People’s [w:/]+[.][w%-/]+ Needs Defining Change HEALTH SERVICES CHANGE GUIDE Source and Referencing Accessing the Change Guide and Additional Supports People’s Needs Defining Change – Health Services Change Guide has been The Health Services Change Guide is available to use online developed following a detailed consultation process and written by Caitríona or to download at www.hse.ie/changeguide. Heslin and Anne Ryan, Organisation Development and Design, Health Service The Additional Resources in Appendix A signposts users of the Executive (HSE), Kells, Co Meath. It represents the second edition of Improving Change Guide to other helpful supports in the system. It will be Our Services: A Users’ Guide to Managing Change in the Health Service updated periodically and can be accessed at www.hse.ie/changeguide. Executive (2008). The following symbol indicates that other helpful information is available in Additional Resources. Material from this Change Guide should be referenced as: Health Service Executive – Human Resources Division – Organisation The Change Hub (www.hseland.ie) provides access to all of the Development and Design (2018). People’s Needs Defining Change – Health documentation, templates, tools and methodologies referenced. Services Change Guide. Kells, Co Meath, Ireland: Health Service Executive. Bibliography references in the document are noted as follows: Acknowledging sources [number] and relate to literature reviewed by the authors available at www.hse.ie/changeguide. In developing the Health Services Change Guide we have gathered and adapted information and knowledge on change from many sources. We always seek to This work is also supported by a literature review completed by do this in a way that respects the work of other people and acknowledges the the Centre for Health Policy and Management, Trinity College Dublin: source of the content. If you feel that we have not adhered to this principle, Understanding Change in Complex Health Systems – a review of the please contact us. We will either modify the content or remove the item. literature on change management in health and social care 2007-2017 available at www.hse.ie/changeguide. Data Protection Further information and feedback In gathering data, particularly regarding service users, citizens, communities We are always open to feedback to help us continually improve the and staff, please ensure that you adhere to the requirements of the relevant guidance and resources available. If you would like to contact us for legislation. This includes the Data Protection Acts 1998-2003 and the General further information or with feedback and comments, please email us Data Protection Regulation 2018. at [email protected]. © Health Service Executive 2018 ISBN: 978-1-78602-081-9 People’s Needs Defining Change Health Services Change Guide Contents i Contents Click to navigate Building Capacity for People Section 1: People and Culture Change Platform 8 and Culture Change viii 1.1 Understanding Organisational Culture 9 Maintaining Commitment to Engagement and Consultation ix 1.1.1 Organisational culture and subcultures 9 1.1.2 Addressing cultural change 10 Preface xi 1.2 People and Culture – the Change Priorities 10 Development Process xi 1.2.1 Practice collective leadership 11 Acknowledgements xii 1.2.2 Model shared values 14 1.2.3 Engage and communicate 17 1.2.4 Understand personal experiences 20 Introduction and Context 1 1.2.5 Support behaviour change 23 1.2.6 Invest in people and teams 25 Key Drivers for Change 2 1.2.7 Network and partner 27 Why is a Health Services Change Framework Needed? 3 1.2.8 Use evidence and lever technology 30 1.2.9 Deliver public value and be accountable 33 Health Services Change Framework 6 Contents Restart this Section Additional Resources People’s Needs Defining Change Health Services Change Guide ii Contents Click to navigate Section 2: People’s Needs Defining Change 37 Section 3: Define 50 2.1 Working with Service Users, Families, Citizens, 3.1 Identify Shared Purpose 52 Communities and Staff 38 3.1.1 Identify need 52 3.1.2 Examine divers for change 54 2.2 Develop Engagement Process 40 2.2.1 Identify and map people connections 41 3.2 Understand Current Services 55 2.2.2 Understand key stakeholders 42 3.2.1 Describe the current situation 55 2.2.3 Tailor engagement to key groups 44 3.2.2 Mobilise people and culture 57 2.2.4 Plan and engage with a purpose 48 3.2.3 Understand prevailing culture and values 57 2.2.5 Develop and sustain engagement and communication 49 3.2.4 Assess readiness and capacity for change 58 3.2.5 Assess and build energy for change 59 3.2.6 Identify levers for change 61 3.3 Agree Better Outcomes 62 3.3.1 Co-design the ‘vision’ for the future 62 3.3.2 Agree change outcomes and objectives 64 3.4 