Methods for effective change management in the NHS

Change Management

This article presents an overview of change management including an example of change model. This is followed by a section briefly presenting some barriers to implementing change in the NHS. The article then presents a set of practical literature on how to implement change.

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Overview of Change Management

Delivery of vital services are reported to be negatively effected when an organisational change is implemented. Some recommendations for managing organisational change are proposed in a paper titled A Case Study of Change Management Effectiveness within the NHS [1].

There is also a selection of interesting literature on the subject of managing change within the NHS which is related to the public sector environment (a selection of which I have covered in section how to implement change).

An overview of change management is presented in the remainder of this section. It aims to highlight just a few common approaches to change, amongst the vast literature of change management.

Two main models for change:

  • (1) planned
  • (2) emergent

These two models are discusses below for the reason to highlight what the model involve. The discussion does not claim to expose strength, weaknesses or critically evaluate these models. The term psychological contracts is also discussed.


Moves from one fixed state, to another fixed state, through a series of preplanned steps. There are many models of planned change [2].

One such model is called the ‘Three step model’

  • (i) freezing — clinging to what one knows,
  • (ii) unfreezing—exploring ideas, issues and approaches, and
  • (iii) refreezing — identifying, utilising and integrating values, attitudes and skills with those previously held and currently desired.



The emergent model aims to provide a model for change that is less relent on a manager outlining stages and objectives. Understanding the complexity of the issues, and identifying a range of possible options. An example of emergent change is a ‘bottom-up’ approach. Such that senior management become facilitators rather than controllers.


Psychological contracts

An interesting concept that is highlighted in this paper [1] is the ‘psychological contracts’. This often referred to in the change management literature and is said to be related to ‘dignity and worth’. If we see a negative impact of change in an organisation, the psychological contract has broken down, and as a result can lead to reduced loyalty, moral and motivation.

What are the barriers to implementing change in the NHS?

This section outlines some of the elements that can cause barriers to implementing change within the NHS.

  • Strategies
  • Leadership
  • Project Management
  • Rate of Innovation
  • Communication
  • Office and Working Locations
  • Salary / bonus and incentives

How to implement change?

There is a vast literature on the subject of implementing change within an organisation. I have lists some books that have helped me in the past and may prove useful.

Implementing Change: Patterns, Principles, and Potholes

This book goes into details about change processes and practical strategies to implement. The change model used in this material mainly focuses on Concerns Based Adoption Model (CBAM). The book explores the practical aspects of creating, implementing, and sustaining change processes as well as important aspects when evaluating change.

The main reason I think this book has helped me in the past is because it contains case studies I can relate to, along with reflection questions to help me improve about my own execution of change.

It also has some helpful examples of common roadblocks to change which have helped me challenge blockers to change. Implementing Change: Patterns, Principles, and Potholes is definitely worth a look.

Managing Public Services - Implementing Changes

This book sets out clear differences between the manufacturing industry and the service industry (ie, the NHS) in order to explain key aspects of ‘how’ and ‘why’ when it comes to implementing change.

It concentrates on public services in particular which often come with unique challenges such as:

  • funding cuts
  • risk management
  • innovation challenges

I like this book in particular because it contains case studies and experiences from public services located in the Europe, United States and Asia. I found this can help gain a wider perspective on the problem and solutions. We can then use this collective knowledge and experience to better tackle problems within our own NHS here in the United Kingdom.

Managing Public Services - Implementing Changes is a good read for anyone wanting to gain a wider view of implementing change within publicly funded and run organisations.


There is a lot more literature on the subject of implementing change. I have listed some more book on the topic that friends and co-workers have found useful, although I have not read these myself, I do know others have gained some valuable insight from them, you may too.

Or you have check out the latest literature on “Implementing Change” here


[1]A Case Study of Change Management Effectiveness within the NHS

[2]Models of planned change

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