Many practices are in the process of making changes to the way their access systems work right now, in response to the contractual changes imposed upon them this year.  But what happens after a change has been made?  What doe we need to do to make the most of the changes we are making?

Once a change has been made the worst thing you can do is file it in the “finished” folder and move on to whatever is next.  Nicola Bateman carried out research following the various stages of an improvement activity and considered the different outcomes in terms of the sustainability at each phase.  She found that any initial gains can be lost, and that there are three actions that determine longer term success, post the initial implementation of a change.

The first action is to stick with the new way of working.  It is quite common for  a new way of working to be introduced, but then when problems occur, or resistance from certain individuals becomes too high, the new system is abandoned and things revert to the way they were previously.  Any gains initially achieved are quickly lost.

The second important action is to close out any technical issues.  So for example when we change our access systems the messages on the telephone system may need tweaking until they are right, or the allocation of slots to different clinicians may need to be adapted so that it matches real demand, or the training and support the reception staff need to be effective as care navigators may need to be updated so that the best possible use of the available capacity can be made (etc).

However, we often introduce a change and do not make time to resolve the technical issues that inevitably occur when we are trying something for the first time.  This limits any improvement we will see from a change to that which is achieved at the point of the initial implementation.  It is hard making changes, so when we invest time in doing so we need to make the most we can out of the new system.  It is worth closing out any technical issues to maximise the overall benefit.

The third action is to work on continuously improving the new system.  While the second action is about closing out any issues preventing the newly identified way of working from being as effective as it can be, this action is about finding new changes that can make it work even better.  So, for example, if we take the case of St Lawrence Surgery in Worthing they found that having a clinician physically based alongside the patient services team undertaking the care navigation made the system work even better for them.

What do we need to do to make sure that continuous improvement takes place?  The research identifies a number of specific enablers.

The first is making sure the whole team is bought in to and understand the changes that are being made.  Taking time to work through the resistance (that there will inevitably be) from certain quarters, and ensuring that everyone, especially those not directly involved in the design of the change, is fully aware of the new ways of working is vital.

The second enabler is making sure the change is part of an overall strategic direction for the practice.  Where does the practice ultimately want to get to with access?  This prevents the change being a one-off reaction to a contractual change, and makes it a step towards wherever it is the practice wants to get to.

The final enabler is making sure that all of the partners in the practice are bought into and involved in the change, that they visibly support it, and that there is a clearly identified lead for coordinating both this change and the ongoing improvement work.  This level of focus from the top creates clarity across the practice and helps build a culture of continuous improvement.

Ultimately, it is often not the change itself that determines the overall level of improvement that is achieved, but the way the change is made.