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Addressing the barriers to adopting best practice at scale

By Wendy Lane
3 January 2019

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There is a great deal of willingness to share best practice across the NHS. Strangely, however, this approach hasn’t always translated into adoption at scale, despite a long history of trying a variety of methods to support learning.

The challenge is in fully understanding both the similarities and differences between organisations and adapting our approach accordingly, says Wendy Lane, consultancy services director, Arden & GEM CSU.

Many NHS organisations face similar challenges, so what better way to tackle them than by pooling resources and learning from the experience of others. This is one of the principles behind the Global Digital Exemplar (GDE) Learning Network which was originally set up to support the first wave of GDEs and their partners.

The vision was to foster a culture among the GDEs of shared learning, to help accelerate transformation among other providers looking to optimise their use of technology.

The principle is a sound one, and we’ve seen best practice being identified with a view to implementing similar schemes elsewhere. But in our efforts to learn by example, we must remember to consider the individual context in which different organisations are operating before attempting to transfer a change to a new setting.

A trust’s ability to transform is influenced by many factors. Is the organisation in crisis? Is it a single or multi-site trust? What services does it provide, in what settings? How are teams structured? Who are the leaders and what style do they adopt? What are the drivers of local issues?

All of these questions will impact a trust’s culture and approach, which can directly affect the process and outcomes of change.

For example, a trust in special measures has a galvanising force to spur staff into action to adopt new ways of working, but may have processes to follow that impact on the change approach.

By contrast, an organisation that is performing well may find it more challenging to persuade staff of the need to change. This doesn’t determine whether you will be successful in transforming care, it simply means different tools and methods may be needed in each case.

But it’s not just cultural differences that need to be taken into account. When looking specifically at digital transformation, existing IT infrastructure may mean that a good solution in one trust is only directly replicable in organisations using similar technology, and needs adaptation to work in sites using a best of breed or internally built system.

These challenges should not prevent us from developing and applying best practice – what matters is the approach we take to implementation. So what steps should we consider?

Firstly, we need to do some homework. Look into the drivers of change at the exemplar organisation. Talk to them about the problem they were trying to fix and what factors influenced their approach, speed and success.

Then apply this to your own organisation. Where are the similarities and differences? What gaps may need to be filled before you start? Can the approach be adapted to suit your own environment? Secondly, don’t underestimate the importance of ownership.

The NHS has faced criticism in the past for a reluctance to adopt new ways of working because they weren’t invented by the NHS. However, ‘not invented here’ syndrome is often more to do with a lack of ownership and engagement in the process of change than where the idea first came from. Teams need to understand and believe in the changes envisaged.

There is an important distinction between ‘lift and shift’ and ‘adopt and integrate’. Simply implementing a best practice model risks missing out on the opportunity to maximise the potential benefits of change by ensuring it is tailored effectively for different circumstances.

Likewise, not working through the mechanics of the change required risks failing to develop the understanding and ingenuity needed to continuously improve it. Engaging end users to tailor the design of solutions to suit efficient ways of working, and using IT literate frontline staff as a bridge to technical staff, helps to build a culture that will continuously improve practice.

A blueprint provides a huge leap forward in enabling swift and effective change. Initiatives such as the GDE programme provide a concentrated boost of funding and support to enable a handful of organisations to pioneer new solutions, blazing a trail for the wider NHS to follow.

Capturing the learning from these frontrunners, and packaging it up in a way that provides clear direction for others, will help deliver maximum benefit for the health and care system as a whole.

But, just as copying a friend’s answers in a maths test doesn’t help you learn, we must be mindful that one size doesn’t fit all. A textbook to follow is a great start, but it does not replace the need to develop our own skills and use them to best effect.