Here is the full report of the NHS Change Model hack event, which took place on Wednesday, 14 October 2015. There has never been a better time to really scrutinise the way we go about change in health and care. There is a growing body of evidence and practical know-how behind effective and successful change and we must make sure that our change efforts are designed to take full account of the evidence based and lessons learned. The NHS Change Model has been one of the leading models of change used in the NHS over the past couple of years. We know that some improvement leaders would not be without it and use the model extensively, to underpin and structure all their change activities. We also recognise that there are some change leaders that are not so keen on the NHS Change Model. They have found it hard to apply the model in a practical and useful way and there are others who think that it should be broadened out from just being an NHS-specific model. The way we lead change must always adapt and evolve with the times and as such, we feel it is timely and opportune to review and revise the NHS Change Model. Our starting point is hearing and understanding exactly what the people leading change in health and care say they need to support them. We want to use methods that fly in the face of tradition and open up new, exciting and creative opportunities. We organised a hack day for about 80 selected people that brought diverse and wide-ranging perspectives to the table. Hack events have traditionally been associated with technology and programming to solve problems, but we are adapting the concept and applying the same principles to ‘hack’ the NHS Change Model, in just one day. You don’t need any techie skills, just insight, ideas and energy to work with others to think deeply about change and collaborate over how we could do it better. On the day, we: Reviewed how change currently happens in health and care and what people leading change need to support them Reviewed the NHS Change Model Designed a proof of concept to support and enable change across health and care

1. The NHS Change Model hack
14 October 2015
#CMhack

2. Change is changing…
…and so must the approaches we use to support and
enable change.
That is why we’ve held our first ever hack.
We hacked the NHS Change Model to gain diverse
and actionable insight into how it can be even better
and more helpful to more people.
Here’s our story…

3. About this report
This report is:
• A collection of the inputs and
outputs of the day
• A record of what happened on
the day
• A wealth of information, a lot of
important voices and a starting
point for considering next steps
• About capturing the feeling of the
day
This report isn't:
• A commentary or analysis of the
NHS Change Model
• A prioritisation of what matters
the most
• A decision document about what
happens next
All the slides used at the event can be accessed via SlideShare
All the pre-reading material is also available via The Edge

4. Why are we hacking the
NHS Change Model?
The NHS Change Model has been one of the leading models of change used in the
NHS over the past couple of years.
We know that some improvement leaders would not be without it and use the
model extensively, to underpin and structure all their change efforts. We also
recognise that there are some that are not so keen on the NHS Change Model.
They have found it hard to apply the model in a practical and useful way and there
are others who think that it should be broadened out from just being an NHS-
specific model.
The way we lead change must always adapt and evolve with the times and as such,
we feel it is timely and opportune to review and revise the NHS Change Model. Our
starting point was to listen to and understand exactly what the people leading
change in health and care said they needed to support them. We want to use
methods that fly in the face of tradition and open up new, exciting and creative
opportunities.
So, we organised a hack day for about 80 people that we felt would bring diverse
and wide-ranging perspectives to the table. Here’s what happened…

5. Dr. Helen Bevan, Chief
Transformation Officer
for the Horizons Team,
NHS Improving Quality,
opened the day.

6. Aims for the day
• Review how change currently happens
in health and care
• Review the NHS Change Model
• Design a proof of concept to support
and enable change across health and
care
• Scope how a change model can be
spread across health and care

7. The NHS Change Model
Developed in 2012 with inputs
from hundreds of people, to
distil twenty years of learning
from change in the NHS into a
useable model to accelerate
and get better outcomes from
improvement
More information:
NHS Change Model

8. Helen Bevan talked about
intrinsic and extrinsic motivators,
how they relate to the each
other and the elements in the
NHS Change Model

9. Five key principles in using the
NHS Change Model
1. Start with “shared purpose” but after that there is no prescribed linear
or logical order
2. It’s important to use the model to check if all eight components are
present but it’s more important to focus on whether they are aligned
3. Use the model to build on what you are doing already
4. Don’t “sell” the change model; “sell” the outcomes you are seeking
5. Build commitment to, not compliance with, the NHS Change Model

10. Peter Fuda
“Change is not the goal, the
goal is the goal”
Peter Fuda

11. Helen Bevan spoke
about how less than
10% of the potential
for improvement at
system level can be
delivered through
type one change
Thinking about large scale change…

12. “Transformation is not a matter of intent...
…it is a matter of alignment”
Peter Fuda

13. Zoë Lord, Improvement
Manager in the Horizons
Team, NHS Improving
Quality, presented
insights gleaned from
interviews and
questionnaires completed
by over 200 people.
This was invaluable in
understanding people’s
preference for leading
change, how the NHS
Change Model is currently
being used and how
people think it could be
improved.

