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You are here: Home The Roadmap for Transformational Change

Roadmap for Transformational Change

Click here for an overview of the Roadmap. To go directly to more detailed information, click on the relevant part of the diagram. If you have used the Roadmap and would like to write a case study, please click here.
Roadmap for Transformational Change Phase I - Initiation and Strategic Planning Phase II - High-level Design and Benefits Planning Phase III - Detailed Analysis and Design Phase IV - Developing, Testing and Training Phase V - Implementing, Tracking and Improving Governance and Management: Establish LHC governance and approve ISI Plan Governance and Management: Establish programmes and  approve Programme Definitions Governance and Management: Establish projects and approve Project Initiation Documents Governance and Management: Manage development and preparation for change Governance and Management: Manage transition and the realisation of benefits Strategy and Benefits: Create an ISI Plan for the LHC Strategy and Benefits: Plan benefits realisation for programmes Strategy and Benefits: Plan benefits realisation for projects Strategy and Benefits: Baseline and validate benefits Strategy and Benefits: Realise, measure and review benefits People, Process and Technology Change: Create a high-level model of the LHC People, Process and Technology Change: Design and agree options for programme-level future states People, Process and Technology Change: Design and specify changes to processes, people, technology and estates People, Process and Technology Change: Develop and test all changes and train staff in new workflows People, Process and Technology Change: Implement, support and sustain change Stakeholder Engagement and Communications: Create and communicate the case for new transformational change Stakeholder Engagement and Communications: Gain programme-level commitment to transformational change Stakeholder Engagement and Communications: Gain commitment to measurable benefit targets Stakeholder Engagement and Communications: Prepare stakeholders for implementing change Stakeholder Engagement and Communications: Communicate and sustain achievements

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Overview of the ISIP Roadmap for Transformational Change

The ISIP Roadmap for Transformational Change (RTC) has been created to support Local Health Communities (LHCs) with their work on Integrated Service Improvement (ISI). It builds on and incorporates ISIP's approach to Strategy & Benefits published in November 2005. (Click here for more information)

What is the RTC?

The 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: it is relevant to both commissioners and providers and can be used across an LHC, a clinical network and an individual trust or organisation.

The framework is currently 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 ensure that these are focused on the realisation of benefits, it is likely that they will need to cycle back later to consider both the integrated change programmes to which their projects (should) contribute and to the strategy that sets the direction for change.

Each phase of the RTC is supported by an Activity Map that identifies a balanced and interconnected set of activities across the four strands:

  • Governance and management
  • Strategy and benefits
  • People, process and technology change
  • Stakeholder engagement and communication

Each activity identified within the Activity Maps is described, together with potential triggers, inputs, tasks and outputs. The RTC also provides access to additional guidance, tools/techniques and relevant case studies.

Do all the activities have to be completed?

Whilst the RTC may look like a complete and prescriptive method for transformational change, it is not designed to be used in this way. It is intended to be a general framework that can be adapted to fit local requirements. 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 extent to 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 that are being developed, for example, by the NHS Institute for Innovation and Improvement.

What is the purpose of the RTC?

The primary purpose of the RTC is to stimulate and guide the local decisions and activity required to realise demonstrable benefits through the delivery of successful and sustainable and integrated change. 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 will require active support from chief executives and senior clinical leaders.

Organisations in LHCs are continually changing to improve capability and performance and to respond to external drivers and challenges. Integrated Service Improvement as outlined in the RTC is intended to strengthen and underpin programmes of planned change by:

  • providing the motivation for organisations to work together in LHCs;
  • highlighting the need for change that is both integrated and transformational;
  • focusing attention on the need to plan and demonstrate the realisation of benefits from change;
  • providing a comprehensive framework for transformational change through which LHCs can share experience and build a skilled and recognised community of change leaders and change managers - a community that has active participants from all groups of stakeholders including management, clinicians, support staff and patient/service user representatives.

Where does the RTC come from?

The use of activites within frameworks similar to the RTC is well tried and tested. Change process and change lifecycle methodologies have been used by many successful organisations in both the public and private sector. Examples in the public sector include the the Department of Work and Pensions Change Lifecycle which was first introduced in 2002. The selection of activities is based on best practice and experience (including, for example, Managing Successful Programmes (MSP) from the OGC and Benefits Management from Cranfield University).

Most of the largest consultancy organisations have developed similar tools to support large-scale business transformation. Many variations are described in published literature and where appropriate these are referenced throughout the RTC. The description of these best-practice activities within the RTC seeks to make them relevant for the particular circumstances of transformational change programmes in the NHS.

Who is the RTC for and how can it be used?

The RTC is primarily intended to support managers and clinicians who are leading or managing integrated service improvement in a Local Health Community (LHC). It can also support those based at Strategic Health Authorities (SHAs) and in individual Trusts.

It is intended to provide these change leaders and change agents with a flexible approach to:

  • strategic commissioning/planning of integrated service improvement;
  • systematic design and planning of benefits-led integrated change programmes;
  • specification and planning of benefits-led projects;
  • development and testing of changes and the training of people to implement and adopt change;
  • implementation, tracking and improvement of planned change and the demonstrable realisation of benefits;
  • review and assess the extent to which current change programmes and projects are, for example, integrated and/or benefits-led;
  • select a relevant and balanced set of activities that enables the LHC, programme or project to undertake transformational change in a way that is appropriate to local conditions;
  • provide materials to support change leaders and change managers.

The RTC is currently published as a proof of concept. It needs to be tested and further developed to ensure it achieves its aim. The RTC will provide even greater value when it can point to case studies and other materials that outline how LHCs have used it to respond successfully to known requirements for change. These could include short-term turnaround, 18-week wait and strategic commissioning. ISIP is working with the NHS, the Department of Health and other stakeholders to faciliate the development of this material.

To access the RTC, click on one of the phases in the overview diagram at the top of this page and drill down through the associated activity map to the description and supporting materials for each of the activities.

Note: The RTC is not intended to be either exclusive or prescriptive, and should be used alongside other sources of information to implement integrated service improvement in a way that is appropriate for each LHC.


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