent
involved fewer than 50 people.

• Overall, 25 percent of NHS organisations took part. NHS Trusts led the
way, in addition to wide support received from NHS-aligned
organisations and individuals. There is still room for improvement for
engagement at CCGs and GP practices in particular, as only 5 percent
of CCGs and 0.1 percent of GP practices were engaged (see left).
• 68 percent of pledges focused on better patient care or spreading
innovation. 10 percent targeted personal development; 10 percent on
using services effective; 7 percent on celebrating services; and 5 percent
on implementing integration (see left).
• 36 pledges encompassed almost 3,500 people involved in simply
‘smiling’ with fellow patients or staff (see below).

Other metrics and patterns have been summarized in “The Difference a
Day Makes – Interim Report from NHS Change Day,” published in May
2013, “Biggest Ever Day of Collective Action to Improve Healthcare that
Started with a Tweet” posted to the Management Innovation
website in June 2013, and “What Did NHS Change Day Pledges Tell Us
About What Matters to Staff and Patients?” submitted in June 2013.
These publications also include metrics around the use of social media, a
topic that is discussed in Chapter 3 of this report.
But what can we learn from pledge-makers themselves? This is where the
spirit and soul of NHS Change Day was made real, where the action made
a difference to patients and practices. The above-mentioned NHS Change
Day publications describe many excellent and inspiring examples of
pledges received. This report does not. Instead, it looks carefully at four
different pledges and draws out the qualitative learning from
pledge-makers.
Victoria Stead, Receptionist,
Becton Surgery, East London

CHAPTER 2: THE PLEDGE-MAKERS’ STORY
One version of the NHS Change Day story is what happened to initiate it
and enable it to grow. This is the story that we told in Chapter 1. Another
version of the story is about pledge-makers on the ground and how their
actions made Change Day real to NHS staff and patients. In this chapter
we look at four distinct pledges in detail to understand their stories and
draw out the lessons they can teach us. These pledges come from (1) NHS
Arden Commissioning Support, (2) Open Minds Alliance Community
Interest Company, (3) Derbyshire Community Health Services Trust, and (4)
Steve Fairman of NHS England. (Three additional pledge-makers’ stories
are included in Appendices A-C; and we draw on some of their learning
in Chapter 3.)
Before exploring these examples, it is important to note that the “behind-the-
scenes” work of the leadership team was invisible to almost all pledge-
makers. Most were exposed to the website, a video, possibly an email or a
Tweet. Colleagues encouraged them by word-of-mouth to make a pledge.
It appeared as an opportunity to many people to take an idea and make it
real, to link existing local work to national purpose, or to step outside of habit
and try something new – without asking anyone for permission.
2.1 The Story of NHS Arden Commissioning Support
The pledge: Working with three local Clinical Commissioning Groups
(CCGs) (NHS Coventry and Rugby CCG, NHS South Warwickshire CCG,
and NHS Warwickshire North CCG), a team of over 50 NHS
Commissioning Support Staff, lay people and patients formed a volunteer-
based NHS Change Day team. They went into shopping centres,
supermarkets, hospitals, GP surgeries and on the streets to ask people’s
opinions about the NHS. The event took place from 9am to 7pm on 13
March at 17 different locations across Warwickshire and Coventry.
Anna Burns, the Director of Strategy & Engagement at the NHS South
Warwickshire CCG, explained: “Volunteers employed a four-step
discussion with individual members of the public that drew on the
importance of patient-feedback as outlined in the Francis Report. First, we
told them, ‘Today is NHS Change Day. If you could make a change to your
local NHS, what would it be?’ Then we asked, ‘How well do you feel the
NHS listens to you?’ Next we used it as an opportunity to explain the
restructuring of CCGs and how it would affect them. Last we recruited
volunteers to serve as Health Champions. Everyone had a clipboard and
discussion form for responses. We spent about twenty minutes with each
person, and spoke with a total of 450 people.”
A logistics team coordinated with contacts at each local site, secured
public liability insurance, staffed each site with volunteer coordinators, and
provided the requisite materials to each volunteer. Although volunteers
approached members of the public individually, they were assigned to
subgroups of two or three in order to support one another. The leadership
team recruited volunteers via email and personal asks and thanked
everyone afterwards.
Why this pledge: Rebecca Davidson, the Communications and
Engagement Lead, explained their reasoning. “In response to the Francis
Report, we translated our pledge as going into the community to ask
what changes the public would like to see and how well the NHS listens to
them and their concerns. Change Day was also happening during a huge
time of change with the establishment of CCGs. It was a timely reminder
to the public about the restructuring going on and how it affected them.
And it was really important that we have a vibrant engagement
programme, so we used the opportunity to recruit Health Champions.
Those were the main drivers for us.”

