What makes change stick?

We know that a lot of change programmes fail – but do we really understand why? Was it that the actual plan for change was not well thought out or was the plan not implemented appropriately? I suspect it is more often the latter problem.

An interesting perspective on this problem has been addressed by focusing on factors that support sustainability. Sustainability is usually understood as the continuation or integration of a new practice, and it is often considered as an add-on to ensure the programme continues, as the funding comes to an end. However, an innovative sustainability model has been developed by the NHS Institute for Innovation and Improvement to embed the change early within the new programme.

19 project teams in north-west London were encouraged to regularly evaluate their progress across 10 factors proposed to affect the likelihood of sustainability. These 10 factors were broadly grouped into 3 areas; Process (benefits, credibility, adaptability, effectiveness), Staff (involvement, attitudes, leadership engagement) and Organisation (fit, infrastructure). Participants anonymously rated their own teams each quarter, and as problems were identified, teams were expected to take action to improve the underlying processes or staff factors in their organisation. Teams were classified according to the level of engagement. The teams that were more engaged, took more actions to promote sustainability, and it was likely that the regular completion of self-ratings raised issues for discussion and later action.

In the discussion, issues of content and facilitation were addressed. Here comments were made about the possibility of expanding the key factors to include descriptions of the economic environment and degree of community involvement. Further, the need to facilitate teams to understand the underlying factors of this model, to identify appropriate intervention strategies and to be encouraged and supported to implement them was crucial. This last point is a very important one, because it encourages the exchange of knowledge across different disciplines. Often within teams tasked with implementing change, individuals have expertise in the some parts of the process they are changing, but they do not always have the comprehensive knowledge and skills to monitor all important aspects of the change. An independent facilitator can often see these gaps and they can signpost the need for further education. They can also engage the team to identify and encourage individuals to take action, in an appropriate manner.

I think this article expands current management thinking beyond stage models to recognise that early planning, facilitation, leadership and education can ameliorate the complexity of change.



I conduct and supervise research that promotes the translation of quality research evidence for use in clinical practice.

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Posted in change, implementation, sustainability

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