Best Practice. Change Management. Guidelines

Transcription

1 Best Practice Change Management Guidelines 1

2 Created by: Denise Phelan, Demand Management lead, (LPP) Reviewed by: Jonathan Porter, HR Workstream Lead, St George s Healthcare NHS Trust Approved by: Mick Corti, Workstream Lead Agency, Temporary Staffing & Professional Services, LPP Release Date: 1 st February 2010 Related Projects: LPP Demand Management Project Sponsor: Mario Varela, LPP Programme Director 2

3 Table of Contents 1. Introduction Scope of this document What is change? What is Change Management? Aims of this document Why is Change Management important? Assumptions Typical Change Management activities Step 1: Know where you re going and why Step 2: Analyse and design Step 3: Gain commitment Step 4: Do it Step 5: Reinforce it Step 6: Sustain it Appendix 1: Workforce Optimisation supporting documents Appendix 2: Document sources

4 1. Introduction This document forms part of the (LPP) Workforce Optimisation initiative. This initiative aims to reduce spend on agency and bank staff through optimised workforce planning and efficiency. This document is the second in a series of documents to support the Demand Management initiative. See Appendix 1 for the full list of supporting documents. 2. Scope of this document The document is intended to provide best practice guidance to trusts on Change Management within a programme/ project to implement Electronic Rostering or Staff Bank software or solutions What is change? Change in an organisation is where the elements of an organisation need to do something differently to how it was done previously. An element of an organisation can be a desktop computer or a machine, but typically the most important elements of any organisation are the staff. Even where a computer is required to operate differently due to a change, it is usual that the staff operating that computer will also need to change something in how they do their job. Therefore the ability of the staff to implement and accept the changes to how they do their job is integral to the success of any change made within any organisation What is Change Management? Change Management is typically a workstream that is added to any programme or project whose aim is to make a change to an organisation. The importance of that workstream, and whether a separate Change Management team is created, depends on the level of impact on the staff. In general, the greater the impact of the change on the staff, the greater the dependence on the staff for the success of that change. Change Management workstreams tend to focus on engaging with impacted staff and guiding them through the change to a point at which the change has been accepted into business as usual activities. Although this document applies mainly to the rostering of nursing staff, the principles of the guidance can be applied to all staff groups to ensure common processes and maximum benefit from workforce efficiency. This document is not intended to be specific to a trust type or geographic location. 4

5 3. Aims of this document This document is designed to complement the Guide to Effective Business Change by NHS London, which was written with an education commissioning environment in mind. This document is intended to build on the generic change management advice supplier by NHS London by providing advice and knowledge gathered from trusts who have already implemented e-rostering and/or staff bank solutions. Together this document and the Guide to Effective Business Change should support Acute, PCT and Mental health trusts who are implementing large-scale change through e-rostering or staff bank solutions. The Guide to Effective Business Change and toolkit can be downloaded from the NHS London website ( by following these links: What we do/ Developing NHS Staff/ Workforce for London/ Leading for Health/ Education and Training/ Education Commissioning Programme. This document should also be read in conjunction with the OGC s Programmes and Projects Resource Toolkit ( and any Change Management specific guidance within your trust. 4. Why is Change Management important? One key theme which emerged from the trusts, who have already implemented e- rostering or Staff Bank software, is that such projects should not be treated solely as software implementations. Rather these projects should be treated more as large change or transformation projects due to the impact on a wide range of staff within your trust. e-rostering and/or staff bank solutions are not simply about switching on a piece of software in your trust: Firstly, any software, particularly e-rostering, is only as useful as the data you input into the system. Therefore you will need the participation of key staff members to identify this data and to ensure the system is fit for the purposes of individual units or departments. Secondly, to mitigate implementation costs, many trusts and system suppliers would recommend using existing staff members to act as Trainers and Super Users. Therefore, their buy-in to the solution and the implementation methods are critical to the success of the roll-out. e-rostering and/or staff bank solutions can only be successful where the staff fully accept and implement the new ways of working: 5

