Planning for

1
Planning for successful change
And avoiding it feeling like this!
2
Service Development Commissioning
Integrated needs assessment
Involving the public
Integrated planning prioritisation
Audit evaluation vs stakeholders measures
Service specification using care pathways
Purchasing agreements
Adapted from The Locality Commissioning Handbook
Ed. Dixon et al 1998 Radcliffe Medical Press
3
Obviously...

• Obviously the obvious isnt obvious... or more
  people would be doing it
• Goffman
• Self-evident (adj.) that which is evident only
  to oneself...
• Ambrose Bierce The Devils Dictionary (ca.
  1902)

People have different agendas and see the world
in very different ways
4
Trust / agreement matrix

• Trust
• High Opponents Allies
• Low Adversaries Bedfellows
• 
  Agreement
• Low High

5
Lewins Force Field Model
Information needs
R E S I S T I N G F O R C E S
Skills deficit
D R I V I N G F O R C E S
New technology
Incentives
Job insecurity
PCT pressure
No perceived need
Help from Project co-ordinators
Established work patterns
CURRENT STATE
DESIRED STATE
6
WIN SMALL, WIN EARLY, WIN OFTEN
STAKEHOLDERS VIEWPOINT
OUTPUT
EFFORT
VS and WS
TIME
Adapted from The Project Leaders Secret
Handbook Eddie Obeng FT Pitman 1994
7
Beckhards Change Equation
Tailoring the message
Change is more likely if, from their
perspective, there is ..
Dissatisfaction with status quo
Powerful vision
Feasible first steps
Capacity for change
X
X
X
Pain of change
gt
And these outweigh
Adapted from Beckhard, R and Harris, RT.
Organisational Transitions Managing Complex
Change. Addison Wesley 1987 Also described in the
NHS Improvement Leaders Guides
8
Tailoring the message
What are the problems people are talking about?
Are there regular grumbles or concerns about
workload, or lack of use of their skills? What
would motivate people towards a different way of
doing things? What would they see as the
benefits (linked to the concerns already
identified)? How can we help them cope with the
new way? Can we shift some of their workload
elsewhere?Would training, shadowing, extra time
help? Starting small and learning, before wider
implementation ..eg trying it for a month, or
just in one type of clinic? Trying what others
have tried and found to work well,?
Pain of change
And any other ways we can reduce the perceived
9
Using the workload tool to solve workload issues
Identify a burning issue. Patient survey, PPI,
QoF, pop.man. etc.
Feedback to practice team and patients.
Use the workload tool to explore that issue
Use workload tool to monitor changes
Develop and implement action plan
10
Group Task

• Identify two issues within your practice for
  which the Workload Analysis Tool could help you
  identify and implement a workable solution
• What exactly are you wanting to achieve by
  tackling these issues?
• How could the WAT help identify a workable
  solution? What analyses would you need to
  undertake?
• How could you convince colleagues this is the
  right way forward (the five parts of Beckhards
  Change Equation)?
• Capture all your great ideas and plans on
  your tablecloth - to cut out and take back to
  the practice - it will grab their attention a
  lot more than a bit of paper!

11
Workload Tool Tips to help make sense of the
reports
Start with Workbook A The Read code chapters 6
8 are usually number 1 2. Your main clinical
workload can be found in the 3rd,4th, 5th top
chapters. Can you notice any change in order or
volume?
In Workbook B looking at sheet called breakdown
all identify the commonest Read codes. Which
staff groups are using these? How is the
workload divided between clinician groups?
Workbook A chapters recording rate
Workbook B Breakdown 1-10 (all)
Looking at individual clinician breakdown
identify significant workloads that could be
transferred or delegated.
Looking at individual clinician breakdown
identify significant workloads that may be able
to be transferred/delegated?
Are there any unexplained variations in apparent
workload between individual clinicians? Are
these due to coding practices, template usage or
actual workload differences?
Looking through the graphs are there any rogue
codes such as had a chat to patient? Workbook
C may identify coding errors such as males who
have had smear tests.
12
The importance of networking
- Knowing who you need to know -
Understanding their viewpoints, values and
vested interests
And knowing who influences their viewpoint,
values and vested interests and who influences
their