How they got involved: Anna Burns explained: “Jackie Lynton (from the
national NHS Change Day Team) asked us to consider getting involved.
To be honest, NHS Change Day did not connect with us as an organisation
in terms of making individual pledges. We are in a market town in a semi-
rural area among a predominantly middle-aged white male group of GPs
that are engaged in improvement, but not in this fashion. In addition,
March is one of the worst months for us because of the timing of the
commissioning process and the financial year starting on 1 April. If it
hadn’t been for Jackie reaching out, I’m not sure we would have done it.”
Outcomes: The NHS Change Day team communicated to the CCG
Governing Body that they should devise more opportunities for people to
offer feedback to the NHS on the services they have received. As Anna
Burns captured in her formal report on NHS Change Day to the CCG
Governing Body: “Face-to-face meetings are an important method of
communication for people to raise concerns, and it is important that the
feedback is recorded and acted upon. Work also needs to be done so that
people know how to provide feedback, and to demonstrate that providing
feedback makes a direct difference to improving services… It is essential for
the CCG to engage with the public and patients to ensure that their views
are fed into decision making and to ensure transparency.”
In addition, the CCG’s pledge allowed them to identify and recruit over
100 local Health Champions. Health Champions are invited to participate
in the CCG by (1) receiving regular news and updates about what is
happening in South Warwickshire’s health care services; (2) taking part in
surveys and consultations to influence the development of services and
how the CCG spends its money; (3) attending events, health seminars and
other patient and public involvement activities; and (4) engaging other
local people, patients and carers across the area. One in four people
surveyed on NHS Change Day agreed to participate in this programme,
which accounts for one in ten of the presently enrolled Health Champions
in the area.
Lessons: In the context of the pledge itself, the local team received direct
feedback about how to improve confidence in the NHS: reducing waiting
times; weekend opening hours for GP practices (and/or access to get an
appointment should be improved); better communication, including more
information available in different languages; a helpdesk available for when
service goes wrong; less political involvement; better staff training;
improvements in care; and doctors focusing more on care and less on finances.
As for feedback to the NHS, 34 percent of respondents previously offered
feedback about NHS services. Of those that provided feedback, most did so
face-to-face, with letter being the second most popular method of
feedback, email the third most popular, and phone the fourth. The majority
of respondents preferred not to be anonymous in their feedback.
There were a variety of reasons for not offering feedback, including: not
knowing how to provide it; thinking it would be a ‘waste of time’ and not
used or applied; being happy with the services and therefore no perceived
need; or feeling decisions were already made. This taught the CCG that
they should do more to let people know how to provide feedback and
demonstrate it makes a direct difference to improving services.
From a NHS Change Day perspective, the team felt the ‘urgency of the
moment.’ Between the Francis Report and upcoming changes to CCGs,
there were many reasons to engage the public more broadly. The team will
use this learning to develop future pledges in the real and present context
“of the ‘moment’” when future Change Days occur.

Team members also valued forming relationships with the public face-to-
face, which also proved an effective strategy for recruiting a large number
of Health Champions. Making personal connections allowed them to
motivate members of the public to join the Health Champions
programme. In turn, volunteers valued the opportunity to take on a
public-facing role. Team leaders also built relationships with contacts from
respective venues, and the CCG is likely to go back – or has already been
back – to those places for further outreach.
In addition, NHS Change Day provided an opportunity for senior leaders in
the CCG (15 people) to work directly with GPs and registered nurses (22
people), as well as lay people and members of the public. As Directors,
Anna Burns and Rebecca Davidson reported the benefit of spending time
as a larger team and working toward a shared purpose. This kind of
activity allowed them to build stronger relationships across hierarchical
and organisational boundaries. Team members are now able to share ideas
more readily and make better decisions together because they can call on
shared experiences with one another that demonstrate their willingness to
improve to the NHS.
Changes in thinking and leading: Anna Burns reported, “Because
people are not inclined to give feedback, when they do, the ability to offer
that feedback face-to-face is a really important mechanism. That was our
biggest take-home message. We use social media and websites for
outreach, but what is important is to talk to patients and the public face-
to-face. We need to make ourselves more accessible and talk to people.
That really took me by surprise. To get feedback, we have to be visible, we
have to ask for it. It helps us to see how others see us; and it helps them
to feel heard by us. Putting a response form on a website is insufficient.
People want to talk.”
The team has subsequently run campaigns and involved volunteers in
direct outreach with the public. They also use press releases, Twitter,
websites and other social media to build capacity around programmes like
Health Champions. They feel it is good to communicate more often and
more effectively with the public, especially face-to-face, and to invite the
public to offer direct impact on the kind of care the CCG provides.
NHS Change Day approach: As Anna Burns reported, “Although we felt
connected to the national effort, for us, this was a very local pledge.
We tweeted a photo of our team at the market in Coventry to the wider
NHS Change Day effort, but really this was about Change Day in
Warwickshire and Coventry. Our people knew less about the national
effort than they did about our local action.
“Our particular CCG has 15 staff. We are always asking them to improve
things, that is our job. Change Day feels a little bit like a false concept,
because we should be continuously improving and finding solutions every
day to benefit patients. As a team we role model this behaviour, we do
not accept mediocrity, we expect things to be better. NHS Change Day is a
useful reminder to all of us that we cannot become complacent in what
we are doing. Organisations who feel competent fail. If we are reminded
to improve – at improvement – we will continue to try harder.
“I invited the GPs to join NHS Change Day and asked whether they
wanted to do something in their own practices; no one wanted to do it.
Some people feel differently [about this approach], and we have to accept
those differences. Not that they don’t get engaged – they do in their own
way! But we can’t make people ‘do’ things. We have to meet people
where they are. They saw what we did. Next year they may feel that it is
relevant to them. But it is not our job to impose it, just to encourage and
support.” That is the spirit of Change Day.

