Questions to help identify development needs

Identifying the context for change

Applying knowledge and evidence

Making decisions

  • Stage 1: your own practice/immediate team
    Do you understand where the organisational vision? Do you actively contribute to decision-making processes aligned to the vision? Do you educate and inform others about your area of work to help influence organisational decisions?
  • Stage 2: the whole service/across teams
    Do you involve key people in making decisions? What involvement do you have in formal and informal decisions about the future of services?
  • Stage 3: across services/the wider organisation
    When was the last time you took a timely decision in a complex situation? Did you remain accountable for that decision? Are you willing to flex direction when faced with new information or changing circumstances?
  • Stage 4: the whole organisation/the wider healthcare system
    Do you take responsibility for ensuring corporate decision-making is rigorous and takes into account the full range of factors impinging on the future direction of the organisation and wider healthcare system? Can you operate without having all the facts? Are you able to take unpopular decisions which are in the best interest of health and care services in the long term?

Evaluating impact

Development suggestions

  • Stage 1: your own practice/immediate team
    • Keep up to date with what is going on in the organisation by regularly reading or listening to communications from the top. Continually remind yourself about the organisational vision to help you understand the drivers for change.
    • Talk with your peers informally. Discuss their reactions to planned changes. Aim to get a full picture of why changes are happening.
    • When a change is being introduced consider the benefits it will bring to patient outcomes. Are there any drawbacks? Share your thoughts on this with peers and your manager.
    • Get into the habit of using evidence (e.g. patient feedback or performance metrics) to suggest changes which will improve services in the longer term. Be prepared to challenge existing systems and processes by gathering evidence and knowing your position. However, listen to what others have to say as the discussion unfolds, rather than simply digging your heels in from the start.
    • Once you’ve implemented changes to the ways in which you work, take time to evaluate how the new systems & processes are functioning. Gather evidence to demonstrate how the new system / process is improving service delivery and patient outcomes. Are there any blockers to making things work? Are there any tweaks that need to be made in order to make things even better? Discuss with colleagues & your line manager.
    • Seek mentoring / ‘buddying-up’ opportunities to focus on enhancing your abilities in this area.
    • Seek out shadowing / secondment opportunities. Ask your local training department for advice in this domain. Or find voluntary opportunities in other sectors e.g. health and care sectors, third sector etc.
  • Stage 2: the whole service/across teams
    • When a change is being introduced ask yourself: What is the rationale? What is happening inside and outside the organisation to cause this change?
    • Engage others in discussions about what the future of the service might look like.
    • At team meetings ask others to consider what has worked well in the past that could be used in the future. Encourage others to make suggestions for improvements which are based on evidence.
    • Contribute to the wider decision making process, by looking for ways to pass on your knowledge and experience to others – e.g. write and present a paper, set up discussions with key decision makers etc.
    • Spend some time evaluating alternatives before making a decision. Look at what has been done before. How well did it work? What elements of that approach could be used or adapted successfully to save time, effort and money?
    • Focus more on the long term implications of decisions, by analysing issues in a wider organisational context. Consider what opportunities and threats there are. Consult others to explore the longer term impact of your decisions.
    • As part of your preparation for a situation where you will need to convince others on a decision, spend time considering their views, attitudes and position. Ask yourself how they might view the situation and what their critical needs and goals might be. Tune into their preferences; if they like facts and figures, give them these; if they are very values led appeal to them in this way; if they want to be consulted, consider how you might do this.
    • Seek mentoring / ‘buddying-up’ opportunities to focus on enhancing your abilities in this area.
    • Seek out shadowing / secondment opportunities. Or find voluntary opportunities in other sectors e.g. health and care sectors, third sector etc.
  • Stage 3: across services/the wider organisation
    • Keep your ear to the ground by: reading the health sector press regularly; attending conferences/NHS events; reading newsletters; reviewing various NHS websites; becoming involved in internal & external projects; reviewing patient feedback forums; keeping in touch with patients and users and drawing on your networks to anticipate and identify the contexts for change.
    • Always apply knowledge and evidence when considering the need for change. Work with others to verify your judgements and gain other perspectives on a complex situation you are faced with. Ask what conclusions they would draw or interdependencies they would see in the given information.
    • When taking decisions, create an ‘Influence Map’. This is a visual representation of the people and teams who will have an influence on the decisions you make. The map will help you understand how services and stakeholders relate to one another and therefore who ultimately has the biggest influence, and where/how to focus your energy when seeking to get things done.
    • Challenge your own decisions by asking yourself the following questions:
      • How will your partners/colleagues feel about this?
      • What’s the worst they might think of it?
      • Are your intentions clear and open?
      • What might be the consequences or impact of your decision on each of the stakeholder interests?
      • How can you promote your idea but keep it open to challenge?
    • Make a concerted effort to be open to information, even if it conflicts with your view (or with established views). Be prepared to change / flex your decisions on the basis of new information or evidence.
    • When testing out new service options, evaluate the new methods and practices and use your networks to disseminate best practice and learning both within and beyond the organisation.
  • Stage 4: the whole organisation/the wider healthcare system
    • Increase your knowledge on political, economic, social and technological trends. Read national newspapers regularly to help you appreciate the broader context in which the health service sits. This will help you identify potential challenges which might create the need for change in the future.
    • Review information on useful websites such as the Civil Service, HSJ, Department of Health, interesting blogs, social networking sites.
    • Stay abreast of what is going on at the Department of Health and ensure you are aware of what is coming out of key national bodies: NHS Employers, NHS Confederation.
    • Avoid being identified with a particular group. Try to set up alliances with a number of organisations and stakeholders that are not exclusive. The more inclusive your alliances are, the easier it will be to build support for your proposals.
    • Seek out best practice used in other sectors and countries to inform decisions you make.
    • Spend time building relationships with influential people (internal and external). This will help enlist support for your vision.
    • Make your decision-making process more visible to your people. Describe the issue. Tell them about the situation and the input you have considered. Let them know what decision you made and explain why you made that decision. Explain what evidence you used to make the decision.
    • If you’re uncomfortable about taking difficult decisions, talk your approach through with a coach or mentor. Practice giving the message. Think about the people who will be affected by the decision, consider the challenges that might be raised, be mindful of the support that might need to be in place for people following the announcement.
    • Consider ways you can share best practice from your organisation with the wider healthcare community – e.g. articles in newsletters or on relevant websites, speaking at NHS events, attending wider meetings, writing case studies.

Setting Direction

Have you completed one of our self assessment tools?