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How successfully are you

delivering change?

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The challenge

Successfully delivering change that makes a real difference to value and productivity requires

radical thinking about new ways to design and deliver services. It requires an approach that

recognises and deals with complexity, constraints and conflict. It needs leaders with a clear,

compelling and shared vision, a drive to realise benefits and a renewed focus on

transformational change.

What is transformational change?

Transformational change is radical in nature, it is also difficult to achieve… “It requires a shift

in assumptions made by the organisation and its members. Transformation can result in an

organisation that differs significantly in terms of structure, processes, culture and strategy.”

(NHS SDO publication of May 2001). ISIP’s core proposition is that integrated service improvement

drives transformational change.

How does the ISIP RTC help?

ISIP’s Roadmap for Transformational Change (RTC) provides a framework to support

people who are leading and managing integrated service improvement as a way to achieve

effective and successful transformational change.

Introducing the Roadmap for Transformational Change (RTC)

www.isip.nhs.uk

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… delivering successful changewww.isip.nhs.uk

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A framework for changeThe RTC is a framework that enables health and social care organisations to design, plan

and deliver integrated and transformational change that is both successful and sustainable.

The primary purpose of the RTC is to stimulate and guide local decisions. It is NOT a

prescriptive method, nor is it mandatory: however, because of its focus on transformational

change and the use of systematic techniques, it requires active support from chief executives

and senior clinical leaders.

For commissioners and providers The RTC is relevant to both commissioners and providers and can be used across a Local

Health / Social Care Community (LHC/LHSCC), a clinical network and an individual trust or

organisation.

Based on recognised good practice The RTC is based on recognised good practice, research and experience including, for

example, the Office of Government Commerce (OGC) approach to Managing Successful

Programmes (MSP) and Cranfield University’s approach to Benefits Management.

www.isip.nhs.uk

What is the RTC?

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Phases, Strands and Activity Maps

The ISIP RTC describes a journeythrough five phases starting with

LHC-wide strategic planning and

ending with the implementation of

change and the realisation of

benefits.

Each phase is supported by an

Activity Map that identifies a

balanced and interconnected set of

activities across four strands. The

activities provide access to additional

guidance, tools and techniques.

As change programmes are implemented, the RTC will be populated with further content

including case studies and will eventually become a key source of knowledge for integrated

and transformational change in health and social care.

www.isip.nhs.uk

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Phases: Describing the journey of change

The RTC is set out as an iterative journey through five phases:

however, change leaders and change agents can choose to

start at any phase and should be guided in doing so by their

priorities and by what it is feasible for them to achieve.

If, for example, an organisation, network or community starts by

using the RTC to improve the way they specify and plan

projects, and to ensure these are focused on the realisation of

benefits, they may want later to consider both the integrated

change programmes to which their projects (should) contribute

and the strategy that sets the direction for change.

Where phases are used in sequence, each phase will:

– validate and use output from the previous phase

– build ownership and sponsorship and secure

commitment to move to the next phase.

Phase IInitiation and strategic planning

Phase IIHigh-level design and benefits planning

Phase IIIDetailed analysis and design

Phase IVDeveloping, testing and training

Phase VImplementing, tracking and improving

www.isip.nhs.uk

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Strands: Ensuring focus and balance

The purpose of the four strands is to ensure that, as the focus of activity changes through

the five phases, an essential balance is maintained between the key aspects of the

integrated and transformational change that is being designed, planned and delivered.

ensuring decision-making and

control

maintaining a focus on

benefits realisation

designing and delivering all

aspects of change

ensuring stakeholder

participation and commitment

Governance &

Management

Strategy & Benefits

People, Process &

Technology Change

Stakeholder Engagement & Communication

www.isip.nhs.uk

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Activity Maps: Guiding local change

www.isip.nhs.uk

Phase V: Implement, Track and Improve (This phase is undertaken separately for each project and co-ordinated across the portfolio of projects within each integrated change programme)

Stakeholder

Engagement

& Commun-

ication

People, Process and

Technology Change

Strategy &

Benefits

Governance &

Management

Implement

Changes

Formally close

project /

programme

Undertake Post

Project Review /

Programme Review

Realise, measure

and review benefits

Set-up ongoing

feedback

mechanisms

Celebrate

new state

Update

communications plan

Manage project plans

for implementation

and transition

Manage programmes

to ensure continuous

improvement

Undertake final

benefits review

April 2006

Set up and deliver

support for all

aspects of change

Continue to improve

workflows and the use

of technology,

equipment and facilities

Continue to update

and deliver training

and education

Phase III: Detailed Analysis and Design (This phase is undertaken separately for each project and co-ordinated across the portfolio of projects within each integrated change programme)