6 Some or all staff will be the end users of the solution, or recipients of the new service. The support of the staff in utilising the tool and/or new supporting processes will be essential to see any return on investment from the software/service. Communication with the impacted staff, from the earliest inception of the project throughout its entire life cycle, is key to achieving this. Staff need to be fully briefed about the reasons for the change, the impact on them and the expected benefits of the changes. The most common reason for an e-rostering and/or staff bank solutions failing to deliver the expected benefits is lack of acceptance and use by staff. 5. Assumptions This document assumes that your trust has not already implemented or piloted an e- rostering or staff bank solution. 6. Typical Change Management activities The NHS London Guide to Effective Business Change divides the process into six stages, each with suggested activities and templates, as per diagram 1 below. Diagram 1: Guide to Effective Business Change 6 step process The aim of this section is to highlight activities that are key to implementing e-rostering or Staff bank solutions within a trust and to provide any additional guidance required. 6

7 6.1. Step 1: Know where you re going and why At this stage of the project, the Project team will be establishing the project milestones and business case, mobilising the leadership team and checking that the correct level of project resource is in place, etc. This is most effectively done through using a robust project management methodology (e.g. PRINCE2), where clear outcomes, benefits, milestones, accountabilities, interfaces and constraints can be set out, where risks and issues and mitigating actions can be detailed and work packages can be assigned and reviewed. The project may fall in to a number of phases such as pre-procurement (i.e. building a business case), procurement (i.e. acceptance of business case) and implementation (i.e. project set up with supplier(s) through configuration to implementation and evaluation. There may be several sources of information required to develop even the initial business case, such as indicative benefit statistics from your shortlisted supplier. However, it is worth taking the additional time to engage with some key stakeholders that may be able to inform your business case even at this early stage. For example; Trust IT Department or additional IT support (ESR helpdesk or ESR benefits manager) Trust Directors of impacted staff areas, eg: Director of Nursing Trust HR Trust Finance Trust Procurement Trust Facilities Management Trust Payroll or trust Staff Bank Could inform any estimates around hosted/ non hosted solutions, costs for equipment, software upgrades on trust PCs, parallel projects that may impact on timelines/ resource, and ESR interfaces. Could inform on expected reaction to change from workforce, other initiatives impacting the same workforce on similar timescales, business case benefits estimates. Revised role of Ward clerks, take work over from RGN. Could inform on any expected union communication required, any expected changes required to roles and responsibilities for AfC banding, eg: ward clerks taking over extra rostering duties from ward manager. Could inform on what evidence is required to support estimated numbers in business case and sign-off processes. Could inform on use of framework contract, SLA development with chosen supplier, and any additional purchases required (IT equipment, scanners, software). Could inform on any project team requirements (seating area, etc) or advise on use of scanners/ biometrics where Time & Attendance is being implemented. Depending on the scope of the project, such areas may be impacted and may need to be involved/ consulted. 7

8 depending on project scope Any relevant trust governance areas For example clinical governance or project governance Feedback from previous implementations in the area of Workforce Optimisation identified selecting the project team and mobilising the leadership team as two key activities which could cause significant issues later in the project lifecycle. Selecting the project team: Establish the correct project team from the outset. This team should complement any resources from the software provider but should look to be a longer term point of contact and communication within the trust. It is this team that will represent your project on a day-to-day level with users of the software. It is critical that your project has the right level of resource to represent and deliver your project. For example; - A permanent roster manager should be considered when developing the business case and designing the solution. A roster manager would be ultimately responsible for the implementation and effectiveness of a roster policy, and where required involved in the implementation of e-rostering. - A full time project manager is essential to any large scale software implementation. It may be the case for Staff bank software that this project manager is only required in the short term for the initial implementation and Go Live. - For e-rostering, a longer term project manager would be required as typically this software is rolled out in a series of mini go lives across a number of wards at any one time. - At least one system administrator/ support staff should be considered as part of the standard project team from the outset. As software users ramp up, there will be a greater dependence on this resource to deal with phone or queries from new users. User acceptance of the software can be seriously impacted by under resourcing this role in the short term. This role may be required permanently following the delivery of the project, depending on the hosting model selected by the trust and should be considered in the business case. - Consideration should be given to how software training will be delivered. Not only does this activity impact on the software provider s implementation costs, it will also impact directly on a user s ability and willingness to adopt the tool and processes into their work routine. - A project board of key stakeholders who are responsible for agreeing the terms of reference and objectives of the project, and act as a point of escalation and decision -making for the project team. - It is recommended that a part time clinical specialist form part of the core rollout team. This person should be a senior staff member within the relevant staff 8