“We positioned our pledge to coincide with Change Day, but we were
planning to do it anyway. We framed it that way among our CCGs and GP
practices, so they knew that it was important to us, whether or not it was
a part of Change Day. It was important to keep the pledge simple, to align
it with what we were already doing. It had to be low-key, with a low-
threshold to be involved. We didn’t spend extra money on it, we asked
people for 3-hours of their time. We used resources we already had.
“We might look at Change Day through a different lens. The fact that
people said that it was so motivating to feel empowered to take action on
one day, that signals that the rest of the time they don’t. That is a much
bigger problem for the NHS. NHS Change Day should be every day!”
2.2 The Story of Open Minds Alliance Community Interest
Company
The pledge: “I pledge to share we can all get through distress and suicidal
thoughts. There is always help/hope via U Can Cope
www.connectingwithpeople.org.” This pledge was posted on 8 March, one
week before NHS Change Day, with thousands of actions taking place over
the following weeks. The pledge was supported by a team led by Alys Cole
King, a Consultant Liaison Psychiatrist, together with the Open Minds Alliance
Community Interest Company, based in London and North Wales.
Open Minds Alliance CIC was established in 2010 and provides suicide
prevention training and resources aimed not just at medical professionals
but society as a whole. As Alys Cole-King and Gavin Peake-Jones explain,
“our belief is that emotional distress, and tragically, suicide still affects and
takes far too many lives. We felt that responsibility for people with suicidal
thoughts was seen to lie with specialist mental health services and others
were more nervous to get involved. However we knew that early
intervention from a colleague, friend, compassionate health provider or
care giver could make a real difference to saving lives.”
From the outset the objective for Open Minds Alliance CIC was to secure
as many supporters of the pledge as possible. The pledge was deliberately
crafted so that it would appear in a single tweet – the aim being to secure
as many re-tweets as possible.
In order to support the pledge, each individual or organisation had to
commit to take some specific action that would spread the message of the
U Can Cope campaign and direct individuals to resources that could help
them if they were troubled by suicidal thoughts. “We had to be sure that
it was not just a paper exercise,” explains Alys Cole-King. In practice this
meant that every supporting organisation had to communicate the U Can
Cope message to their members, supporters or staff.
Why this pledge: For Open Minds Alliance CIC, participating in NHS Change
Day was about much more than a publicity or marketing drive. Their
approach to suicide prevention is built on a belief that it is possible to develop
the protective factors of each individual and help them to gain knowledge
and control over suicidal thoughts and impulses. Alys Cole-King describes this
as, “a compassionate alternative to the so-called ‘management’ of suicide
risk…it promotes a role for all, and recognizes that each encounter with an
individual with suicidal thoughts is an opportunity to intervene and potentially
save a life.” When she talks about promoting a role for all, she really does
mean all: the resources made available by Open Minds Alliance CIC are
intended to be used by everyone and anyone.
How Open Minds Alliance CIC got involved: Alys Cole-King has been
working collaboratively for many years on the issue of suicide prevention

and has a wide range of national contacts. One of these contacts, Kath
Evans, is Head of Patient Experience for NHS England and has worked
closely with a number of the NHS Change Day Core Team. When Kath
heard about NHS Change Day she immediately thought of Alys and the
work of the Open Minds Alliance. Kath knew Alys and her colleagues
were looking for a way to effectively engage the wider NHS and might be
attracted by the possibilities offered by Change Day. So she got on the
phone and invited Alys to make a pledge.
Outcomes: The U Can Cope pledge secured over 58,000 supporters –
more than any other single NHS Change Day pledge. As the Open Minds
Alliance CIC team point out this is an especially remarkable achievement
given the social stigma associated with suicide. “Change Day had an
amplifying effect,” explains Gavin Peake-Jones. “It enabled us to get to a
much wider range of people. It has been a catalyst to broaden thinking
about suicide and has enabled us to have impact at all the different touch
points. By breaking down stigma, people will get the support and
resources that they need.”
Open Minds Alliance CIC was notably successful in securing the support of
a number of large organisations both inside and outside the NHS.
These included The Royal College of Psychiatrists, The Professional
Cricketer’s Association and The Rugby Player’s Association – all of whom
committed to take action. In the case of the Betsi Cadwaladr Health
Board, where Cole-King is Consultant Liaison Psychiatrist, this included
handing out leaflets to staff and patients, two direct emails to all staff and
coverage in internal newsletters. “It was absolutely unprecedented,”
reflects Cole-King. Other supporters included the College of Emergency
Medicine, which communicated the U Can Cope message to all its
members via its newsletter and Twitter and Barnsley Metropolitan Borough
Council which put a mailshot through every home in their locality.
From their own research, Open Minds Alliance CIC knew that people who
are in distress tend to be seen first in primary care and that there is a
deficit of training and resources in that area. As a result of contacts made
and supporters recruited through NHS Change Day, new work in this area
has begun, for example in Dudley & Walsall where Open Minds Alliance
CIC is working across mental health teams and their partners.
The overall success of NHS Change Day has provided an additional and
unexpected impact for the work of Open Minds Alliance’s partners.
“Being part of Change Day provided a greater level of credibility for our
work,” says Kirsty Thomson, Head of Fundraising at Awyr Las Gogledd
Cymru – a funder and close partner of Open Minds Alliance CIC. “To be
able to talk to future supporters and to speak to our bosses about the
impact of the work – their ears pricked up when they heard it had been
part of NHS Change Day.”
Lessons: Open Minds Alliance CIC is located in North Wales and Alys
Cole-King is based at Health Board within the Welsh NHS (not the English
NHS). While Open Minds Alliance CIC works extensively with the NHS in
England, the Welsh team’s distance from London is one reason why the
advantages of being part of a single day of action stand out for the team.
“The national platform brings a heightened level of awareness and
provides a focus,” says Gavin Peake-Jones. “Change Day is something you
can’t avoid.” According to Kirsty Thomson there was also value in
participating alongside others: “Seeing that there is a national Change
Day was inspiring. Understanding that it’s not just people on the periphery
who want to make change happen but people throughout the NHS. There
was a sense of solidarity – of not being on your own. Feeling part of
something bigger is a really important factor.”

