Transformational change in the NHS: using action research to improve the way change leadership skills are developed

This practice-based project explores the change leadership capabilities required in the English National Health Service (NHS) to undertake large scale change across complex environments. Due to a plurality of perspectives in the academic literature and limited empirical evidence about the mechanisms of major change, uncertainty exists about the nature of these capabilities and how NHS leaders can be supported to develop and apply them.
The context for this research is the work of a team who design and deliver professional development programmes for those seeking to undertake transformations across NHS services. Through insider action research, cycles were used to build the knowledge and collective intent required by the team to guide their on-going programme design activities between May 2016 and May 2018. During this period the research supported the team’s delivery of seven development programmes, reaching over 400 individuals engaged in transformational change.
The research assisted the team in the creation, adaptation and testing of programme content and designs. Mixed methods were used to help the team engage in reflective discussions, undertake collaborative design activities and review participant programme evaluations. In parallel, inductive enquiries aided the team’s understanding of transformational change by exploring the experiences of change experts and previous programme participants.
The research resulted in the refinement of a framework categorising major change leadership activities, underpinned by a new action-oriented model of transformation. Key aspects of change praxis were described through a definition of transformational change and a guide to the principles of effective change practice. Programme designs also came to explicitly emphasise the interdependency of content areas and encourage change leaders to establish their own theories of practice within which they could adopt mutually reinforcing actions.
Within the team, the collective understanding of members’ tacit perspectives on transformation and associated pedagogical practices was enhanced. This created new insight into the factors contributing to complexity and greater awareness of some of the paradoxes shaping programme design decisions. Views on change leadership also evolved. The importance of trust building and cultural change as enablers of transformation were highlighted. Similarly, the value of creating increased connections between people in the system undergoing change whilst supporting their alignment around a common purpose was also recognised. Further, leadership was suggested to include the navigation of the tensions and uncertainties encountered in transformation, appreciating the cognitive and affective demands of change at scale on both those involved in the change and those leading the change process.