HTP Change Agent pack

HOSPITALS TRANSFORMATION PROGRAMME

CHANGE AGENT PACK

Contents page

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Welcome to the team

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Hospitals Transformation Programme

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The Clnical Model

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Expected milestones

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Golden Circle Model

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How to effect change

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Bridges Transition Model

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The management of change process

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Role of People & OD

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Support available

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Resources

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Useful links

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Communications links

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Useful contacts

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Next steps

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Welcome to the team From all of us in the HTP team–THANKYOU and a warm welcome from us.

This pack contains information which will guide you through the necessary next steps in your role as a HTP Change Agent.

We are pleased to have you on this journey with us as we navigate change, build trust, engage, communicate and all strive towards two thriving hospitals.

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A multi-million pound investment in our hospitals and community sites We’re improving care for everyone through modern, purpose-built facilities as part of our Hospitals Transformation Programme.

Our doctors and nurses have led these plans to develop two thriving hospitals supported by more services in the community.

Opening in 2028, our exciting multi-million pound investment will benefit all our patients.

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The clinical model Royal Shrewsbury Hospital Royal Shrewsbury Hospital will become the site specialising in emergency care.

A modern, purpose-built Emergency Department – with separate children’s footprint A critical care unit Consultant led maternity care Children’s inpatient services Emergency Medical Specialist Services, including Cardiology, Stroke, Respiratory and Acute Medicine Emergency and trauma surgery Head and neck inpatient services Radiotherapy and inpatient and day cancer care and treatment Princess Royal Hospital Princess Royal Hospital in Telford will become the site specialising in planned care.

24/7 urgent care services Planned inpatient surgery and medical and surgical emergency patients on a planned pathway of care Local anaesthetic procedures Day case surgery Midwife led maternity unit Enhanced rehab facilities and wards Cancer treatment day unit – aligned to HTP Respiratory treatment centre – future opportunity Both sites Most patients will continue to use their local hospital.

Adult, children’s and maternity outpatients Endoscopy services Urgent care services and medical Same Day Emergency Care Diagnostics, imaging services including X-ray Frail and elderly care services

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Expected 2025 milestones

March 2025 ED1 works complete – providing new majors and resus

March 2025 Meeting with SLT to agree clinical space allocation

April 2025 Launching the master programme with Divisions

May 2025 Begin works on building components that separate the indoors from the outdoors Summer 2025 Transition workshops and transport planning with stakeholders September 2025 ED2 works begin

August 2025 Sample room completion of new healthcare facilities

September 2025 Building envelope completion (area 1) Autumn 2025 Conclude workforce requirements for clinical model

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November 2025 Concrete frame completion (Area 3)

Workstream milestones

Construction milestones

April 2025 Concrete frame of basement complete

March 2025 Operationalising resus and majors from 26 March

Golden Circle Model - Simon Sinek Simon Sinek, the author of several books around leadership, created the golden circle concept. This is a model to explain how understanding your reason why and focussing on that, will help to inspire others into action. His theory, is that successfully communicating the passion behind the why, is a way to communicate with the part of the brain that processes feelings, such as trust and loyalty, as well as decision making. This will ensure you have the necessary buy-in for your project by those who will be affected by it, your stakeholders.

Why do you do what you do? What’s the purpose?

The circle he created has the why in the centre and should always be considered How first, by really understanding what your do you do purpose is. Very few people, or companies what you do? can clearly articulate why they do what they do. Remember, it is not about running a What successful business or project, that is your the hell do result, but more importantly, it is about your you do? purpose; why do you exist and why should you care?

When we start with why, we go from the inside to the outside of the circle.This can be a powerful tool in improvement, ensure you start in the centre and establish your purpose and reason for change, before working outwards and agreeing how you are going to do it and what ideas you are going to test out to achieve your purpose.

Let’s look at this example around patient flow. Our purpose is to provide a safe and effective system to care for the population of the local area when they need us.How we do this is by ensuring we maintain flow through the hospital to prevent delays in care and potential deterioration of patients by delaying discharge to a safer environment, such as home, or a care home.

What we do is hold discharge improvement events, ensure we hold action focussed board rounds that can identify the tasks needed to maintain flow, or other interventions that will help us achieve our purpose.

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How to effect change

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How Change Agents effect change Support and influence colleagues who are struggling with change Establishes relationship with people who influence the programme Link in with Stakeholders Builds trust in what the Trust are doing by communicating locally and regularly Helps identify when/what engagement and communication is needed to satisfy the audience Helps target people who could assist to promote the project Identify individuals who could disrupt the process

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25 reasons why it won’t work We tried that before Our systems are different It cists too much That’s beyond our responsibility That’s not my job We’re too busy to do that It’s too radical a change There’s not enough help We’ve never done it before We don’t have the authority Ther’s not enough time Let’s get back to reality It’s not our problem Why change? It’s still working OK I don’t like that idea You’re right, but ...

