Turnarounds in the NHS are difficult. Here are 5 practical ways to improve your chances of success from a turnaround practitioner that works in both the public and private sectors.

1. “TURNAROUND – WHY IT PAYS TO THINK
DIFFERENTLY”

2. FIVE AREAS WHERE DELIVERY COULD
BE IMPROVED IN THE SHORT TO
MEDIUM TERM
NHS Transformation programmes are difficult; they require behavioural
and attitudinal change to be effected on a scale only normally seen by
governments and large consumer goods companies. Add to that the
complexity of cross organisational processes, a heritage of public service
and skills that are focused on improving patient well being rather than
delivering large commercial change the challenge starts to become
clearer.

3. FIVE AREAS FOR IMPROVING TRANSFORMATION
DELIVERY
1. Cross Organisational working – many schemes require change to be effected in
several domains of the healthcare system e.g. CCGs, Providers, the Public etc. Few
schemes have joint ownership or cross organizational working
2. Change model - an effective way of changing behaviour that combines the
marketing disciplines of segmentation, targeting and positioning along with an
effective marketing mix, rewards and sanctions, constraints, and performance
feedback.
3. Business Intelligence - Regular reporting that allows the programme to be
developed and managed around individual level behavioural data
4. Programme Leadership - senior ownership of the programme with appropriate
coaching and management along with defined escalation and senior intervention
regimes
5. Confidence - belief amongst the team that they may and can change the
behaviours of clinicians

4. 1. ADDRESS CROSS ORGANISATIONAL
WORKING
Many schemes require change to be effected in several domains of the
healthcare system e.g. CCGs, Providers, the Public etc. Success will
require joint ownership and planning along with cross-organizational
working. Successful models can be seen in other industries such as
Grocery Retail and Automotive who now comfortably embrace shared
data, resources, processes and management.

5. 1. CROSS ORGANISTIONAL WORKING
• Stakeholders in all organisations are identified
• All are managed as separate units within a whole
• Makeup of programme leadership reflects all constituencies
• Benefits are clear to all parties at a macro and entity level.
• Investments are in direct proportion to potential returns
• Risks are acknowledged and bourn by all parties
• Developed by all parties and accommodates different local
requirements
• All parts managed as a single programme
• Remains within the influence of all declared stakeholders
• Covers the full length of the process, across organisational
boundaries
• Team made up of members of all stakeholder groups
• Commitment from all parties to free up time and give degree of
dedication to the programme
• Taken from the view of each stakeholder group
• Managed as a single programme team
• Supplier/ customer relationship replaced by programme based
partnership

6. 1. CROSS ORGANISTIONAL WORKING
• Stakeholders in all organisations are identified
• All are managed as separate units within a whole
• Makeup of programme leadership reflects all constituencies
• Benefits are clear to all parties at a macro and entity level.
• Investments are in direct proportion to potential returns
• Risks are acknowledged and bourn by all parties
• Developed by all parties and accommodates different local
requirements
• All parts managed as a single programme
• Remains within the influence of all declared stakeholders
• Covers the full length of the process, across organisational
boundaries
• Team made up of members of all stakeholder groups
• Commitment from all parties to free up time and give degree of
dedication to the programme
• Taken from the view of each stakeholder group
• Managed as a single programme team
• Supplier/ customer relationship replaced by programme based
partnership

7. 2. DEVELOP AN EFFECTIVE CHANGE
MODEL
For transformation to be effective specific target individuals have to
change what they think and do. Plans need to understand this change
and outline a way of effecting it. Many units feel that this is ‘surely
impossible’, however this is what the marketing departments of Pharma
and Healthcare companies successfully achieve every day. Combining the
marketing disciplines of segmentation, targeting and positioning along
with an effective marketing mix, rewards and sanctions, constraints, and
performance feedback will achieve the required result.

8. 2. Effective Behavioural Change Models
Thinks
Feels
Does
Has

9. | 18-Sep-13 | 9
What change do we want to effect?
Where are they now?
What can we do to change this? Where do we want
them to be?
Think Think
Feel Feel
Do Do
Have Have

10. 3. BUSINESS INTELLIGENCE
The NHS is a data rich environment however little is used in the delivery
of change. These internal sources, combined with selective use of
external information from providers such as IMS and Cegedene will allow
the Program director to devise strategies that are based on fact and
evidence. Impact can also be more accurately tracked with regular
reporting that allows the projects to be developed and managed as they
progress.

11. The NHS is set to be externally focused
“Improving the outcomes for all Patients in line with the NHS Healthcare Outcomes Framework”
“Maximising the resources that are spent on Healthcare by making the NHS an exemplar in
customer focus”
“Ensuring Local Area Health Policy aligns with public and patients needs and preferences.”
“Improving outcomes by designing and delivering care around the needs and choices of each
individual patient by transforming patient and public participation in the NHS”
“Ensuring inequalities in access to healthcare in the area are addressed and that every person
who comes in to contact with the NHS is treated fairly and equally, whether a patient or a
member of staff.”
“To become a customer service focused organisation”
“Removing areas of disadvantage from the system and guaranteeing no community is left behind
or disadvantaged”
“Prioritising patients in every decision we make listening to the people and communities we serve.
“ ...... including public behavioural change through social marketing and, where appropriate,
access to expert patient programs”

12. 3. Business Intelligence and Research - illustrative
Research Data Use Possible Source
Profile All descriptive elements e.g.
geo, size of practice, years
experience, specialty etc.
Segmentation and targeting In House
IMS
Cegedene
Usership and Attitude View on the therapy area, the
centrally driven changes in
clinical pathways generally
etc.
Understanding how to
influence and to plan
messaging
IMS
Commissioned
Current Behaviors What is the clinician doing
with regard to the preferred
behavior?
Understanding to what
degree their behavior needs
changing. Tracking
performance.
Admissions and referral data
Media use and influence
maps
Use of web sites, attitude to
reps, who influences them,
preferred learning
environment
Ensuring that appropriate
channels are used for the
target community
In House
IMS
etc

13. 4. ENSURE SENIOR PROGRAMME
LEADERSHIP
Programmes of this level of scale and organizational importance should
be lead and managed at the board level. Senior ownership of the
Programme with appropriate coaching and management along with
defined escalation and senior intervention regimes are also necessary as
are sophisticated programme management skills and tools. Investment
in senior project teams with cross industry experience will be essential.

