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Ten high-impact actions for transformational change

Thursday, 23 February 2017

Ten high-impact actions for transformational change

Following the letter from the National Director of Impact to chief executives advising that actions are no longer enough to drive transformation, commissioners and providers are expected to consider aiming to implement High-impact Actions (HIAs) as a matter of urgency going forward.

The secretary of state has made it clear that HIAs are to become part of everyday business for NHS organisations. As HIAs become the norm, a new category of Very High-impact Actions (VHIAs) will need to be developed for use in exceptional circumstances.

Any standard action should be retired with immediate effect and replaced with an HIA, defined as an upgraded action that would give a more plausible than usual impression of potential impact particularly in the context of a report or press release.

The following template is for use in all HIA planning situations.

HIA 1: We will through the use of a number of well-meaning statements aim to make a very real difference to the lives of ordinary people, patients, carers, citizens and communities without missing anyone out.

HIA 2: We pledge to use the very latest terminology based on familiar words combined in innovative and meaning-centred ways.

HIA 3: We will collaborate with and consult stakeholders at all times and co-produce things with them whether they like it or not.

HIA 4: Senior managers will be trained in Action Readiness (AR) to support them to understand how to plan for HIAs and embed them in organisational culture.

HIA 5: We will hold workshops to identify issues, work through scenarios, decide what good looks like and agree next steps.

HIA 6: We will write a report setting out our firm draft proposals and potential recommendations.

HIA 7: We will commit to develop locally appropriate impact metrics and evaluation measures at some point in the future.

HIA 8: We will launch a high-impact social media campaign.

HIA 9: We will demand a meeting with Simon Stevens to discuss funding.

HIA 10: We will settle for a call from an Associate Regional Director of Impact (RDI) who will promise to get back to us about the money.

See separate guidance Step-changes, New Paradigms and Channel Shifts, which contains a glossary of useful high-impact terms.

See also the Impact Maturity Index (IMI) and associated resources to self-assess your organisation’s current impactfulness and monitor your Impact Improvement (II) across all 27 High-impact Domains (HIDs).

STP areas must appoint an Impact Improvement lead (or II Captain) as soon as possible, reporting directly to the Regional Director of Impact.

Paradigms editor: Julian Patterson


Alison Giraud-Saunders
Alison Giraud-Saunders says:
Feb 24, 2017 11:19 AM

Best ever, I think!

Judy Aldred
Judy Aldred says:
Feb 24, 2017 03:00 PM

II Captain resulted in full on snort

Andrew Rix
Andrew Rix says:
Feb 25, 2017 02:03 PM

Actions speak louder than achievements.

Well done, Julian for another cracking idea that could transform the NHS performance monitoring system. By rolling Impact and Activity into one reporting number, we, at last, have a measure of what really matters – whether the NHS is keeping busy.

Reporting in the NHS used to be about inputs (money) and outputs (things done). Planning and evaluation followed the same simple model and effectiveness were judged by how many activities you got done for the cash you could squeeze out of the paymasters. The new way of reporting and payment is based on a presumed relationship between inputs (resources = the sum of everything that goes into producing a specified result) and outcomes (results = the outcome related to the inputs as judged by clinical indicators and patient satisfaction)), a notion that stems directly from the misguided view that medicine is an evidence-based science. It's no longer enough to do something; you have to do what NICE tells you, or, can you believe it, what patients say they prefer. As both NICE and patients are at best fickle, and often wrong, it's no wonder financial management in the NHS is in such turmoil. Targets and payments linked to specific medical interventions are just plain confusing.

The police realised this potential for confusion years ago when they replaced 47 key performance indicators with the ‘single measure' of public confidence; A rolling local opinion poll asks residents ‘On the whole do you think the police are doing a good job around here?’. Low scores provoke doing more of what matters, which surprisingly turns out not to be catching criminals but having police horses on duty at public events. (see Andrew Rix, Faye Joshua, Professor Mike Maguire and Sarah Morton., Improving public confidence in the police: a review of the evidence Home Office Research Report No.28 December 2009)

A combined measure of Action and Impact is far more easily understood and fits the populist paradigm that something - anything - must be done and that doing more of it is bound to be better than doing less. Redefining activity as impact is a stroke of genius. Demonstrating you are busy is much easier than proving you are efficient and is all the public needs to know.

Julian Patterson
Julian Patterson says:
Feb 25, 2017 10:53 PM

An elegant solution, Andrew. From a fellow fan of simplified performance measures.

Alan Moore
Alan Moore says:
Feb 28, 2017 02:24 PM

Top of my High Impact Action would certainly be to remove the top layer of Civil Servants running the NHS along with the politicians who tinker with it

Andrew Rix
Andrew Rix says:
Mar 05, 2017 09:56 PM

Normal service will be resumed...
Well, I for one, hope so and that this is not the beginning of an insidious regime of cuts to save Mr Stevens bacon as the deadline for impossible savings looms. The efficiency savings promised in a spirit of optimism, it is well acknowledged, are unlikely to be delivered. In their place, pseudo-savings, based on intangibles will be substituted. Likely pseudo costs ready for the chop include:
Exchanging greetings
Being polite
Whip rounds for birthdays/leaving presents
Asking questions which are not directly relevant to the matter in hand and, of course, laughing out loud at Julian's blog.

The cost of any or all these activities can only be estimated and never actually be 'realised'' in financial terms. Stopping them is impossible but saying they were banned and estimating the savings at, let's say, about £500m would go some way to making up the shortfall.

Start fighting back now by establishing the positive monetary worth of, say, politeness or humour and adding it into your budget as a contribution in kind.
Meanwhile hurry back Julian - the NHS needs you.