Managing change in social care: A review for practitioners and managers
Managing change in social care: A review for practitioners and managers
47
01 May 2014
01 September 2012
30 April 2014
20 months
Change Management; Organisational Change; Social Care; Managers
- Dr Tim Freeman, Health Services Management Centre, University of Birmingham
- Mr Robin Miller, Health Services Management Centre, University of Birmingham
- Professor Jon Glasby, School of Social Policy, University of Birmingham
- Ms Deborah Davidson, Health Services Management Centre, University of Birmingham
- Ms Emma Pender, Health Services Management Centre, University of Birmingham
Project objectives
Social care services are undergoing profound transformation at a time of financial scarcity, focussing attention on what should be done and how, and many practitioners are ambivalent about changes which may appear to run counter to principles of social care. While there is much research evidence available on the use of change management / organisational development models to support implementation, it is diffuse and little known within social care.
In collaboration with two 'reference groups' comprising managers, practitioners and service users this study aimed to undertake a structured review of the research evidence associated with change management approaches / interventions that have been successful in supporting organisational change. A key output from the study was expected to be a compendium of research evidence based on these reviews to provide managers and practitioners with an accessible and focused digest of research evidence, available electronically, to inform social care practice regardless of the sector in which it is delivered (local authority, voluntary, independent).
Brief summary
Organisational change is an integral part of the life of a social care manager, either initiating within their own service or contributing to programmes begun elsewhere. Whatever their size, pace, objectives and approach, change projects encounter common challenges, including securing necessary support from key stakeholders, being clear about outcomes, co-ordinating activities to timescales, and sustaining improvements. While the process of organisational change appears difficult in most sectors, social care has particular complexities due to the vulnerability of many of the people it supports, its interconnections with other professions and agencies, and the public scrutiny of failings in its work. There is little empirical evidence on how change can be successfully achieved in social care organisations. This project sought help team and service managers by bringing together generic evidence on organisational change within academic literature and the experiences of those who have led and participated in such initiatives in adult social care.
Methods
A review of general and social care specific change literature was completed and combined with discussions with people who lead change and those who have experienced it to develop a set of ‘principles of change management in adult social care’. Building on these, key ‘approaches to change’ (overarching frameworks to guide a change process) and ‘change management tools’ (methods to understand or support a specific aspect of the change process) were identified and subject to further literature review.
Findings
Social care change management principles
Organisational change management involves assisting people to move from an arrangement that is familiar and with which they may feel comfortable to something which is new, uncertain and which may initially feel threatening. This can lead to anxiety and stress being felt by people who access a service and their families, and also by staff who work in the services. Leading a change process is difficult, particularly when there are a range of options and a lack of agreement about which is the best one. It can be helpful for those responsible for leading organisational change to have a set of principles to guide the process they follow and their decisions. This reflects adult social care more generally, in which principles help to shape how underlying values (or ‘what people commonly believe is worthy or valuable’) can be applied in direct practice, including situations which are contested and difficult (BASW 2012). Common principles are the need to uphold the rights of all, to promote the welfare and inclusion of those who are disadvantaged, and to recognise and build on the assets of individuals and their communities (Waine et al 2005). Principles can act as a common binding vision of what is important, a compass to guide direction and a standard by which those leading change can evaluate their practice.
As there was no agreed national set of organisational change principles in social care, the project team built on previous work by Skills for Care (2009), SCIE (2007) and the perspectives of change experts and wider stakeholder groups, to develop one (Box 1). This was used to consider relevant change approaches highlighted in the literature and to develop guidance about how the selected approaches could be used in practice.
Box 1: Principles of change management in social care
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Successful change management in adult social care should….
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Four key approaches to change
A literature review was completed to identify ‘approaches to change’ and ‘change tools’ commonly deployed within the field of organisational development. An ‘approach to change’ is defined as an ‘overarching framework that can guide a change process’ and a ‘change management tool’ as a ‘method which can be used to understand or support a specific aspect of the change process’. Examples of the latter would be stakeholder mapping exercises, organisational diagnostic methodologies, engagement processes, and direct interventions. An advisory group including representatives of people who access services, wider partners, service providers and commissioners provided insight into change within adult social care and the principles that should underpin it.
Consultation was undertaken with change practitioners and national social care leaders on the emerging principles and a short-list of approaches and tools identified, from which four overall approaches to change, and a number of tools , were selected and subject to further literature review. Finally, additional consultation with the advisory group and the change practitioners helped to identify change scenarios commonly encountered by adult social care managers which could be used to illustrate the practical application of the approaches and tools.