NHS Change Day approach: Alongside the focus and solidarity created by a
single day of action, the team at Open Minds Alliance CIC was also struck by
the way in which Change Day gave permission for people to initiate and
embed change. “The national day was symbolic – giving people the time and
space to think about the change they would like to make.”
In addition the structure of Change Day itself reflected a different
approach to culture and organisational change that resonated strongly
with the approach of Open Minds Alliance CIC:
• “The way in which NHS Change Day was formulated – people
identified issues for themselves and others could sign up or not – meant
that it was self-selecting. What came up were the issues that mattered
to people.” (Sian Peake-Jones)
• “In the same breath as talking about the change we were also talking
about being part of Change Day. It allows people to get on with things
and breaks down barriers.” (Gavin Peake-Jones)
Although he now gives much of his time to Open Minds Alliance CIC,
Gavin Peake-Jones has a professional background in organisational change
having worked for the likes of Marks & Spencer and Ford as well as
founding a successful social enterprise. He saw NHS Change Day as a rare
example of a large organisation demonstrating that it understood the
complexity of the change process “rather than seeing the organisation as
a machine with inputs and outputs.” For Peake-Jones, “working with
people at the grassroots to set strategy is critical.” This was one of the
strengths of Change Day as it enabled a flow of ideas between the people
who were pledging. In this way Change Day “created the right systems
and processes to enable the change to take place.”
Changes in thinking and leading: Open Minds Alliance CIC recognise
that as innovators they have tended to work in ways that are not
universally adopted within the NHS. “I’m an enthusiastic user of Twitter,”
says Alice Cole-King, “which led to raised eyebrows from some
colleagues!” One of the successes of Change Day was that “it inspired
people who may not normally engage in social media. It showed how it
can enable individual nurses, physios – frontline staff – to collaborate.”
In addition the team itself valued the changes in their own thinking
prompted by their interactions with a whole new set of contacts as a
result of Change Day: “We’ve had people asking us challenging questions
and asking us to do things slightly differently. NHS Change Day has been a
catalyst to broaden our thinking.”
Gavin Peake-Jones reflected that Change Day had the effect of generating
new points of leadership in the NHS, of which Open Minds Alliance CIC
was just one: “Change Day is a national initiative that gives us permission
to initiate culture change.”
It is perhaps not surprising that Open Minds Alliance CIC was able to
make such good use of the opportunities of NHS Change Day. After all, as
Gavin Peake-Jones says, “there is a campaigning quality to our work.
We’re passionate about embedding change. We want to be that change.
It’s not a routine job for any of us.” Or as Alys King-Cole concludes, “It’s
also a very enjoyable activity. These are the things that motivate us when
we go to work – making a difference for people.”
2.3 The Story of Derbyshire Community Health Services Trust
The pledge: The staff of the Derbyshire Community Health Services
(DCHS) Trust made a corporate pledge to “identify and support Innovation
Scouts” through a local “NHS Change Week.” Individual and team
pledges included pledges on Change Day and Change Week – and some
are ongoing today.

The corporate energy for the pledge came from the Service Improvement
team who secured a Board commitment to support a Change Week to
coincide with Change Day. Led by Ian Murray (Head of Service
Improvement & Innovation), Donna Clemens and Helen Short (Service
Improvement Managers), the Service Improvement team communicated
directly with the 200 voluntary Innovation Scouts asking them to make
personal pledges for NHS Change Day and to recruit others in their part of
the organisation to do the same: “the Improvement Leadership Training
they had all taken was voluntary so we already knew they were passionate
and engaged about improvement and creative thinking. We knew most of
them would say ‘yes’ – and they did!”
“We wanted to make sure that most people knew about Change Day,”
explained one team member. “So we put together a PR campaign which
included email invitations to all staff to join in Change Day and Change
Week. The ‘comms’ team was great! We had a 10-day count down with
daily emails including the Change Day branding asking ‘what are you
going to do to make a difference?’ and we highlighted the pledges that
the Chief Exec and other members of the Exec Team were making.” As
part of the PR strategy the Service Improvement team developed a ‘menu’
of pledges which they encouraged staff to adapt, adopt or use as a
prompt for their own thinking.
The Service Improvement team was keen to ensure that Change Day and
Change Week fast-forwarded change in a sustainable way. They launched
the ‘My Idea’ email address as part of the Change Day/Change Week
campaign and most of the DCHS pledges were made using this route. This
meant that all the pledges came through to a single point in the Service
Improvement team: “It was important to understand who was making
pledges and where they were in the organisation. It meant that we were
able to provide support and enable corporate pick-up where appropriate.”
The team created a local ‘pledge wall’ and all the DCHS pledges were
uploaded to the national NHS Change Day website.
One Innovation Scout on each of the Trust’s sites volunteered to raise
awareness of Change Day and to promote it amongst teams.
During Change Week they were asked to make themselves as visible as
possible to encourage people to make pledges.
Why this pledge: DCHS has taken a proactive approach to supporting
innovation for a number of years. A survey identified that staff often
didn’t know where to go or what to do with their ideas for innovation and
change. DCHS therefore developed an innovation infrastructure which
included identifying volunteer Innovation Scouts who were provided with
Improvement Leadership Training. Innovation Scouts came from all parts
and levels of the Trust and so could act as “the eyes and ears of the
organisation… if staff came up with an idea they would be the first point
of call.”
The Service Improvement team had aspirations to go further. They wanted
to make it as easy as possible for members of staff to share their ideas and
get the support they needed to make them a reality. The Service
Improvement team therefore planned to launch a dedicated ‘My idea’
email address with a commitment that each email would receive a
response within three days including a short plan setting out the support
they could provide.
Change Day “seemed like an ideal catalyst and was a driver to publicise
and fast-track some of the things that we were already thinking about.
We brought things forward because Change Day created a deadline.
We thought ‘let’s get it done for Change Week’ so that we can promote
a full end-to-end model that people can have confidence in.”