14. Feedback on the
current NHS Change Model
Over 200 people were surveyed about how they currently undertook change and
what they thought of the NHS Change Model. Here are some of the insights:
• Use:
– It is used for many different purposes; projects, events, meetings
• Knowledge:
– The more people know, the more they find it useful
– Easy accessible information on practical application is required
• Language:
– Some of the language is inhibiting
• Name:
– NHS brand brings prestige
– NHS brand is hindering the uptake from other care providers
– Is it a model or framework?

15. Going forward…
• Bring on board the people who don’t like it and keep hold of the people
who do like it
• Enhance the positives – rather than change for change sake
• Address what ‘it’ should be called
• Think about spread and implementation
• How we frame it so that we focus on the goals not the model

16. Activity 1: BINGO!
We kicked off the event
with a game of bingo, so
we could all get to know
each other’s skills and
experiences a little
better.

17. Perry Timms is one the UK’s leading
advocates of hackathon approaches
for service transformation, so we
were thrilled that he was involved
with our hack. Here’s Perry
explaining how it was all going to
work.

18. We asked our hack participants to…
• Go with the flow and have faith in the process
• Unconference - self organise and follow your interests!
• Bring and voice your own perspective – that is why you are here!
• Collaborate, support and constructively challenge others
• Take collective responsibility for completing the task in the timescale
• Put yourself in other people’s shoes
• You have permission to create!
• Let reflectors reflect!
• Have fun!

19. What is a hackathon?
• Strategic
• Socialised
• Participative
• Fast
• Conclusive
Perry has written an article for us “Saving the world from mediocre ideas” which gives great
insight into a non-technical hack.

20. TRIZ: Theory of Inventive Problem solving
For the first part of the hack
process, delegates were asked to
use the TRIZ method to think
about the change model, why it
should be improved and how it
could be improved.
Stopping counter-
productive activities
and behaviours

21. Delegates were asked to
answer three questions:
1. How could we create a
framework that never gets
used?
2. Are we currently doing
anything that resembles the
items on list 1?
3. What do we need to do to
stop getting undesirable
results?

23. How could we create a model that never gets used?
Here’s some of the responses we
received…
• Use lots of jargon
• Tell people they must use it
• Have 100s of different versions
• Make it completely irrelevant
• Make it extremely complicated to use
• Exclude values
• Make it really academic
• Make sure it requires specific skill to
use
• Make it long and complex. NO pictures,
just long text
• Make it really complicated and complex
• Do not be clear about what it is for
• Every time you use it you will get
an electric shock!
• Obscure and unhelpful name
• Keep it on the shelf
• Make sure you need training to
understand it.

24. Are we currently doing anything
that resembles the items on list 1? Yes!...
Here’s some of the responses we
received…
• Top down
• Uses jargon and so people disengage
• Feels academic
• Published in an unattractive medium
• In house language/ acronyms
• Not sharing great work
• Documents too long
• Same people, using the same tools,
mechanisms and approaches
• Needs training
• Don’t engage with a diverse
audience
• Too hierarchical
• Don’t have explicit practical
applications
• No help available to use it. No ‘go to’
for help
• It is hidden away: not easy to find
• Ignoring other change models
• We call it a ‘model’
• Doesn’t offer a simple process for
frontline staff

25. What do we need to do to
stop and start doing?
Here’s some of the responses we
received…
• Need to make it simpler to use it.
• Make it applicable by using outcomes
it is in use.
• Need to put it into training and
education
• Need to create a technique to
remember the components.
• Need to market it using credible
people with the goal at the heart of
the sell.
• Need to build it with other sectors in
mind.
• Be clear about how it is relevant/ can
be relevant to your change.
• Careful use of language - Stop using
jargon
• Need to consult with diverse and
‘expert’ reference group (the key people
who are involved), using a variety of
mediums.
• Need to tell people it exists. Engage,
engage, engage. Tell the right people in
the right way.
• Needs to be easy to access and use and
adapt.
• Need to bring it to life with case studies.
Keep them recent and applicable.
• Need to focus on outcomes. Nail the
why. Confirm the real issue. Patients.
Shared purpose.