You’re two years ahead of your time It isn’t in the budget We’re not ready for that Sounds OK but impractical Let’s give it some more thougt That’s my bowling day That doesn’t affect me or my child Nobody cares about that We’ve always done it this way

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How would you like to receive change?

Put yourself in the shoes of the receiver of the change.

I want to be kept informed

I want them to understand the impact of the change on my work

I want to be involved in the solution

I want all the information I want to truly understand the reason behind the change

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Assumptions we make Change is external to people within the organisation and happens to them whether they like it or not.

There are many types of organisational change, including a merger or acquisition, creating and launching a new product, and implementing a new business strategy.

Change is concerned with achieving outcomes.

Transition If change is external, then transition is internal. Transition is the internal psychological process that change puts people through.

It is how people feel as they process and come to terms with the new situation that change brings about. A transition occurs in the course of every attempt to change.

Unfortunately, most leaders concentrate on change and assume that transition will happen simply because the change is happening; this, unfortunately, isn’t the case.

Change can happen very quickly, whereas transition usually takes longer.

All organisations must change to survive Change Fails if its not managed properly Change happens , if you like it or not (its an external process to people in the organisation) Transition is internal , the psychological process you go through You need to manage the transition more than the change

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Bridges Transition Model The Bridges Transition Model helps organisations manage change successfully by mapping out the human response to change over three stages. These are: Ending, Losing, and Letting Go Allow people to let go and say goodbye to old ways.

The Neutral Zone The in-between time when the old is no more, but the new hasn’t arrived yet.

The New Beginning The confusing time when people begin to engage in their new future.

The three stages aren’t discreetly demarked and can coexist at the same time within a change.

You can see how the relative importance of each stage changes as time goes by.

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Bridges Transition Model It’s worth noting that the greater your seniority with your organisation, the more quickly you are likely to move through the transition process.

This is often because you understand the need for change long before others in your organisation.

This means that as a senior manager, it can be easy to forget that others will take longer to transition.

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Bridges Transition Model

Ending, losing and letting go How people feel People have to let go of how things were, and they also have to let go of how they were or used to be. Some things they might need to leave behind include relationships, team members, processes, etc.

This stage often percolates feelings of resistance and emotional upheaval, as employees are forced to give up something they are familiar and comfortable with. Just think how you would feel if you had been happily doing the same job for twenty years and suddenly everything was changing.

Common feelings for people to feel during this stage include: Denial Anger Fear Loss Disorientation

What are people saying in this stage?

How will we know they are in this stage?

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Bridges Transition Model

Ending, losing and letting go How to lead Reflection Allow the team time to reflect on the change . What was good, what have they been proud of, what will they miss, what are they looking forward to.

Recognition Give space for the negative thoughts , as a change agent you can try and think about what these will be in advance and consider your responses for each. Don’t at this stage try and force people to be positive. Allow the negativity to be acknowledged.

Communication Always have a clear communication plan , include the reason why in this.

Vision Create a positive vison for the future, what will be the benefits to the change

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Bridges Transition Model

The neutral zone How people feel In this stage, people have accepted the old way has ended but find themselves unable to move forward. They are entering the neutral zone: an in-between stage full of uncertainty and confusion. This in-between state is so full of uncertainty and confusion that simply coping, not moving forward, takes almost all of people’s energy.

Despite the challenges of stage two, this is the stage in which people create and try new ways of working, so it can also be a time of innovation and renewal.

Common feelings for people to feel during this stage include: Low morale Resentment toward the change Scepticism

What are people saying in this stage?

How will we know they are in this stage?

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Bridges Transition Model

The neutral zone How to lead Planning Planning is essential , you need everyone to know what is expected of them and how things will work.

Quick wins Aiming for some quick wins can really help with momentum and seeing the change in a positive light. It can demonstrate progress.

Remove blockers Blockers and barriers can derail change, so they need to be removed as quickly as possible, planning and making sure you have the right support will help with this. Put in place the structure for change, and continually check for barriers to it.

Removing barriers can empower the people needed to execute the vision and it can help the change move forward.

What we can do: Identify, or hire, change leaders whose main roles are to deliver the change Look at the organisational structure, job descriptions, and performance and compensation systems to ensure they're in line with the vision Recognise and reward people for making change happen Identify people who are resisting the change, and help them see what's needed Take action to quickly remove barriers (human or otherwise) Communication Communication will help remind the team why they are going through this process, what they are aiming for and what support is available for them.

Feedback Giving constructive feedback to the team and to individuals can encourage them to talk about how they are feeling and coping with the transition.