How DCHS got involved: Members of the Service Improvement team
responded to early adverts for NHS Change Day and brought it back to
the team and organisation. The team saw NHS Change Day as an
“exciting opportunity to motivate and engage staff in innovation and
change.” In particular the team viewed NHS Change Day as a way to
“mobilise and motivate” the 200 Innovation Scouts already developed
within DCHS and to “to get them to influence harder to reach groups.”
Outcomes: In total over 500 teams and individuals made over 150
different pledges: “Big themes appeared around talking and listening
more; with patients and with staff. Seeing things from different angles
and perspectives to ensure we are managing our staff in the best way and
delivering care in the way our patients want. This has lead us to having a
drop-in at our AGM where we will be asking patients about the best way
to communicate…what they think about our services which isn’t
necessarily a complaint or a compliment, this could simply be small things
they think could make a difference.”
The Harlem Shake: DCHS Healthy Work Champions in the Health Records
Team at St Oswald’s Community Hospital pledged ”to be active in our
workplace as part of our health and wellbeing.” During Change Week
they ran a range of drop-in activity sessions for staff which ranged from
yoga to Nordic walking. To promote this pledge and encourage
participation in the sessions they made a video of themselves doing the
Harlem Shake which they posted and which became a local sensation with
over 2000 hits. Not only did this help to bring 100 people to the sessions
it also helped to create a buzz around Change Day in DCHS. “All in all this
was definitely worth doing and worth all our hard work and effort, and
from the feedback we have received from staff they all really enjoyed it,
and were very grateful to us for giving them the opportunity to get
involved, look at new things, and really take a look at themselves (which
we don’t very often have time to do),” Nicola Shaw, Medical Secretary.
Podiatry Services: Danny Connor, Podiatry Manager, pledged “to obtain
patient questions via video and play at team meetings to discuss feedback
and communications to patients/service users” as a way of enabling
patients “to tell their own story, in their own words, in their own way.”
Staff reported that sharing the experience of patients in this way “brought
patients into the room… ensuring that patients remain at the heart of
what we do.” As a direct result of video shot during NHS Change Week
there have been improvements in signage, patient information and
notification.
The team now embraces this way of capturing the patient experience:
video items have become a regular feature of agendas and videos are
shown quarterly at team meetings. Video replies from the Podiatry
Manager responding to patients’ ideas, observations and questions are
also provided “to present a ‘face’ to the public (as opposed to the faceless
management!)” There are now plans to roll out this approach to capturing
patient experience across DCHS. DCHS is also looking at other ways to
develop this pledge such as filming staff with questions for governors and
managers to be discussed at leadership and staff forums.
The ongoing impact of Change Day can still be felt at DCHS: “We’ve got
initiatives that have happened and are continuing as a result of Change
Day. It allowed a bigger footprint of opportunity within the organisation to
have permission to make a difference. It allowed people to channel ideas
through a framework. Before, they might have been lost or forgotten
before they had been able to grow. People now know where to go for
support and we can help nurture them.”

The Service Improvement team have been continuing to support many of
the Change Day pledges through their ‘Let’s Keep it Going’ programme.
This has included visiting teams and individuals who made pledges to
discuss sustainability and to identify barriers and blockages. Change Day
has become part of the improvement and innovation landscape at DCHS:
“We keep talking about Change Day and feature it in our Trust comms
flyer to celebrate what we’ve achieved. The Chief Exec mentions it in
emails. The scene is being set for next year!”
Lessons: “The amount of effort that went into putting an effective PR
campaign together beforehand. We are a big organisation with over 4500
staff. Getting the message over in as many different ways as possible was
fundamental to making sure that people got involved.
“We needed to make it as easy as possible for people to pledge – e.g. having
the menu of pledges to sow the seeds which really increased take up.
“When we first heard about Change Day we thought it was a brilliant
idea but in some parts of the organisation there was a kind of ‘so what’
concern asking ‘what does it do for longer-term change and improvement
and change at scale?’ So we had to think about how we could make sure
that it wasn’t just one day without any measurable impact. Having the
pledges channelled locally meant they could be followed up after Change
Day and in some cases developed from local to corporate pledges.
“It remained entirely voluntary – the spirit about it is wanting to make a
team or an individual difference. I truly believe that for service
improvement one volunteer is better than 10 pressed men.
“Where there is something a bit different you start with the people who
are most committed and then you get some momentum which brings the
uncommitted and then even the most resistant.”
Changes in thinking and leading:
“We seem to be coming out of a culture where we’ve found we’ve had to
overtly give permission for staff to make a difference. In our Improvement
Leadership Programme we say ‘if you need it this is the permission to
make a difference’ and people say ‘oh, right, OK. We didn’t know we
could do that.’ NHS Change Day did that too.
“For the NHS, Change Day was a little bit different. To bring it into the
NHS had some foresight. But it was simple – it didn’t require complex
mobilisation; you could think about your pledge on the day and then carry
it out. You can make a simple pledge that will make a difference to a
single patient or a cohort of patients.
“Pledges were made where you think ‘we should be doing that anyway’
but in a lot of cases we don’t. It helped to bring you back to basics.
“It influenced the approach of managers and showed them the skill and
creativity they have in their teams. It demonstrated that people at the
front of their teams know their business better than others e.g. the
managerial support for the Healthy Working initiatives – I don’t think that
would have happened before.”