27. Lets get hacking!
We ran a series of hacks to explore design a proof of concept to support and
enable change across health and care. A number of hacks focused on:
• What’s it called?
• Elements: language, in/out, what’s missing?
• What does it look and feel like?
• How is it underpinned? Resources and format
• How do we engage people in spread and sustainability?

28. Here are some
of the outputs
from our
hacks, starting
with mini hack
#1,
“Who is the
Change Model
for?”

29. Who is our new Change Model for?
Who is our customer?
Here’s some of the responses that came from our
participants on the day:
1. Anyone who wants to make a change in health and care
2. Those who are directly leading the change e.g. policy
change
3. Those affected by or part of the change should be
involved
4. People at any level who want to make a difference
5. People with purpose and passion
6. People who don’t know where to start
7. People with ideas
8. Busy, practical people
9. People creating change, wanting leaders
10.Patients
11.For change makers whoever wants to reach an ultimate
goal

30. Mini hack #2:
this team
wanted to
make the
Change Model
cool!

31. Mini hack #3:
how do we support
people to best use
the Change Model?

33. Mini hack #4:
using the
‘Oshry’ model
to hack the
Change Model

34. Mini hack #5:
let’s strip the
Change Model
back (to basics)

35. Mini hack #6:
our use of
language
This hack team
focussed on
language.
There was extensive
discussion about the
language that should
be used which in the
Change Model.
Questioning was a
preferred approach

36. Mini hack #7:
how can we
include change
(improvement)
in education
and training?

37. Mini hack #8:
creating
resources to
support the
Change Model

38. Mini hack #9:
our un-model
(a philosophy
not a model)

39. The un-model continued…

40. Mini hack #10:
how could we
get it used?
This hack team focussed
on dissemination and
how it could be used.

41. Mini hack #10: ‘Team
Cool’…it’s more than a
model…

42. Mini hack #10: ‘Team
Cool’…it’s more than a
model…

43. Possible designs for the new model

44. Early stats for #CMHack today: 6.7m impressions; 1K+ tweets; third healthcare
worldwide trend - via @symplur
On the day we
were the third
trending
healthcare hashtag
in the world!
@symplur

45. Some feedback at the end of the day…
“It’s gone really quickly.
Focus on outputs has
been really worthwhile”
“Encouraged by diversity
and depth of thinking. Also
encouraged by alignment of
thinking”
“Exciting discussions. Really
respectful of each other’s
opinions”
“Great day. Inspired and
engaged. Let’s now
involve more people
and co-design”
“Thank you for taking us
through the process.
Thoroughly enjoyable”

46. To conclude…
It was a fantastic event that created more than we’d ever imagined!
There was energy, passion and strong desire to ensure change happens
effectively across the whole of health and care (not just the NHS) and that
people feel supported when undertaking change.

47. To conclude…
With your help, we will continue to synthesise and build on all the outputs,
conversations and ideas to coproduce a prototype ready for further testing.
We are looking to prototype a ‘change space’, a change platform that will house
a change model and all the relevant resources and conversations that are
needed to support and shape the future of change in health and care.
If you would like to (continue to) provide input (and we really hope you do!) you
can tweet us on #CMhack @ZoeLord1 or email: Zoe.Lord@NHSIQ.nhs.uk

48. @PerryTimms

49. Further reading:
• More information about the NHS Change Model
• Here’s the SlideShare from the event
• Read through the tweets of the day and continue with the
conversation using #CMHack
• We took lots of pictures and shared on Pinterest as the day
evolved
• Here is all the pre-reading material that we made available to
our participants including information on hackathons and
insight into the current NHS Change Model