Frameworks for change in health & sickness organisations Sandra Dawson Cambridge International Health Leaders Programme 2006

Context is always important! And health systems are some of the most complex at every level -policy -managerial -professional -individual

Cost, complexity and the need for effective change management infinite supply infinite demand political involvement political sphere state funding, regulation, party politics scientific sphere knowledge & applications professional sphere diversity & dominance industrial sphere global investment public sphere public expectations of life and death

Increasing therapeutic potential Informed and assertive patients Drive for public and preventive health measures across the population Universal coverage Health workforce under pressure Increasing co modification and individualisation of health issues, and targeting of policy Consumer choice Tensions in Health Policy

Complex scientific and technological processes concentration of specialists Societal factors affecting health Demand for assurances on public safety issues, and for more provision accessible diagnosis & treatment inter-sectoral approaches in health Behavioural factors affecting health Tensions in Health Policy

Managerial context What are the managerial imperatives (core purposes)? –Cost, value for money, quality of public health, quality of sickness service (clinical and non-clinical) political support, achieving targets, keeping the organisation going and the people employed… How do you secure your resources? What specialist skills do you have? How is the shape of your organisation created?

Administration, management, leadership A Implementing policies and decisions,following rules M Securing, committing, controlling resources (financial and human), solving problems, making rules L Encouraging, motivating, inspiring

Conditions for Behaviour ChangeKnowledge CapacityMotivation dawson1992

Change Processes in Organisations Precipitating factors Members’ felt need for change Decisions/plans for instituting change Implementation Outcomes Feedback (including evaluation) Chance Serendipity Creativity Learning Intuition

Creating a realistic sense of what may be possible, why it is important and how it may be achieved Iteration between policy and practices

Systems Thinking Innovation associates (1996)

Why change? What are the imperatives? Threats and opportunities? Appraise and evaluate What are the alternatives? And the consequences? Always communicate!!