2.4 The Story of Steve Fairman, NHS England
The pledge: Steve Fairman, the Director of Business, Improvement and
Research for NHS England, pledged to spend a day shadowing a GP, James
Gray, in Sheffield; and he asked James for a reciprocal pledge to shadow
Steve for a day.
Steve spent a day in June with over 100 patients who came into contact with
members of James Gray’s general practice team. Throughout the day, Steve
shadowed two receptionists, a GP responsible for telephone triage, a GP
conducting home visits, and a GP doing in-patient surgery. He also shadowed
the practice manager. “I saw all ends of the spectrum in a single day.”
GP James Gray and practice manager Joanne Marshall now plan to shadow
Steve for a day. “I don’t want to make it easy for them; they are going to get
the nitty-gritty. They will be here when I have corporate decision-making
work. They are going to see that I spend a lot of time video-conferencing
because I can’t be in two places at once, and that is what a national job
demands. It is a very different way of working than on the frontlines.”
Why this pledge: Although Steve had been aware of NHS Change Day for
months, he had not committed to a pledge that was meaningful to him until
a few weeks before Change Day. “Over the years as my career developed I
got further and further from patients. I wanted to do something that would
engage me with the patients and also provide a reciprocal lens for someone
else to see what it was like at my end of
the NHS.”
How Steve got involved: Steve was first exposed to NHS Change Day
through his work with Helen Bevan on the Change Model and was a part of
the NHS Change Day Expert Oversight Group.
Outcomes: “People have asked me: What was the point of my day in
Sheffield? What has changed as a result? For me, my attitude has changed.
But I can’t show you that on a graph or a run chart. It will manifest its impact
because other people hear what I say or because I develop a relationship in a
different way or because I argue a point more persuasively by drawing on my
experience. Some people need numbers to understand change. I started my
career in information management, and I appreciate the numbers. But I’ve
moved on from that.
“I lead a lot of leadership development programmes for the NHS, and my
pledge has armed me with real life examples. I used to put up PowerPoint
slides with data and evidence and walk through them. Now I put up the same
slides and call on my experiences with GPs and patients to illustrate why a
particular idea is important…
“For instance, when I put up a slide that says ‘patient expectations are rising,’
I can tell the story of Mr. Jones. James and I visited Mr. Jones at his home and
found him lying on a sofa in the corner of the room watching television. Mr.
Jones did not greet James as his doctor but instead jabbed his finger at the
television and asked James whether he watches Embarrassing Bodies (the TV
show). James said no. Mr. Jones said, ‘Well, I have exactly what the guy on
last week’s show had, and I know exactly what needs to be done about it.’ I
saw how Mr. Jones’ expectations affected his encounter with James, their
relationship and the care he received. I realised how hard the work of the GP
is in dealing with those kinds of expectations before an exam has been
completed.
“I also tell people about Mr. Smith. While I was sitting with another GP
between surgery appointments, the phone rang from reception. ‘Mr. Smith is
here, can you see him?’ The GP said yes, send him in. Mr. Smith did not have

an appointment. He was in his early 80s and had dementia. The practice
agreed that they would care for him even when he turned up on the wrong
day to see his doctors. They agreed that whoever had space would find time
to see him. They also agreed with Mr. Smith’s daughter that they would write
any instructions for care on a brightly coloured card and put it in his top
pocket. She agreed that she would look for the cards and follow the
instructions. On this day, Mr. Smith needed long socks and cream for a sore
on his leg. I tell this story to demonstrate what a dementia-friendly practice
looks like.”
Lessons: “I was surprised at how profound an impact my pledge had on me.
I didn’t expect to learn many of the things that I encountered.
For example, I learned about the – sometimes directly conflicting – incentives
of ownership in GP practices. GPs are partners in small businesses. They all
have a vote, and unless they all agree to something within their group, the
practice as a whole cannot change.
This [approach] has potential to create a significant, even if not always
intentional, blockage to improvement.... There is a tension in having the
incentives of small businesses play such an important role in the NHS.
If we want to improve, we have to change the incentive structures.”
Changes in thinking and leading: In his day job, Steve is responsible for
developing transformational healthcare change programmes at a national
level. He has a varied background extending from academic social research to
health economics to demographic forecasting. He is also responsible for
helping develop a better evidence base to inform future NHS-wide decisions.
In Steve’s words: “Now that I know more about what happens at the
frontlines, I ask myself: ‘What are the gaps in knowledge that frontline
practitioners would find helpful if they could commission research on it?’
I am involved in a piece of work to identify research priorities from clinical
groups across the country, and I have asked two GPs from Sheffield to take
part because I want their views to be heard.
They believe they can do things in primary care that are currently being done
in secondary care. Initial studies suggest that they are right.
“My team needs to bring this kind of credibility to our work. It comes from
understanding what people at the front lines are doing and the issues they
are facing.
“I now seek out this kind of thing. For example, I work with a graduate
trainee. Usually she comes to my office, and we discuss issues pertaining to
where she works, the people she works with. I decided to take the train to
London to visit her at her hospital. Now I understand who her people are and
what her building looks like, and I can empathize when she tells a story. It is
important – not only to her training, but to the outcome of our relationship –
that I made this effort to understand her experience.”
NHS Change Day approach: “Change Day is a very important part of the
NHS. If we all have tools for change in our tool bags, as it were, Change Day
is a very important tool. It’s not a tool that everyone will want to use. I asked
my own team to make pledges, and not all of them did. I understand; it’s not
how most people in the NHS think change happens. I have many traditional-
thinking people on my team. Change Day is not their thing. They would
rather do some lean thinking down the corridor. But Change Day is about
doing something differently.
It’s not an expert telling you the best way to change; it’s not a consultant
working with you to create change. It’s about people seeing things from their
standpoint and saying: ‘I am going to change that’.