Confirm project

governance structure

Create and approve

PID (for new projects)

Analyse and design

workflows for projects

including care

pathways

Agree objectives for

project

Define and plan

outcomes, benefits

and measures

Produce project

benefits realisation

plan

Design workforce

changes required for

future state

Design and plan

required changes to

facilities and estates

Create specifications

for required

technology and

equipment

Maintain PID,

Programme Definition

and ISI Plan

Complete impact

assessment

Design and deliver

stakeholder

transformational skills

training

Obtain organisation

management

commitment to

stretch targets

Update and continue to

implement

communications plans

Reaffirm costs and

priorities across all

programmes within

the ISI Plan

April 2006

Stakeholder

Engagement &

Communication

Governance &

Management

People, Process

and Technology

Change

Strategy

& Benefits

People,

Process and

Technology

Change

Governance &

Management

Stakeholder

Engagement &

Communication

Strategy &

Benefits

Each phase of the RTC is supported by an

Activity Map that identifies a balanced and

interconnected set of activities across the four

strands. The map for each phase is shown

later in this booklet.

A systematic approach to integrated change

will require at least the consideration of all of

the activities in the relevant phase(s). The

sequence of these activities and the extentto which they are followed, should be based

on local conditions and requirements and on

an assessment of likely costs and benefits.

Individual activities and the RTC as a whole

should be used alongside other

complementary approaches, for example

those that are recommended by the NHS

Institute for Innovation and Improvement.

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Activities: Accessing guidance, tools & techniques

Clicking on any area of a phase brings up an activity map

Clicking on any activity brings up a page which describes the activity, its triggers, inputs, tasks, outputs and links to supporting materialincluding guidance, case studies, tools & techniques and other sources of useful guidance

www.isip.nhs.uk

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What can the RTC do for you?

Your organisation, network or community can use the RTC to share experience and build a

skilled and recognised community of change leaders, including clinicians and managers, to

deliver successful transformational change.

It provides your change leaders with organised access to guidance, tools, techniques that

support:

• collaborative decision-making and control over a portfolio of integrated change

programmes

• design and implementation of benefits-led integrated change

• people, process and technology changes through the integration of national enablers

• the involvement of all stakeholders including patients, service users and staff.

ISIP’s vision for the RTC is that it will become an ‘evolving source of knowledge used and

maintained by enthusiastic change leaders, including clinicians and managers, working with

patients and staff to achieve transformational change’. ISIP recognises that achieving its

vision for the RTC is itself likely to require transformational change. Publishing the RTC in its

current form as a proof of concept is the first step in this journey.

www.isip.nhs.uk

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The RTC is an evolving source of knowledge used and maintained by enthusiastic change

leaders, including clinicians and managers, working with patients and staff to achieve

transformational change.

ISIP’s vision for the RTC

www.isip.nhs.uk

RTC is an evolving source of

knowledge

Community of

change leaders including clinicians

and managers

use

own & maintain

ISIP Support

organise & manage

research& advise

• Relevant, useful & proven

• The agreed ‘way we do things around here’

• Supported by patients, service users and staff

• Part of all leadership training

Is perceived to be …

… by

RTC is an evolving source of

knowledge

Community of

change leaders including clinicians

and managers

use

own & maintain

ISIP Support

organise & manage

research& advise

• Relevant, useful & proven

• The agreed ‘way we do things around here’

• Supported by patients, service users and staff

• Part of all leadership training

Is perceived to be …

… by

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Phase I: Initiation and Strategic Planning

A clear case for collaborative cross-community change and an agreed

plan to deliver the change through a portfolio of integrated change

programmes which is accepted by the leaders of the LHC, including

clinicians.

Success Criteria:

Integrated Service Improvement Plan (ISI Plan) and a comprehensive

Communications Plan.Key Output:

To agree and gain commitment from leaders of all organisations in the

LHC on the portfolio of integrated change programmes that contribute

to their shared vision for health and social care across the LHC and

address the case for change.

