Managing Change in the NHS: Exploring Change Management in the NHS & NHS Change Management Processes

Managing change in the NHS: Implementing the goals of the NHS Long Term Plan involves a great deal of changes for all concerned. But how is everyone involved expected to manage these changes? This post explores change management in the NHS and the primary NHS change management processes PCNs should follow along their journey towards successfully meeting the challenges ahead.

Change Management in the NHS

Before we look at change management processes, let’s take a brief look at what change management is and is not …

It is not a stand-alone:

  • Business solution design process.
  • Method of process improvement.
  • Organisational performance improvement technique.

So, if it is none of the above, what is change management? It is a:

  • Combination of processes, techniques and tools designed to aid management of change’s “people side”.
  • Method for managing and reducing resistance to change during the implementation of organisational, technology or process changes.
  • Component necessary for the success of any process of organisational performance improvement like, for example:
  1. Business Process Reengineering, Organisational Development & Restructuring.
  2. Six Sigma*, Total Quality Management & Continuous Process Improvement.

It is, in a nutshell, about realising business results by managing change.

*Driving towards six standard discrepancies between mean and nearest specification limits, the Six Sigma approach is a data-driven, disciplined methodology for the elimination of flaws within any process, including anything from service to product and from transactional to manufacturing processes.

NHS Change Management Processes

The process of change management is essentially a series of activities or steps a change management project or team leader should follow to effectively apply management of change to any given project or change.

According to research into the most commonly applied and most effective change (Prosci), these steps/activities are in most effective change management processes taken in three phases:

Phase 1: Preparation for Change (Preparing for, assessing and developing a strategy for change).

Phase 2: Change Management (Detailed planning and implementation of change management).

Phase 3: Reinforcement of Change (Gathering data, taking corrective action/s and recognising results).

As you can see, these three phases contain eight elements of change management:

  1. Readiness Assessments
  2. Communication & Communication Planning
  3. Manager Training & Coaching for Change Management
  4. Training Development & Training
  5. Sponsor Activities & Sponsor Roadmaps
  6. Resistance Management
  7. Data/Feedback Collection, Analysis & Corrective Action
  8. Recognition & Celebration of Success

Let’s look at each of these elements in a little more detail…

The 8 Elements of Change Management


1 – Readiness Assessments

Change management project/team leaders use assessments as tools to evaluate their organisation’s (PCNs) readiness to change. Providing project teams with insights into potential opportunities and challenges they might have to face during the process of change, such readiness assessments may, for instance, consist of:

  • Change, historical and cultural assessments
  • Organisational, employee and sponsor assessments

As such, PCNs should assess the:

  • Scope of change, including: the severity (i.e. is it radical or gradual?), size (i.e. is this a minor or major change?) and extent (i.e. how many people will be affected?) of change.
  • Readiness of the organisation/people affected by change, including: affected groups’ backgrounds & value-systems, how much change is already happening, and what type of (and how much) resistance should be expected.
  • Change management team’s strengths.
  • Change sponsors’, which should include taking initial steps to enable said sponsors to lead the process of change effectively.

2 – Communication & Communication Planning

All too often, managers assume that all they must do to get the job done is to clearly communicate with employees. The fact of the matter is, there are numerous reasons why employees frequently fail to hear or indeed understand what they are told the first time a message is passed on. You may have heard that for a message to be cemented into employees’ minds, it must be repeated six or seven times – and there is much truth in that.

The reason for this is simple: your employees’ readiness to hear what you are saying depends on multiple factors. Effective communicators therefore carefully consider these three communication components:

  • Their audience
  • The message (i.e. what is being said)
  • Timing (i.e. when something is said)

The first steps in managing change, for example, are building awareness around the necessity of change and creating the desire for change among employees. Initial communications are consequently typically designed to generate awareness around the reasons for change and the potential risks of not changing.

Communications at every step of the process should likewise be designed to distribute the correct message at the correct time.

Communication planning consequently starts with a thorough analysis of your audience/s, key messages and those messages’ timing. Change management project/team leaders must design communication plans that address everyone’s needs, including those of executives, supervisors and front-line employees, bearing in mind that each audience has specific requirements for information based on the role they are expected to play within the implementation of change.

3 – Manager Training & Coaching for Change Management

Playing key roles in change management, managers and direct supervisors ultimately have more influence on employees’ motivation and readiness for change than anybody else within an organisation.

Unfortunately, supervisors and managers are often the most difficult group to convince of a need for change. As such, they can be a significant source of resistance. Gaining supervisors’/managers’ support and building change leadership is consequently a vital task for change management teams. This should include use of individual activities of change management to help resistant supervisors through the process of change.

Once supervisors and managers are “on board”, change management teams must prepare coaching strategies and provide training for managers/supervisors – which should include training for using individual change management activities/tools with employees.

4 – Training Development & Training

Training is the very foundation of building knowledge about change and skills needed, making it necessary for project teams to develop training requirements hinging on the behaviours, knowledge and skills necessary to implement change.

These training requirements form the starting point for training groups or training programme development project teams.

5 – Sponsor Activities & Sponsor Roadmaps

Executives, business and organisational leaders play critical roles within management of change. Change management teams must consequently develop sponsor activity plans and assist key leaders in carrying out these plans.

To be considered THE most important factor of success, sponsorship should, by the way, not be confused with support: a leader may support a project, but that does not necessarily mean they sponsor the initiative.

In other words, sponsorship involves senior leaders’ visible and active participation throughout the process of change. Many executives do, however, unfortunately lack understanding of what this kind of sponsorship looks like. Change project leaders’ roles include assisting senior leaders in doing what is right to sponsor projects.

6 – Resistance Management

It is perfectly normal to encounter resistance from managers/supervisors and employees. If that resistance is persistent, however, it can put a project’s success at risk. Change management teams must consequently identify, understand (the reasons for) and manage resistance across all levels of an organisation.

Resistance management essentially consists of project teams assisting executives and managers in the use of tools and processes designed to to effectively manage employee resistance.

7 – Data/Feedback Collection, Analysis & Corrective Action

Involvement of employees is an integral, necessary part of change management – and by no means a “one-way-street”. A key element of managing change, employee feedback, analysis thereof and corrective actions based thereon provide a robust change implementation cycle.

8 – Recognition & Celebration of Success

Both early and long-term successes must be both recognised and celebrated. To reinforce and cement change within an organisation, group and individual recognition are equally necessary components of change management.

Change management ends with an after-action review. This, the final step of the process, is the point at which you stand back from your entire programme, evaluate both failures and successes, and identify necessary process changes in readiness for your next project. It is part of continuous, ongoing change management improvement that will ultimately lead to change competency.


These eight elements encompass the components or areas of an effective change management programme. Effective application of these components allows good project managers to create an effective change management system that ensures project success, avoids loss of valuable employees and minimises any potential negative impact change could otherwise have on productivity, services and service users.

Managing Change in the NHS

Managing the many changes required by the NHS’ Long Term Plan is clearly an extremely complex challenge that requires extensive project/programme planning and management. At Scale can help you meet this challenge more effectively. Contact us today to learn how.