“I was so pleased that it came from the bottom up way of thinking about
change. Change Day empowers individuals in the NHS – and there are an
awful lot of them – to make change happen, no matter who you are.
Look, if half a million NHS staff commit to Change Day 2014, they are
making a powerful statement that the NHS needs to change. Half a
million people can spread the word about Change Day to everyone they
go home to. One of the potential sources of Change Day’s power is that it
is building a base for change.
“I have noticed that the reports about Change Day highlight numbers:
how many people did this, how many Tweets, how many pledges, how
many organisations, how many chief executives. Are they responding to
the critics who want to see measurement, metrics, impact? I don’t know.
But it leaves out the bigger lesson that we can learn from Change Day.
It is about leadership.”
Whizz Kidds featured on NHS Change Day at Healthcare Expo

CHAPTER 3: LEARNING FROM NHS CHANGE DAY 2013
3.1 ‘Impact’ or ‘Design & Outcomes’?
There is considerable debate about the ‘impact’ of NHS Change Day.
There are those who have been decidedly sceptical arguing that without
firm data showing the link between Change Day and an improvement in
patient care or specific cost saving, it is not possible to call Change Day a
success. It is certainly true that while there are many examples of specific
improvements detailed in this report and associated case studies, NHS
Change Day 2013 was not designed in a way that would allow
measurement against traditional improvement metrics. The appropriate
place for traditional improvements metrics to emerge within Change Day
is at the level of pledge-makers, and it is thereby a voluntary activity – as
part of a pledge.
Those involved in the design of NHS Change Day 2013 do not shy away from
this criticism and readily admit that “if you want evidence of direct patient
change that is sustained I suspect there is not a lot” (Damian Roland). This
very issue was debated among the core leadership early on, and they
intentionally pursued a strategy that gives people the option to choose the
nature of their pledge, instead of signing onto one or two specific pledges
that would take on the quality of a national campaign (and measured more
traditionally). Thus the number of pledges alone is not so much evidence of
change but the impact of reach in using social media.
The Change Day leadership team sees the emphasis on pledging – instead of
acting on a pledge – as an area for improvement. “It is one thing to pledge, it
is another in terms of what difference it made,”points out Helen Bevan. “We
don’t have conversion rates. What percentage of pledges made converted to
action? When you talk to people in the voluntary sector, they have a
conversion rate for pledge-based campaigns. The fact that so many people
pledged was important, but we have to understand a lot more about what
impact it had for patients and the system as a whole.”
The core team has been examining the patterns in the 2013 pledges in
order to develop metrics for 2014. They recognize that many more
elements of Change Day can be measured, such as impact measures from
pledges or on the effects of pledges on involved patients and staff. For
example, since many pledges in 2013 suggested that participation arose
from a commitment to the values of the NHS, and that involvement was
intrinsically motivating, Change Day 2014 could assess whether Change
Day contributes to motivating staff in their jobs. It might also be helpful to
measure the impact of pledges on organisations in the system.
For example, Hertfordshire Community Health Service Trust used Change
Day as an opportunity to bring together clinicians from across their system
to review the paperwork that they are required to complete, resulting in
significant changes to the entire reporting system. In addition, Change
Day 2014 can track the conversion rate of pledges into actions.3
Beyond impact measures, developing metrics that reflect the unique
character of NHS Change Day is both possible and desirable: NHS Change
Day 2014 can embrace its unique design by quantifying how it works.
For instance, it is important to count how many pledges came from
frontline staff and patients, as well as senior leaders as an indicator of the
effect on distributed leadership.
3
The NHS Change Day team already has plans to make it easy for people to pledge and report what happened. Pledge-makers will get a text message that reads: ‘Did you do it? How did it go? What happened as
a result?’

Measuring how many people told an online or on-the-ground narrative to
mobilise others as part of their pledge would provide evidence of the level
of new capacity developed through NHS Change Day. Similarly, counting
how many new relationships were built through Change Day is an
important indicator of success.
Quantifying the design elements of the Change Day approach helps tells the
story of how it enables distributed leadership, commitment, and boundary-
crossing relationships to innovate around patient care – and contribute to
other ongoing organisational challenges.
Measuring the impact of specific pledges – and collecting evidence around
the outcomes of the Change Day design – cannot be understated.
But despite the prevailing culture of evidence-based activity in the NHS, an
absence of impact measures is not in itself an indication of the success or
failure of NHS Change Day 2013. Change Day did not set out to be a
traditional improvement programme. On the contrary, it was deliberately
designed to be something new; a movement of people within the NHS
motivated by shared values and a commitment to the possibility of change
and improvement. As one leading participant puts it: “For this sort of thing I
think it would be counterproductive to try to measure the direct impact of
the interventions” (James Haddow). Another adds: “The greatest success
Core leadership team members on NHS Change Day

