An Assessment of Behavioural and Cultural Change in the NHS

BackgroundHQCfA has set a profound challenge. It promotes an NHS that is clinically-driven, patient-centred, responsive to local communities and - above all - is focused on quality. Such espoused values are empty if they are not enacted by leaders and staff throughout the NHS. It is essential to identify the nature and extent of cultural and behavioural change in the NHS. Our research is designed to respond to that requirement. But it is also designed with a view to practical application of the evidence we generate. We will identify effective strategies for accelerating change and characterise the conditions for innovation, consistent with the HQCfA vision and values and securing value for money. We will also enable, where appropriate, NHS leaders to celebrate success and spread good practice. AimsWe aim to provide robust evidence of how the NHS is responding to the HQCfA challenge of making quality its central focus. At the core is an assessment of behavioural and cultural change, including mindset change. We will:• Assess the nature and extent of behavioural and cultural change over time • Identify the extent of leadership and staff motivation for engagement with the principles of HQCfA• Assess how well the cultural and behavioural aspirations of HQCfA are being supported by organisations• Improve understanding of how change happens, how change in the right direction can be accelerated, and how innovation can be facilitated• Generate practical, timely lessons and solutions for implementation of the HQCfA visionPlan of InvestigationOur investigation will involve a multi-method, multi-disciplinary and multi-layer approach to inquiry. It is informed by change models that recognise different organisational levels and that take account of processes, structures and the content of change. Our approach allows us to explore: leadership; local cultures and sub-cultures (norms, values, attitudes and behaviours at all levels); and staff engagement and mindsets. Our design, involving an integrated package of workstreams, both quantitative and qualitative, offers both a high-level and a close-up view, and allows identification of more universal features of systems as well as recognising the relevance of issues such as organisational size, hierarchy, history and context. Potential ImpactWe are committed to our research having a profound impact, in particular by identifying the practical action needed to promote cultural and behavioural change in the NHS. A key strength is our use of a range of feedback techniques, including Problem Structuring Methods (PSM), to enable teams, practices, trusts and DH Policy Groups to develop solutions in real time. We will report emergent findings through research-in-action workshops, and thus help to elicit models for improvement in culture and behaviour and find collaborative ways of achieving early localised gains. We will make success stories available as a resource. Key to our approach will be effective liaison with the DH and promoting rapid dissemination.