Manage Workloads Manage people , its not all about leadership, some people may need extra support to manage their caseloads or need management strategies to help with time and work constraints. As Change Agents you can advise people to go to their manager or seek coaching/support for this type of help.

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Change networks What is a change network?

Made up of variety of different people from across the organisation Provides insight and challenge to the Programme and support and advice to peers and colleagues Can make the change effort a success and encourage the sustaining of the change for years to come Why a change network?

Provides deep, trusting relationships with people the Programme team would not be able to develop such relationships with Enables the reach of the Programme to increase exponentially across the Trust Helps impacted users absorb the change from friendly, familiar faces Reduces resistance through 2-way engagement Drives consistency of messaging – what the Programme is trying to achieve and how it’s going to impact on user Promotes a collaborative approach between digital and business users Provides enduring support to make the change stick How does a change network succeed?

It is impossible for the Programme Sponsors and Change Managers to gain the trust of everyone in the organisation Establishing and maintaining trust is based on a combination of competency and caring Focus on gaining the trust of Change Agents and Change Champions who, in turn, have the trust of their colleagues in the organisation, allowing genuine participation to reap its benefits

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Bridges Transition Model

New beginnings How people feel The new beginning is characterised by people embracing the new ways of working. This can be scary because people are leaving the old ways of doing things behind that they were very competent at, and starting to work in a new and unfamiliar way. This is especially true if the organisation’s culture has historically been to punish mistakes.

Common feelings for people to feel during this stage include: High energy Openness to learning Renewed commitment

What are people saying in this stage?

How will we know they are in this stage?

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Bridges Transition Model

New beginnings How to lead The biggest challenge for management during this phase is to sustain the change.

Mechanisms the leadership team should use to navigate this stage include: Celebration Celebrate , keep celebrating quick wins along the way , but also celebrate with teams or the wider organisation when things have become the new normal Communication Communication communication communication… remember the reason for the journey , where were we , where are we now, where are we going A Quality Management System Have a quality management system (name to be decided) as this will help individulas, teams and organstions keep on track of their targets, performance indications, training, improvements etc Leader Standard Work Leader standard work, allows everyone to know what their roles and responsibilities in the organisation areand how they align to the organisational vision 21

The management of change process What is organisational change?

Management initiated change to the way services are organised, structured, or delivered Creates a significant or direct impact on the employment, working arrangements or working practices of employees Examples include; a change of hours, location, change of working practices, increase to service provision which changes the way people are expected to work As managers we will commonly find that change occurs.

Sometimes this change requires that a structured management of organisational change process is followed To help to understand when it applies we have some examples:

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The management of change process Let’s talk policy - W24 Our policy provides: Framework to enable fair and consistent approach to organisational change Robust and meaningful consultation with employees and union representatives Timely process ensuring early notification and engagement with employees To support Managers, it provides: Step by Step guide for managers on how to assess, prepare and deliver Includes Flow chart, timeline, templates, roles and responsibilities The policy and templates can be found in Managers Resources or on the intranet

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The management of change process What type of change would we anticipate under HTP?

Change of site/base

Change to cross-site working

Change to service being delivered at site based at e.g. from high to low acuity

Change of hours to suit new service delivery

Merging of both site teams in the specialty

Changes that do not qualify as a Management of Change Change of location of the department within the same site Change of line management Remaining at the same site but delivering the work more remotely due to technology 24

The management of change process Key principles of the MOC process Change can cause concern and uncertainty and should therefore be managed fairly and consistently

Transparency

Meaningful consultation and engagement

Support for staff – Occupational Health, (EAP) HELP,Flexible Working Requests, Training and development to meet new skill requirements.

Personal circumstances should be discussed in individual meetings

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The management of change process Stages of managing organisational change Scope & Assess Workforce templates Workforce plans What changes are expected – does it require MOC? Pre-consultation Update staff and staffside on what changes are expected How do staff feel about the changes JNCC approval Consultation Start at least 6 months before change Team briefing Individual meetings Consider redeployment/retraining etc Implementation Pre-site visit and familiarisation Team building Move to new area

Review 3 months post change Team building

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The management of change process Major change consultation timeline JNCC Approval

Consultation starts

MOC Paper Circulate to affected team

Notification Letter of proposed change Briefings First Briefing Additional briefings 1:1 Discussions Invite to 1:1 1:1 Discussion Script 1:1 Outcome letter Consultation ends

Consultation end if extended

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Implementation 12 weeks notice of change unless shorter timescales are agreed with staff

The management of change process Change of site Where an employee is in a department that is changing site, the consultation will explain why the change is happening. Through their 1-2-1 consultation meeting they will be able to raise any issues that they may have in this change.