we had was getting people involved in something that just wouldn’t have
been possible a decade ago, five years ago – maybe even two years ago”
(Damian Roland).
The design of NHS Change Day inevitably shaped outcomes that were
achieved. In this chapter we look at that design and consider the range of
outcomes that flowed from it, the challenges and limitations that emerged
and opportunities for development in the future.
3.2 Design: NHS Change Day, Social Movements and Hierarchy
NHS Change Day did not emerge from nowhere. For over ten years a
number of leaders in the NHS have been laying the groundwork for the
development of a social movement principles to improving health care.
This included engaging with and adapting insights from social movement
theory and research, developing skills used in community organising and
developing a ‘Call to Action’ framework used to mobilise action on critical
challenges (Bate, Bevan and Robert, 2006; NHS Institute for Innovation
and Improvement, 2011). This activity led to success but on a small scale;
the next challenge was to deliver change across a whole system.
Yet by no means did all the members of the Change Day core team
participate in this prior activity. Having recently completed the intense
years of clinical training, emerging leaders like Stuart and Damian were
entering practice, dissatisfied by what they found. They had an appetite
for learning from leaders of great social movements, people who had few
resources, and no hierarchical or positional power, but delivered results by
building power through collective action.
While learning from social movements, these change agents within the
NHS also engaged creatively with the hierarchical structures in which they
operate. The design of NHS Change Day is unique precisely because it is a
social movement approach that is consciously empowering people at the
frontlines to take action while at the same time engaging hierarchical
leaders. In their own words the NHS core team sought to make “the best
of both networks and hierarchies, working through informal networks and
communities of interest and creating a genuine grassroots movement at
the same time as enabling leaders with positional authority to role model
‘change leadership’ in a new way” (NHS Improving Quality, 2013).
As Jackie Lynton puts it: “It was important to work with the hierarchy at
an early stage. I sought the support of Jane Cummings, Bruce Keogh,
David Nicholson and Miles Ayling, who were all massive supporters but
respected the grassroots nature of Change Day.”
The innovative design of Change Day resulted in a particular set of
outcomes (as opposed to metrics) that we consider in this chapter.
We explore outcomes that resulted from design elements including a
distributed leadership model, an emphasis on building relationships,
taking voluntary action, mobilisation around shared values, collective
action, social media, support from the ‘grasstops,’ and networks.
We consider the strengths, challenges and limitations that emerged and
opportunities for development in the future.
3.3 Outcomes: Distributed Leadership
Distributed leadership is already a familiar concept in public, private and
voluntary organisations. There is no single definition, but it is broadly
taken to describe leadership as something that arises from the behaviours
and actions of an individual anywhere in an organisation rather than
something associated with a position in a hierarchy. Structures of
distributed leadership aim to create many ‘leaders’ throughout an
organisation who are capable of taking action on their own initiative while
welcoming a high level of personal accountability (Northouse, 2013: 289;
Wise, Woods and Harvey, 2003: 7-9). Social movements, which rely
entirely on the voluntary commitment and resources of their supporters,
exhibit many of the characteristics of distributed leadership.

The structures and process of the NHS, with its clear hierarchies and culture of
targets and top-down accountability, is clearly a very different kind of an
organisation. Indeed, it is striking how often those we have interviewed have
commented on the extent to which their NHS colleagues feel that they need
to have ‘permission’ before they can change something or make an
improvement. Having observed this pattern of behaviour among staff, Jackie
Lynton commissioned a cartoon for Change Day that captures the prevailing
culture of staff seeking permission to take action:
Comparison of hierarchy leadership model and
interdependent leadership model
Traditional Structure
Distributed leadership

NHS Change Day was explicitly designed to challenge this culture and to
create opportunities for people throughout the NHS to take action
without having to ask for permission.
This design was reflected in the decision not to have a single pledge that
everyone would be asked to adopt. “One of the core values of the NHS
Change Day was inclusivity and empowerment of the frontline rather
than imposing or dictating what people on the frontline should do…[we
wanted it to be] an empowering experience based on social movement
theory where people would be connected through their core values. You
can’t do that if you tell people what their core values should be” (James
Haddow). Instead, a group from the frontline got together to make
something happen and invited others to contribute their own ideas and
energy to the collective effort.
This design principle had one very specific outcome: it created space for
the individual motivations and insights of NHS staff to be expressed
through a rich variety of pledges. As Damian Roland puts it, “there were
no rules – it was simply ‘make a pledge’.”
Each Change Day pledge reflected an individual’s priority for change
responding to his/her own local context and personal gifts and
motivations. This would not have happened if Change Day had been
designed differently. As Liz Saunders, then at the King’s Fund and now
at the Hay Group, reflected, “NHS Change Day gave permission for
people to go where their passion is. In the NHS we often look for change
to a particularly end, for example to reduce waiting lists or improve a
particular pathway. This doesn’t tend to lead us to the unexpected, or
things that might improve patient experience. What about baking cakes
with your patients? It might be really effective but unlikely that you’d be
given the time in regular day to day. Where do you get time to think that
stuff up? Change Day created that opportunity.”
This design principle was echoed in the approach taken by a number of
pledge-makers. The teams in Birmingham City Hospital (see Appendix
B) and Derbyshire Community Health Services (DCHS) (see Section 2.3)
were aiming to mobilise colleagues across their organisations. Both
teams considered and rejected the idea of pursuing a single pledge
precisely because they wanted to stay true to the spirit of NHS Change
Day. As a result, DCHS generated over 150 different pledges from 500
teams and individuals.
For some pledge-makers the central objective of NHS Change Day – with
its emphasis on mobilizing a movement for change across the NHS based
on the belief that everyone has a contribution to make – was itself a
motivation for getting involved. This approach mirrored the values and
beliefs of Open Minds Alliance and the U Can Cope campaign perfectly
(see Section 2.2). “We were attracted by the fact that this was a
grassroots initiative,” explains Gavin Peake-Jones. “People at the front
line doing one thing together.”
Ironically, some staff may have seen NHS Change Day itself as providing
a kind of hierarchical authority – but one that offered agency to them.
Alys Cole King, Consultant Liaison Psychiatrist at the Betsi Cadwaladr
University Health Board, observed, “People in the frontline can think that
they can’t change anything. People wouldn’t have had the confidence
but because it’s part of Change Day it sort of gave them permission.”

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