Purpose:

www.isip.nhs.uk

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A high level design for a benefits-led integrated change programme

that clearly articulates the current state and scopes specific projects

that are required to deliver the future state. Agreement from executive

teams, including clinicians, of all relevant organisations in the LHC to

move forward to detailed design and analysis.

Success Criteria:

Programme Definition that includes a business case, a description of

high-level process changes and a Programme Benefit Realisation Plan

(BRP) with high-level estimates of costs and benefits.

Key Output:

To work with staff and patient representatives to design an integrated

change programme that delivers transformational change and realises

quality and value benefits.

(This phase is carried out for each integrated change programme and

co-ordinated across the portfolio of programmes in the ISI Plan.)

Purpose:

Phase II: High-level Design and Benefits Planning

www.isip.nhs.uk

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Local managers and clinicians in organisations responsible for

delivering the project give their unequivocal commitment (in terms of

sponsorship, dedicated resources and funding) to move forward to

development, testing and training.

A detailed design for a project which integrates relevant changes to

workforce, processes, technology, facilities and estates the benefits of

which are understood and fully accepted by staff and patient

representatives.

Success Criteria:

Detailed specification of all aspects of the design. Project Initiation

Documents including, where required, a Project Benefit Realisation

Plan.

Key Output:

To carry out detailed analysis and design for a project and ensure that

each organisation within the LHC understands the implications of

implementing the programme.

(This phase is carried out for each project and co-ordinated across the

portfolio of projects within each integrated change programme.)

Purpose:

Phase III: Detailed Analysis and Design

www.isip.nhs.uk

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All proposed changes have been successfully piloted and staff are

confident that they can work in the new environment.

Senior management and clinicians declare that they are ready to go

ahead with the required changes and to move forward to

implementation.

Success Criteria:

Comprehensive training in the new tested workflows; new systems,

facilities and associated policies and procedures ready for

implementation; confirmed baseline measurements for all benefits;

detailed plans for implementation and transition.

Key Output:

To develop the changes specified during detailed design and

analysis, test these with the people affected by the change and to

provide training.

(This phase is carried out for each project and co-ordinated across

the portfolio of projects within each integrated change programme.)

Purpose:

Phase IV: Develop, Test and Train

www.isip.nhs.uk

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New responsibilities, new ways of working and/or new information

systems are operational across the LHC and employees fully trained.

Patients, service users and staff are realising measured benefits and

are keen to celebrate and share the success of the change.

Success Criteria:

Final Benefits Review and plans for continuous improvement.Key Output:

To implement all of the changes that have been designed, developed

and tested, ensuring that the actions needed to deliver the benefits

are completed, the benefits realised are measured and a plan for

continuous improvement is agreed.

(This phase is carried out for each project and co-ordinated across

the portfolio of projects within each integrated change programme.)

Purpose:

Phase V: Implement, Track and Improve

www.isip.nhs.uk

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What now, what next?

The RTC can be accessed through the ISIP website: www.isip.nhs.uk.

Encourage change leaders, including clinicians and managers, within your organisation to

visit the website, use the RTC and provide us with feedback. Our aim is to ensure that the

RTC becomes the framework that you need to deliver successful transformational change.

• evidence of your success in delivering transformational change to inform and populate the

RTC

• your help to identify change leaders from within your organisation for whom the RTC could

become a valuable resource.

You can contact us via email on isip@nhs.net or by calling 0870 850 3039.

Alternatively you can find out more via your SHA ISIP Lead (details of your local contact can

be found on our website at www.isip.nhs.uk).

We are particularly looking for:

www.isip.nhs.uk

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Are you ready to deliver successful transformational change?

The ISIP Roadmap for Transformational Change… helping Local Health Communities deliver successful change

Does your LHC have

leaders who are

committed to delivering

transformational change?

Does your LHC have a

shared vision for health

and social care?

Is your LHC designing

benefits-led change that

exploits national

enablers?

Is your LHC managing

change so that patients

and staff fully appreciate

its value?

Is your LHC using the right

processes, tools and skills

to deliver transformational

change?

Is there clarity,

co-ordination and control

across all change taking

place within your LHC?

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NHS Integrated Service Improvement Programme7th FloorNew Kings Beam House22 Upper GroundLondonSE1 9BW

Further informationwebsite: www.isip.nhs.ukemail: isip@nhs.nettel: 0870 850 3039

Version 3 – released November 2006© Crown Copyright 2006

Working in partnership with the Department of Health, the Office of Government

Commerce and the NHS Institute for Innovation and Improvement.