Measure for Success 65 3.4.1 Design measurement plan 65 3.5 Make Case for Change 68 3.5.1 Agree governance and mandate 68 3.5.2 Establish change management team 69 3.5.3 Identify resource requirements 70 3.5.4 Communicate the Business Case 70 Contents Restart this Section Additional Resources People’s Needs Defining Change Health Services Change Guide iii Contents Click to navigate Section 4: Design 71 Section 5: Deliver 86 4.1 Agree to Co-Design 73 5.1 Implement Actions 88 4.1.1 Agree service design principles 73 5.1.1 Energise collective leadership and governance 88 4.1.2 Address enablers of co-design 76 5.1.2 Scale-up engagement and communication 91 4.2 Design Service Operational Model 76 5.2 Support Implementation 92 4.2.1 Confirm user need 76 5.2.1 Intensify individual and team supports 92 4.2.2 Design service choices and options 77 5.2.2 Prioritise inter-team/service and inter-agency working 93 4.2.3 Determine the detail of the Service Operational Model 80 5.2.3 Sustain engagement with services users, citizens and other key partners 93 4.3 Test and Refine 80 5.3 Measure Progress 93 4.3.1 Test change in practice 80 4.3.2 Undertake gap analysis 81 5.3.1 Adapt to emerging needs and take corrective action 95 4.3.3 Assess impact and interdependency 81 5.4 Celebrate Success 96 4.4 Agree Action Plan 82 5.4.1 Acknowledge increased change capacity 96 4.4.1 Consolidate key changes actions and measures 82 5.4.2 Mark key milestones 96 4.4.2 Identify risks and dependencies 82 5.5 Sustain Improvement 96 4.4.3 Identify enabling and sustaining actions 84 4.4.4 Identify impact for resources 84 5.5.1 Evaluate and share learning 98 4.4.5 Clarify responsibility for actions and timeframes 85 5.5.2 Scale-up innovations 98 4.5 Communicate Action Plan 85 Contents Restart this Section Additional Resources People’s Needs Defining Change Health Services Change Guide iv Contents Click to navigate Section 6: Essential Templates 101 6.3 Essential Templates – Design 145 Template 6.3.1: Service Design – Option Generation 6.1 Essential Templates – Working with service users, and Appraisal 146 families, citizens, communities and staff 102 Template 6.3.2: Detailed Design of the Service Template 6.1.1: Influence – Interest Mapping Grid 103 Operational Model 151 Template 6.1.2: Guidance on Stakeholder Mapping and Analysis 105 Template 6.3.3: Service Design – Gap and Impact Analysis 161 Template 6.1.3: Guidance to Develop Engagement Template 6.3.4: Action Plan 172 and Communication Plan 107 6.4 Essential Templates – Deliver 174 6.2 Essential Templates – Define 109 Template 6.4.1: Factors to Monitor During Implementation 175 Template 6.2.1: SWOT Analysis (Strengths, Weaknesses, Template 6.4.2: Personal Checklist for Change 181 Opportunities and Threats/Challenges) 110 Template 6.4.3: Working with Emotional Reactions to Change 182 Template 6.2.2: Context for Change – Why What How Method 112 Template 6.4.4: People Indicators to Support Behaviour Change 186 Template 6.2.3: Description of the Current Situation (Service Operational Model) 113 Appendices* Template 6.2.4: Guidance on Defining your Personal Values 122 Appendix A: Additional Resources 190 Template 6.2.5: Cultural Web Exercise 123 Appendix B: Development Process 277 Template 6.2.6: Personal Readiness for Change 126 Appendix C: Stakeholder Engagement 279 Template 6.2.7: Team Diagnostic 127 Template 6.2.8: People and Culture Change Platform – Glossary of Terms and Definitions* 291 Readiness Factors 130 Abbreviations* 301 Template 6.2.9: Developing a Vision for the Future 134 Template 6.2.10: Clarifying Measures 136 Bibliography* 303 Template 6.2.11: Project Initiation Document (PID) 138 * Note: electronic version of above documents is available at: www.hse.ie/changeguide Contents Restart this Section Additional Resources People’s Needs Defining Change Health Services Change Guide v Health Services Safer Better Healthcare, Change Framework FUTURE and Staff & Public Value VISION CHANGE OUTCOMES Click diagram to navigate DELIVER ã ã DESIGN C H S A N ãT I E DEFINEG E A C T I V I Practice Collective Leadership Engage & People’s Communicate Needs Defining Model Shared Values Understand Change Personal Experiences Service Users, Families, Citizens, Communities & Staff Use Support Evidence Behaviour & Lever Change Be Technology Accountable for Invest in Performance People & Teams Network & Partner CURRENT SITUATION PEOPLE & CULTURE CHANGE PLATFORM © People’s Needs Defining Change – Health Services Change Guide vi People’s Needs Defining Change People’s Needs Defining Change – Health Services Change Guide People’s Needs Defining Change – Health Services Change Guide presents the overarching Change Framework that connects and enables a whole system approach to delivering change across the system.