9 group and with experience relevant to the roll-out. For example, to roll out e- rostering in a trust a senior nurse(s) from the unit(s) impacted would be required, who has extensive experience of creating and managing rosters, managing staff to meet clinical demand and with a good understanding of what users require from the system within their unit(s). Mobilising the leadership team: In order for the project to have been established, the trust Chief Executive should have been briefed and a trust board member assigned as project sponsor. It is important to consider the benefits of this level of sponsorship: - The implementation of Staff Bank software and in particular, e-rostering software requires consideration at a strategic level and therefore should be approved by the Chief Executive and the Trust Board. - It is recognised that e-rostering software alone does not deliver benefits. It is the rostering policy and associated rules captured in the tool result in benefits. Therefore, Chief Executive and Trust Board support may be required to drive through any significant policy changes. - Staff communication is typically better received when cascaded directly from the Chief Executive pr project sponsor, with an explanation of the importance of the project; - Careful consideration of and the early engagement with staff-side colleagues may ease the implementation of a system and if involved in the delivery, they can act as advocates for the benefits (defining and delivering) of a system; - An early analysis of stakeholders should be carried out, as this will help inform the strategic and operational communication approach used by the Trust during the project lifecycle. The table below may assist: High I N F L U E N C E Keep satisfied Keep an eye on Manage relationship closely Keep informed Low Low INTEREST High 9

10 - The level of expected expenditure, for e-rostering in particular, is best discussed and accepted at least at board level before proceeding with the project. - A number of trusts have used their e-rostering software to highlight a new category of Performance Issues ; for example, overstaffing on wards to accommodate informal working arrangements, and thus overspending on staff bank shifts Step 2: Analyse and design At this stage of the project, the Project team will be considering design options, developing a strategy to deliver the change and understanding the impact of the change on the stakeholders identified in step 1. Understand your solution design: It is very important at this stage to harness the knowledge of the stakeholders to feed into the design of the solution required for your trust. For e-rostering and staff bank solutions, the Workforce Optimisation framework presents a wide range of options from which a trust can select the best supplier and solution for their needs and budget. It is important that the trust spends some time at this step understanding what the requirements of their trust is and what their appetite is for change. For example, if a trust is interested in e-rostering, there are a number of key decisions to be made in designing the appropriate solution; What staff groups does the trust envisage using e-rostering? The number of users will impact the business case, and will also inform decisions on additional functionality below. Alongside the basic e-rostering module, does the trust require self rostering, additional management information capabilities or demand management tools? The stakeholders representing the staff groups expected to use e-rostering should be able to input significantly into this decision and inform the project team about the useful of such additional modules. Does the trust want to implement time and attendance through the use of swipe cards, biometrics or other means? This roll-out would require significant capital investment in equipment and an increased level of change management activity. A wide range of stakeholders will need to feed into this discussion; for example, stakeholders representing the staff groups expected to use e-rostering, Estates and Facilities, IT, HR and Finance. (The usefulness of time and attendance in an organisation has been linked in the past to the staff groups expected to use e-rostering. A nurse that has not turned up for a shift on a ward is typically noticed sooner than a member of the cleaning staff who has not appeared on the ward, due to multiple locations during a shift.) 10

