title: Frameworks for change in healthcare organisations: a formative evaluation of the NHS Change Model.
abstract: BACKGROUND
  Organisational change in complex healthcare systems is a multifaceted process. The English National Health Service recently introduced a 'Change Model' that seeks to offer an evidence-based framework for guiding change. We report findings from a formative evaluation of the NHS Change Model and make recommendations for those developing the Model and its users.
  
  
  METHODS
  The evaluation involved 28 interviews with managers and clinicians making use of the Change Model in relation to a variety of projects. Interviews were fully transcribed and were analysed using an approach based on the Framework method.
  
  
  RESULTS
  Participants saw the Change Model as valuable and practically useful. Fidelity to core principles of the Model was variable: participants often altered the Model, especially when using it to orchestrate the work of others. In challenging organisational contexts, the Change Model was sometimes used to delegitimise opposition rather than identify shared purpose among different interest groups.
  
  
  CONCLUSIONS
  Those guiding change may benefit from frameworks, guidance and toolkits to structure and inform their planning and activities. Participants' experiences suggested the Change Model has much potential. Further work on its design and on supporting materials may optimise the approach, but its utility rests in particular on organisational cultures that support faithful application.
authors.affiliation: SAPPHIRE Group, Department of Health Sciences, University of Leicester, UK graham.martin@le.ac.uk.
authors.forename: Graham P
authors.initials: GP
authors.lastname: Martin
authors.affiliation: SAPPHIRE Group, Department of Health Sciences, University of Leicester, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sutton
authors.affiliation: SAPPHIRE Group, Department of Health Sciences, University of Leicester, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Willars
authors.affiliation: SAPPHIRE Group, Department of Health Sciences, University of Leicester, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Dixon-Woods
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D058016:Health Facility Administration / Q000379:methods; D006801:Humans; D007407:Interviews as Topic; D017146:Models, Organizational; D009936:Organizational Innovation; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom
keywords: England; health care; organisational development; quality improvement; strategic management