We are currently reviewing the following options to help address concerns: Whether the Trust can provide transport between sites regularly Whether travel expenses would be covered for the additional travel A system for retraining and redeployment of staff As part of the consultation the manager will explore the following options: Whether flexible working will support them being able to get to the other site Whether they would like to be retrained in another specialty and redeployed for suitable alternative employment to be sought Any other support the employee identifies that the manager can arrange

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The management of change process Change of function Where the change under HTP results in the function of the Ward/Department changing and the employee is not happy to remain in the same department the following may be explored as part of their 1-2-1 consultation: Retraining and redeployment to another area Facilitate a move to the site where the work they would like to continue doing exists (this is subject to there being enough posts)

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Team building There will be teams that will change due to the changes under HTP. So, we will see teams merging and sometimes teams splitting across two sites.

In these situations, the manager will ensure that they provide the support to ensure the team feel like one, this could be achieved by some of the following options: Team Away Day Session on Team Identity Values and Behaviours session Team Huddles regularly held Bringing the new team together a few times before the change under HTP happens Site/new area orientation

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What is our redeployment policy?

Before any post is made redundant, the Trust must exhaust all potential suitable alternative employment options.

Where someone cannot move site the Trust would be looking for suitable alternative employment.

A suitable alternative post will, in the first instance be at the same or one band lower than the employee’s substantive post.

A number of points will be taken into consideration including; The individual’s personal circumstances Location and cost of travel Current hours of work Skills, knowledge, experience and scope to retrain Individuals will be kept on the redeployment list for a minimum of 12 weeks which includes their notice period with the aim of redeploying them to suitable alternative employment.

4 week trial will used when redeployed into a new post to ensure suitability.

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Role of People & OD Business Partner and People Advisory Team Support is provided for Managers throughout the process. In summary support is provided as follows: People & OD Business Partner – will scope the management of change with Managers. They will support in any service review and workforce planning and will support writing the proposal. They will advise you on engagement with staff side and the team.

People Advisory Team – once the paper has been to JNCC, managers will be supported by a member of the People Advisory team with consultation. They will advise through this process with any queries that may be raised by individuals, and they will also support with any redeployment process. The Business Partner will be updated on progress for oversight.

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Support available We can offer support to anyone who has been emotionally affected by a situation at work.

If you experience something distressing in your role as a change agent, the following may be helpful: 1:1 support (face to face/telephone/online via MS Teams) with one of our of team. You can self-refer or ask your manager to do this by contacting us on: sath.staffpsychology@nhs.net If you are attending a reflective practice group that we run, this may be something you can discuss in the next session

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Resources Minute Tools Content Team, Bridges Transition Model, Minute Tools, Jan, 2022 https://expertprogrammanagement.com/2022/01/bridg es-transition-model/ William Bridges Associates | Transition Management Leaders Transitions (40th Anniversary Edition): Making Sense of Life's Changes Paperback – Special Edition, December 17, 2019

by William Bridges (Author), Susan Bridges (Author) Trust Library Recommended Reading: Creating a Lean Culture (David Mann); Lean Hospitals (Mark Graban); Journal Articles & NHSE/I publications Improvement Hub: Limited books available to borrow; Consultancy service; Coaching

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Useful links SaTH Website For the latest nformation on our HTP Programme. https://www.sath.nhs.uk/about-us/hospitalstransformation-programme/ Improving hospitals Mailbox Have a question? Need to contact the HTP Project Team? send an email to sath.improvinghospitals@nhs.net SaTH Intranet Hospitals Transformation Programme Improvement Hub Bitesize videos Case studies Leadership Management of organisational change policy W24

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Comunications links Intranet news Construction cascade Cascade Information Bulletin HTP awareness events

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Useful contacts Name

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HTP Link Role

Email

Sabeena Khanna

HTP Workforce Transformation Lead

sabeena.khanna@nhs.net

Melanie Powell

People & OD Business Partner - W & C and Facilities

melanie.powell13@nhs.net

Heather Rowley

People & OD Business Partner – CSS

heather.rowley4@nhs.net

Juliette Eveson

People & OD Business Partner – SACC

juliette.eveson@nhs.net

Mike Timmins

People & OD Business Partner – MEC

m.timmins1@nhs.net

Next steps Familiarise yourself with supporting materials to understand the programme and its benefits for staff and patients Identify yourself as the HTP Change Agent in your team/area – this could be done through a team meeting or more informally Consider signing up to the construction cascade distribution list (via comms) if you are based at RSH so you can share any construction related updates with colleagues Start to gather questions, feedback and concerns from teams – again this could be done through team meetings or more informally through conversations with colleagues Regularly share feedback captured with HR BP/HTP Workforce lead at monthly catch up meetings If needed, you could organise a HTP briefing session with your team and the relevant HTP lead for your area Collect positive stories and case studies to feedback – what are people excited about?

Network with other champions to share tips and challenges

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