14. Programme Leadership and Management - The
Cadence Process
Current reporting is a collation of all of the 'bits', particularly those that are broken:
• Served up to the ‘accountable’ from the ‘responsible’ as a long list of problems –
‘Dead Cats’.
• Takes hours to run through everything - frustrates both parties.
• Seniors need to now whether the overall commitments are to be made and where
they can help
Cadence is designed to support this:
• Designed to roll up the full organisation in half a day
• Not a status report - shows
– gaps and risks around the number that is committed to
– how the responsible person is addressing any risks
– need for mitigations.
• Supports a short (no more than 10-15 min) one to one call between the
Accountable and the Responsible.

15. Weekly Cadence Report
Overall Performance
Date
01-Nov-12
Summary
£'000
Demand
Management
schemes
Other
Schemes
including
new QIPP
Contracts
management
Other Total
Recovery Plan Commit 35,549 19,465 33,380 0 88,394
Recovery Plan
Benefits completely secured and in FIMS 0 3,148 0 0 3,148
Benefits completely secured not yet in FIMS 483 0 0 0 483
Benefits still to be secured and in Recovery Plan 23,239 18,074 32,417 0 73,730
Total planned and delivered Recovery 23,722 21,222 32,417 0 77,361
Gap 1 - Planning Gap to Sussex Recovery Plan
Commitment
(11,033)
Summary of Project Risk
Project 1 (1,639) 0 0 0 (1,639)
Project 2 (277) 0 0 0 (277)
Project 3 (799) 0 0 0 (799)
All Other Project Risk 0 0 0 0 0
Risk (4,615) 0 0 0 (4,615)
Gap 2 - As above (Net of Risk) to Sussex
Recovery Plan Commitment
(15,648)
Mitigating actions %
Recovery of underspent budget 0 0 0 0 0
Implementing strict spending controls 0 0 0 0 0
Better working of top 20 contract performance 0 0 0 0 0
Other mitigations 100 287 0 0 901 3,888
Mitigations 287 0 0 901 3,888
Gap 3 to Recovery Plan Commitment (760)

16. The 7 Key Questions for Cadence
1. IS THE COMMIT STILL THE COMMIT?
2. DO WE HAVE A PANNING GAP?
3. WHAT ARE THE MAJOR RISKS THAT ARE EFFECTING THE SURETY OF OUR
PROGRAMME
4. HOW ARE WE MITIGATING GAP 1 AND GAP 2?
5. WHICH ACTIONS DOES THE RESPONSIBLE WANT THE ACCOUNTABLE TO TAKE TO
INCREASE SURETY FOR DELIVERY OF THE COMMITS?
6. WHAT SHOULD EACH PARTY TELL THE OTHER ABOUT WHAT IS COMING UP OVER
THE NEXT 7 DAYS?
7. OCCASSIONAL DRILL DOWN

17. 4. ENSURE SENIOR PROGRAMME
LEADERSHIP (CONTD…)

18. Transformational Leadership a la Lou….
“You can't mandate it [the culture change], can't engineer it.”
“What you can do is create the conditions for transformation. You can provide incentives. You can
define the marketplace realities and goals. But then you have to trust. In fact, in the end,
management doesn't change culture. Management invites the workforce itself to change the
culture.”
“ I knew the leader of the revolution had to be me—I had to commit to thousands of hours of
personal activity to pull off the change. I would have to be up-front”
“We started with a statement of principles. Why principles? Because I believe all high-
performance companies are led and managed by principles, not by process.”
“Of course, different people are motivated by different things. Some by money. Some by
advancement. Some by recognition. For some, the most effective motivator is fear —or anger. For
others that doesn't work; it's learning, or the opportunity to make an impact, to see their efforts
produce concrete results. Most people can be roused by the threat of extinction. And most can
be inspired by a compelling vision of the future. Over the past ten years, I've pulled most of those
levers”

19. 5. CONFIDENCE - BELIEF AMONGST THE
TEAM THAT THEY MAY AND CAN
CHANGE BEHAVIOURS
Instilling Confidence - belief amongst teams that they may and can
change the behaviors of clinicians, who they see as their superiors, is
necessary if they are to be successful. Similar attitudinal changes have
been undertaken in the airline industry as well as surgical teams within
major teaching hospitals.

20. And the last word is Lou’s
“What you can do is create the conditions for transformation. You can provide
incentives. You can define the marketplace realities and goals. But then you
have to trust. In fact, in the end, management doesn't change culture.
Management invites the workforce itself to change the culture.
Perhaps the toughest nut of all to crack was getting employees to accept that
invitation. Many use hierarchy as a crutch and are reluctant to take personal
responsibility for outcomes.
In the end, my deepest culture-change goal was to induce people to believe in
themselves again—to believe that they had the ability to determine their own
fate, and that they already knew what they needed to know.”