NHS & organisational change
Most programmes push harder. We find out why it is not moving.
When a system is under pressure the instinct is to accelerate. Across twenty years of NHS delivery we have repeatedly found the block is rarely the technology or the plan. It is the behavioural and organisational system around them. Work that out first and the change becomes much more precise.
primary-care teams, the whole of Devon, moved to online consultation
coaching the NHS England national digital-transformation team
teams supported, local, regional and national
01Does this sound familiar?
The plan exists. The change is not holding.
Four situations we are called into most often. They look different from the inside. Underneath, they behave the same way.
- 01
A transformation programme that is not landing.
More communication, more training and tighter milestones make things worse when the real constraint is time, whether it feels safe to raise a problem, or the number of priorities running at once.
Change and implementation
02A team that has fractured, or meets and decides nothing.
It is rarely the agenda. More often it is unclear authority, a difficult subject everyone is avoiding, or a pattern in the room that nobody is willing to name.
Team repair and psychological safety
- 03
Services keep adding fixes without resolving the constraint.
Each fix is reasonable on its own. Together they add load to the part of the system that was already the bottleneck, which is why the same problem keeps returning in a new costume.
Service redesign
04A funded innovation that will not embed into routine practice.
Everyone agrees it is a good idea and it still does not stick. Evidence on its own does not change what people do; getting something into everyday practice is a separate piece of work.
Implementation and evaluation
02How we work
Most change consultancies arrive with a model. We arrive with a question.
Kotter, ADKAR, Prosci, 7S: the frameworks are useful and we know them all. But arriving with the answer before you have understood the problem is how change programmes fail. What is specific about your team, your history and your current pressure is signal, not noise.
The formulation
What started it, what shaped it, and what is keeping it going.
Push harder on a burnt-out system and the extra load lands on the part already breaking.
We listen to what the team says about why it is not working, and to what is missing from that account. Then we formulate what is actually happening and design an intervention that comes out of your organisation rather than being imported into it. Sometimes that is an established framework. Often it is something that has to hold several at once.
Where formal evaluation is needed we design it in from the start: mixed-methods, board-ready, and peer-reviewable if you need it to be. We have published from NHS delivery programmes before.
03Case study
Rolling out online consultation across Devon’s primary care.
The case we point to when a commissioner asks what we have actually delivered. It began as an implementation problem and became something larger, because the real block was understood before anyone tried to move it.
Case study
The Devon Digital Accelerator
Devon NHS STP, then NHS England
Devon needed online consultation rolled out across primary care, quickly. The block was not the technology and it was not training. It was a system under severe resource pressure, with leaders out of capacity for change.
The workforce was the perpetuating factor. Nobody needed telling it was burnt out. What nobody could see was which part of the system would actually shift if you pushed it, and which part would simply absorb more damage.
A resilience-and-leadership change model built to add capacity rather than demand it: conferences, group coaching that left change capability inside the teams, and educational assets each team kept. The evaluation ran alongside as learning reports, so each one could alter what happened next.
Delivered across the whole of Devon’s primary care and awarded a Digital Innovation Award. Through COVID-19 the blueprint went on to support the national primary-care change programme, and NHS England then separately commissioned UXC to coach the national digital-transformation team, including the national clinical lead, across three years.
“Probably the most important project I have been involved with in my last 18 years in general practice.”GP, Devon Digital Accelerator
“It effects real change in a psychologically safe environment. The DDA concept should be a model for change across many aspects of the NHS.”
GP, Devon
04More case studies
Three more NHS case studies.
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Regional NHS implementation
GP TeamNet
Eighteen months of implementation evaluated for the journey and the learning, then written up as implementation guidelines to support national spread.
Read the case study -
NHS wellbeing response
COVID-19 coaching approach
Over 1,000 coaches and therapists trained for the conditions NHS staff were actually working in. Accredited by the Association for Coaching.
Read the case study -
NHS teams
Psychological safety in teams
How psychological safety is managed in talk rather than in policy, with training built around the phrases that open a room and the ones that close it.
Read the case study
These are a selection. More of the work, across NHS services, universities and ventures, is on the our work page.
05Start the conversation
If pushing harder is not working, start by finding the real constraint.
Thirty minutes with a senior psychologist. No preparation is required, and no sales presentation. Tell us what the programme is meant to do and where it has stopped moving.
Afterwards we will send you our initial view of what is likely to be maintaining it, whether or not you decide to work with us.
30 minutes · Senior psychologist · No preparation needed