Capability building for large-scale transformational change: learning from an evaluation of a national programme

BackgroundThe Long Term Plan presents an ambitious vision for England’s National Health Service which will require a sustained programme of transformational change. The Virtual Academy of Large-Scale Change (VALSC) was developed to build capability in health and care system teams involved in transformation or redesign programmes.MethodsTo evaluate the VALSC, quantitative and qualitative data were collected and reviewed against the Kirkpatrick model. Quantitative data were collected via end-of-session surveys to assess individual knowledge before and after participating in capability-building interventions. Qualitative data were also collected and included post-intervention surveys and interviews. Interviews were transcribed and analysed using an inductive approach to identify themes that were subsequently assessed against the Kirkpatrick model.ResultsResults suggest that the VALSC programme has helped build capability for large-scale change in terms of learning, behaviour change and impact. Participants’ ipsative self-assessment of knowledge demonstrated a significant change (p<0.001) and qualitative data suggested three broad themes in which the VALSC made an impact. First, participants were empowered with transformation and change skills which they applied to local health and care challenges. Second, VALSC helped strengthen connections within and between transformational change teams. Third, VALSC helped transformational change teams to engage more effectively with their stakeholders.ConclusionsThe VALSC developed knowledge, skills, behavioural change and application impact that built capability in individuals and teams. Therefore, continuing to develop capability-building offers that empower and build agency in front-line staff working on service transformation and equip them with approaches, methods and tools to increase their chances of success, is recommended.

Systems consultation for opioid prescribing in primary care: a qualitative study of adaptation

BackgroundIn order to promote guideline-concordant opioid prescribing practices, a blended implementation strategy called systems consultation was pilot tested in four primary care clinics in one US health system.ObjectivesTo describe (1) how systems consultation worked during the pilot test and (2) the modifications necessary to adapt this implementation strategy to primary care.MethodsA team of investigators conducted observations (n=24), focus groups (n=4) and interviews (n=2). The team; kept contact logs documenting all interactions with the intervention clinics and preserved all work products resulting from the intervention. Initial analysis was concurrent with data collection and findings were used to modify the intervention in real time. At the conclusion of the pilot test, a pragmatic descriptive analysis of all data was performed to explore key modifications.ResultsTime constraints, entrenched hierarchical structures and a lack of quality improvement skills among clinical staff were the main barriers to implementing systems consultation. Modifications made to address these conditions included creating a consulting team, giving change teams more direction, revising process improvement tools, supporting the use of electronic health record (EHR) functionalities and providing opportunities for shared learning among clinics.Discussion and conclusionWith the lessons of this research in mind, our goal in future iterations of systems consultation is to give clinics a combination of clinical, organisational change and EHR expertise optimised according to their needs. We believe a streamlined process for assessing the key characteristics identified in this study can be used to develop a plan for this kind of optimisation, or tailoring, and we will be developing such a process as part of an upcoming clinical trial.

Feasibility of Multiagency Change Teams Involving the Department of Corrections and Community Substance Abuse Treatment Agencies

This study demonstrates the feasibility of forming multiagency change teams including correctional and community agencies involved in the community reentry of prisoners with histories of substance use. The sample included 148 participants from 21 change teams. Results showed that change team members’ perception of their “home” agency affects the change team process, but change teams also develop their own group processes independent of their home agency climate.

Sustaining Management Commitment to Workplace Health Programs:

This article investigates management commitment to workplace health and safety through an analysis of the implementation of participatory ergonomic (PE) interventions in three worksites. The PE programs were established to address the burden of work-related musculoskeletal disorders. Drawing upon interview and observational data, the analysis examines the evolution of managerial support for PE programs over time and in the context of pressures internal and external to the worksites. Ergonomic Change Teams in all three sites experienced problems establishing authority to act as change agents and in accessing employee time to carry out their activities. Resolution of these problems was heavily contingent on the commitment of senior management, and the efforts of individual management personnel to intervene in support of the PE program. Our findings highlight that “management” is not a monolithic entity and managerial structures are often marked by divisions in priorities, including health and safety.

Characteristics and Performance of Organisational Change Teams: An Empirical Study of Korean Large Firms

This study explored direct relationships among top management support as the major organisational context, the characteristics of organisational change team (OCT), and OCT performance. Based on the previous studies on change agents and organisational groups, and the practices of change efforts in Korean large firms, six hypotheses were generated and tested through questionnaires culled from 58 teams among four Korean conglomerate groups. The four OCT characteristics studied were professionalism, functional diversity, team position and team size. By controlling for the group difference, it was found that the professionalism and functional diversity of OCTs were significantly correlated to managers' satisfaction with the OCTs. Beyond our expectations, strategic support of the top management had more direct effects on the performance of the OCTs than the OCT characteristics. This study suggests that getting the strong support of the top management as well as having their own professional knowledge and abilities are very important for OCTs to achieve higher performance.