Rosalind Eve, Co-director, Centre for Innovation in Primary Care, Sheffield

Millions of pounds are spent every year on research into new technologies for the NHS, but only very recently has much attention been given to getting them used efficiently and equitably.

Rational information such as guidelines and National Service Frameworks is an excellent start. They tell us what:needs to be done. But they usually throw little light on how it can be done in a rapidly changing environment, where healthcare professionals are subjected to a multitude of competing demands.

General practices themselves are rich in diversity and choice, each with its own administrative system, clinical philosophy, style, culture and way of looking at the world. Service configuration, resource allocation, expectations, hopes and fears – all vary from one area to the next.

It's hardly surprising then that the barriers to and incentives for change also vary. There are no magic bullets – each situation needs to be analysed on its own merits to get a thorough understanding of the world to be changed. This isn't difficult, but it does require dedicated time from a change agent (the person leading the change) who commands the respect and trust of health professionals.

One-to-one meetings give people the chance to talk informally, in their own time and on their home ground, about any difficulties they may have with the proposed change. They could prove a more profitable way of identifying barriers than large multidisciplinary meetings where hidden agendas and sensitivities may have to be negotiated.

Once the barriers to and drivers for the change have been comprehensively assessed, the task is to devise ways to minimise the problems and utilise the drivers – making the change as easy as possible for the clinicians.

Devising administrative routines that can be easily adopted, working out how to extract patient population information from the practice computer system, securing access to the appropriate diagnostic facilities or the endorsement of leading local clinicians – there is a myriad of possible problems and solutions.

The key to success is understanding and overcoming the problems that clinicians experience, and then taking shrewd, well-informed risks that cut a path through a multitude of uncertainties.

Putting a complete change programme together involves assessing risks and making judgments about what will and will not work. In essence it is about getting the politics of your team, your practice, your organisation or your health community working to achieve your goal.

Designing a change programme, and then securing the commitment of busy clinicians to do the work and carry out the change, can be a rewarding experience.

Such skills are not much celebrated in clinical communities, but as the need to deliver successful Health Improvement Programmes or implement National Service Frameworks becomes more acute, they become more and more essential.

Guidelines in Practice, December 1999, Volume 2
© 1999 MGP Ltd
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