Service Development through Change Management

1. Service Development through ChangeManagement Diana Yardley Lead Nurse Diabetes Care Britsh Forces Germany

2. Objectives • Understanding how change management and the involvement of service users can facilitate service development • Critically analyse the theory and evidence which underpins advanced practice and recognize the legal, professional and ethical implications of practicing as an advanced practitioner.  • Appreciate the use of expert facilitation skills in relation to advancing practice.

3. Over the last decade • Government publications identifying and endorsing the importance of remodelling services around service users • Quality driven initiatives to make policy and service delivery changes • Strong clinical leadership (DOH 1997; DOH 2000; Audit Commission 2001; DOH, 2008)

4. The Advanced practitioner • Great deal of development of the role. • Integral in the implementation of these directives (RCN 2008; NHS 2006; Davies & Hughes 2002).

5. My Experience • I was commissioned to lead the development of a transition service, by the deputy director of operations • Further championed by the service manager for paediatric service

6. “Children’s nurses are in a unique position to influence commissioning: they combine clinical expertise, an ethos of child-centred care and an understanding of their local health economy or clinical speciality” RCN (2004) pg 4

7. “All young people with diabetes will experience a smooth transition of care from paediatric diabetes services to adult diabetes services, whether hospital or community based, either directly or via a young people’s clinic. The transition will be organised in partnership with each individual and at an age appropriate to and agreed with them.” Department Of Health (2007) Rational

8. . NSF Diabetes (DOH, 2003) National service framework for children, young people and maternity services: Executive summary (DOH, 2004) Transition: getting it right for young people: Improving the transition of young people with long term conditions (DOH, 2007) Your welcome quality criteria (DOH,2007) HWPH Childrens NSF executive summery and action plan - identified as the person responsible for transition

9. Why me . Specifically employed specialist adolescent diabetes nurse in an NHS foundation Trust Smooth the transition for the young people with diabetes transferring from the childrens services into the service provided to adults

10. Project facets • Alternative model of working • Change management • Change management is particularly important when developing services for children and their families (Hodges 2008).

11. The role of Transition Service Co-ordinator encompasses the practice dimensions of clinical expert, consultant, change agent, leader, researcher, and educator (Betz & Redcay, 2005). Communication Increasing observability (Rogers 2003) Presenting in a format appealing to nature of clinical stakeholders(Harvey et al 2002)

12. Models of change • Plan, Do, Study, Act (PDSA)

13. Models for Change

14. Further research • Underpinned by the work of early writers • Lewin (1951) cited Cummings & Huse (1989) • All require a degree of unfreezing, changing and refreezing.

15. Lewin 1951 Making the change permanent Finding the motivation to change What needs to be changed

16. Start as you mean to go on • The advanced practitioner can bring about improvements in patient care by promoting and contributing to evidence based practice. (Castledeine & Mason 2003; NHS 2010) • Obtaining commissioner backing and senior managerial support to ‘champion’ a project is fundamental to its success (NHS 2007)

17. Unfreezing • Present situation must be considered • 3 parts • Problem diagnosis or awareness • Sources of problems identified • Develop images of the desired future and set the direction for improvement (Barr & Dowling 2008; NS 2007; Beckhard and Harris 1987; cited in Deegan et al 2004).

18. Principles of evidence-based practice. • Pertinent evidence supporting advantages of a change in process over current ways of working • Communicate a vision of that change initiative via organisations • Greatly increases the likelihood of a positive outcome (Hayes 2002; RCN 2008; NHS 2010).

19. Change Change should be locally led and clinically driven by the staff delivering patient care Lord Darzi’s High Quality Care for all-Next Stage Review (DOH 2008b) Planning and preparation Development of ideas for solutions/alternatives to problems identified in unfreezing stages concerned with negotiating and communicating a plan to the team;

20. Easing the transition • Settling concerns or fears of team members • Identify reasons why change is necessary • Modifying behaviours to reflect new knowledge and insights

21. Refreezing • Maintain a modification of attitudes and practice. • The impact on healthcare delivery and motivation to work in a new way is maintained. • Security that the changes are sustainable • New problems identified are acted upon.

22. Discipline of Improvement NHS 2007

23. Process and Systems thinking • Castledine (2003) NES (2008) • 2 of the core elements of advanced practice • ability to challenge professional boundaries • pioneer innovations • Senior backing

24. Personal and organisational development • Ability to work collaboratively, recognising and valuing differences • within the organisation • within oneself • Lewin’s model (1951) hailed as a basis for the expansion of organisation development; • Most evident in the refreezing stage • orientated towards the stabilisation

25. Making it a habit, initiating sustaining and spreading • Once organisational changes are under way explicit attention must be directed to sustaining energy and commitment for implementing them. Cummings & Huse (1989). • Ensuring an innovation is congruent with the needs of an organisation key in establishing a degree of prolonged sustainbility

26. Sustainability Vital element to any improvement initiative Ensures change is embedded Not only continues but evolves to enable ongoing positive benefits Concerns of longer-term sustainability are paramount to successful diffusion of innovation in clinical care. Sustainability Master score system

27. Involving users, staff and public • A large portion of the success of the clinic has to be allocated to the actual patients themselves • Efficiency, safety and the patient experience • Policy changes across the last decade have resulted in a focus on quality, performance standards and patient power Lord Darzi’s (2008)

28. Linking to advanced practice

29. Leadership is Intrinsic Making change actually happen takes leadership. It is central to our expectations of the healthcare professions of tomorrow Darzi (2008) Leadership in nursing is a rapidly evolving discipline, through development of the acknowledged qualities, skills and roles it is closing the gap between nursing practice and policy (NHS 2006; Antrobus and Kitson 1999; Hopwood 2006)

31. Leadership styles Goleman (2000) & Harvey et al (2002) The most effective leaders switch flexibly among the leadership styles as needed The most effective implementation techniques are multi-facetted in their approach

32. Transformational .v. Transactional Leadership

33. Conflict Management • Conflict caused by differences in ideas/values/ feelings, is inevitable due to differences of those working within any work environment. • Within a organisation which is fast evolving and persistently under pressure most people will have experienced both positive and negative relationships with colleagues (RCN 2005). • The optimal goal in resolving conflict, is creating a win-win solution for all. (Quinn et al. 2007).

34. Interprofessional/collaborative working • Networking and developing collaborative relationships • Developing vital political and valuable leadership skills, • allowing the potential to maximize personal profile, • responding to change effectively, • establishing credibility and • influencing at strategy level • Crucial to the implementation of any modification

35. Historical barriers • Contrasting histories of medicine and nursing can mean that it is difficult to change clinician behaviour, medical practice and healthcare organisations. • This can inhibit a truly collaborative partnership • This swing demands that we deviate from the traditional professional partitions and focus instead an emphasis on interprofessional collaboration (DOH 1999 & NHS executive 1999, NES 2007).

36. Conclusion • The planning and implementation of a transition project was been significantly aided by the use of change models. • Good understanding of myself, my place in the organisation and also the organisation itself.

37. Conclusion cont These concepts are the lynch pin for the core areas of the leadership qualities framework and are also highlighted as an essential capability for an advanced practitioner. The advanced nurse practitioner is in an ideal position to influence procedure and policy at strategic level if attributes defined by guiding organisations are readily accessed and utilised.

38. Thank-you