11 The trust can also decide between a hosted or non hosted solution. Again this has significant cost and service management implications that should be considered with the trust s IT and Service Management teams. Interfacing with the staff bank if the trust has an existing solution or provider. Does the trust want remote access for staff and how this may be accomplished within IT security protocols? Careful communication about what is not intended; for example, if using time and attendance, making clear whether or not the system will enable managers to alter salary for non-attendance. The high level design of a solution in the short term and the appetite for change in the medium to long term can impact on a trust s choice of provider. Therefore all of the points above should be discussed during step 2, and where a decision cannot be reached, steps put in place to ensure decisions are reached as soon as possible in the project lifecycle Step 3: Gain commitment At this stage of the project, the Project team will be building momentum for the change and preparing for implementation, conducting any pilot testing and assessing readiness for change Step 4: Deliver it At this stage of the project, the Project team will be training staff on new systems and ways of working and continuing to implement the changes. Celebrate early successes: One of the key pieces of feedback from staff who have undergone change, is that they are not kept informed of the tangible/ intangible benefits of the change. They may be aware of small improvements to their working day and may share anecdotal examples with colleagues. However to retain momentum within a unit and to ensure the project is discussed in a positive light at a trust level, it is important to share the project successes as they happen. With e-rostering the typical roll-out plan is to complete three to four units at a time. Successes may be communicated from each such go live in different forms. Positive quotes from staff on their experience could be obtained from units that have gone live. The Key Performance Indicators could also be populated and communicated from the first units go live. The biggest improvement, indicated by trusts who have already implemented e- rostering, is related to interfacing the e-rostering system to the Electronic Staff Register (ESR). Many trusts implement the e-rostering solution across the majority of units 11

12 before returning to consider the ESR interface. Where success has been recognised early in the project, was in trusts where ESR was interfaced with after the first group of units went live. This gave additional weight to the KPIs being communicated to staff, and staff morale was reinforced by the removal of enhanced hours reporting and consistently correct payslips being issued Step 5: Reinforce it At this stage of the project, the Project team will be reviewing and embedding the new ways of working and capturing lessons learned and feedback Step 6: Sustain it At this stage of the project, the Project team will be measuring the change and achievements against goals, planning for continuous improvement and sharing success stories. 12

13 Appendix 1: Workforce Optimisation supporting documents Supporting documents from the Workforce Optimisation initiative: Document Title Document Overview Document Location Best Practice Best practice examples of workforce optimisation were gathered from trusts across rostering policies all staff categories, LPP website and workforce (ie: Nurses, Medical Locums, AHPs/ HSSs, Admin & Non Clinical staff). ( under efficiency levers Engagement policies for Bank and Agency staff were also included in this document. Demand Management, Workforce Optimisation Change Management guidelines Template Business case and Benefits Tracking Guide Modular Template specification LPP gathered lessons learned from NHS implementations of Workforce Optimisation projects (ie: e-rostering, internal or managed staff bank). This document is based on best practice examples of Business cases from trusts who have already implemented e-rostering and/ or bank staffing systems. Similarly best practice examples of benefits tracking tools to track the key benefits of rostering policy reviews and/or e-rostering and/or bank staffing systems, were included in this document. This is a best practice specification for e-rostering software, staff bank software and managed service staff bank, based on previous experience of national trusts. The document includes requirements for links to additional systems, for example ESR, absence management systems, patient acuity data and existing e-rostering/ staff banks systems. Framework LPP website ( under Demand Management, Workforce Optimisation Framework LPP website ( under Demand Management, Workforce Optimisation Framework LPP website ( under Demand Management, Workforce Optimisation Framework 13

14 Other sources of information: NHS Employers guidelines on implementing e-rostering tools, October NAO report on improving the use of temporary nursing staff in NHS acute and foundation trusts, July Audit Commission report, Brief Encounters getting the best from temporary nursing staff, September

15 Appendix 2: Document sources Meetings were held with the following organisations/ trusts as part of the LPP Workforce Optimisation initiative; NHS Employers NHS London PaSA OGC Re:source Procurement hub, East Midlands Improvement and Efficiency West Midlands Procurement Hub Yorkshire & Humber Commercial Procurement Collaborative (CPC) Barnet and Chase Farm Hospitals NHS Trust Great Ormond Street Hospital for Children NHS Trust Guy's and St Thomas' NHS Foundation Trust Homerton University Hospital NHS Foundation Trust Imperial College Healthcare NHS Trust South West London and St George's Mental Health NHS Trust University College London Hospitals NHS Foundation Trust Camden and Islington NHS Foundation Trust 15