Creating the conditions for change: an NHS perspective

Improving early diagnosis of cancer through system change initiatives is endemic in England's NHS cancer services. These initiatives, however, often fail to gain traction due to the complexities of health system structures. The purpose of this paper is to explore whether using a change framework grounded in systems thinking could be of help to system leaders.

A portfolio of geographically independent projects, all implementing cancer service changes as part of the Accelerate, Coordinate, Evaluate Programme, was used for the study. Eight projects were purposively selected to give a varied case-mix. Two semi-structured interviews were conducted with each project. Analysis of interviews was carried out using the Framework Method.

Processes working for (growth processes) and against (limiting processes) change were evident in and common across all eight projects. Projects commonly encountered challenges of relevance, time and bounded thinking. Having a network of committed people was vital for both initiating and sustaining change. Furthermore, understanding stakeholders' emotional responses to change helped mitigate emergent challenges.

Leaders should pay constant attention to the dynamics of change, taking time to anticipate and diffuse challenges whilst simultaneously working to create the conditions that help change flourish. A change framework rooted in complex systems theory can help leaders understand the contradictory and non-linear processes inherent in transformational change.

Few studies seek to understand change dynamics by comparing the experiences of separate change initiatives implemented contemporaneously. The findings offer leaders practical insights on how to implement transformation.