The four overall approaches to change selected are:
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Action Research |
Arose within the field of organisational development to better enable people who would be affected by a change to participate in the enquiry and decision making process. It seeks to analyse an issue from a range of perspectives, generate possible solutions, and test the ability of the chosen solutions to respond to the original issue. It involves cycles of collecting and analysing data, joint consideration of what can be learnt and taking action on the basis of these discussions. Key strengths: Through seeking to engage stakeholders so actively action research can support the involvement of people who access services and their families in the change (Principle 1). It is based on collective learning about an issue and so potentially promotes trust and partnership working (Principle 5), and, therefore, may also develop a more holistic understanding of the issue and the desired impacts (Principle 2). Key weaknesses: There is a danger that the people leading the action research process can take on the role of experts and, hence, for their views to dominate (Principle 1). The costs of working with an external party may prevent the approach being supported by senior managers (Principle 4). Stakeholders may be reluctant to share more negative views within a collaborative process and therefore inhibitors of change may not be uncovered (Principle 2). Finally, managers may set out to follow an action research process, but if they are not aware of its core principles and methodologies they may be unable to implement it properly (Principle 3). |
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Appreciative Inquiry |
In contrast to many traditional approaches to change which focus on what is not working as a means to avoid similar problems in the future, Appreciative Inquiry (AI) seeks to understand the positives, and to use these as a platform for improvement. It is based on the premise that services will move towards the positive images that people have of them. It follows a process which seeks to identify the best of what could be, discuss what should be and then taking action to create what will be. AI seeks to overcome individual and team resistance to change through generating a common and inspirational vision, and does not start with a set premise about what the end result will be. Rather, the future gradually unfolds through conversations, stories and discussions. Key strengths: AI emphasises the assets held by stakeholders, including people who access services and people who work in them, and the importance of involving them (Principle 1). It has the potential to develop and strengthen networks between stakeholders, including senior managers and politicians, and so create foundations for future action (Principles 4 & 5). Key weaknesses: Through not starting with set objectives it may conflict with the need for social care organisations to respond to specific expectations of policy and contracts (Principle 2). People who are not involved in the process may find it hard to engage with radical proposals(Principle 4). |
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Lean |
This was developed initially within Japanese car manufacturing and has been used within a variety of industries including health care. It begins by seeking to understand the value of a service or process, primarily from the perspective of people who access it but also that of other stakeholders. Value adding activities are mapped out, along with those that are seen as wasteful through adding delay, duplication, and diversion from more beneficial activities. Lean is therefore particularly relevant for improving organisational processes, for example the referral, assessment and care planning pathways used by care management teams. As well as removing waste, the change centres around developing ‘pull’ rather than ‘push’ in the system – i.e. the next stage in a process is ready to do the necessary task rather than only doing so because it is under pressure from early stages. Key strengths: In understanding and enhancing the value of a services Lean can provide a clear purpose and objectives for a change (Principle 2). Whilst senior support within an organisation is required, Lean is grounded in the views and experiences of people who access and work in services and therefore can be an opportunity to enhance their engagement (Principle 1) and to learn together about what is important (Principle 5). It emphasises the need to be structured in the improvement process and to break this down into achievable steps (Principle 3). Key weaknesses: If too focussed on adhering strictly to the methodology then lean practitioners can find it difficult to accommodate the complexity of social care (Principle 3). The terminology within Lean and its industrial heritage can make it feel somewhat alien and lacking in relevance to users and carers, frontline staff, and indeed operational managers (Principle 1). |
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Soft-Systems Methodology |
This was developed in response to ‘hard systems approaches’ that focus on using technology and processes to achieve objectives. Soft Systems Methodology (SSM) recognises that stakeholders may have different understandings of the purpose and problems of a service and, therefore, how it can be improved. SSM provides a process through which different stakeholder viewpoints can be shared in order to build agreement on what the changes will be. It does not assume that consensus can be reached but rather looks for compromises. Key strengths: SSM emphasises the importance of engaging different stakeholders and valuing their perspectives (Principle 1) . Through encouraging dialogue and discussion it may also lead to people developing a fuller understanding and being more willing to accommodate the wishes of others (Principle 5). As it makes the purpose of a change process clear, it creates the potential for the setting of clear outcomes and relevant measurements (Principle 2). Key weaknesses: Concerns have been raised about the time and cost implications of following the process which may make it difficult to get endorsement by senior managers (Principle 4). There is also a danger that through seeking to take on board all viewpoints more radical and potentially unpopular changes may not be achieved (Principle 2). |
Conclusion
Through literature review and the experiences of those engaged in adult social care this study identified four overarching approaches to managing change,. However, none of the four approaches appear to fulfil all of the principles of social care change and, therefore, care needs to be exercised in their implementation. The lack of empirical evaluations of their adoption may reflect the limited awareness of such approaches by managers and their organisations. Greater awareness and confidence in applying different methodologies in isolation or combination will improve managers’ competence to achieve change. It will also open the door to capturing practice-based evidence on what has worked and also what has not. Whatever the methodology, meaningful and sustained support from an organisation and its funders are vital to ensure change processes are not compromised. Ensuring those leading changes have sufficient capacity and resilience is crucial to enable them to see the process and future change projects through.
References
- BASW (2012) The Code of Ethics for Social Work: Statement of Principles, Available at http://www.basw.co.uk.
- Fauth R, Mahdon M (2007) Improving social and health care services, Available at http://www.scie.org.uk.
- Skills for Care (2009) The principles of workforce redesign: a framework for service transformation in adult social care, Available at http://www.skillsforcare.org.uk.
- Waine B, Tunstill J, Meadows P, Peel M (2005) Developing social care: values and principles, Available at http://www.scie.org.uk.
Plain English summary
Social care services are undergoing profound transformation at a time of financial scarcity, focussing attention on what should be done and how, and many practitioners are ambivalent about changes which may appear to run counter to principles of social care. While there is much research evidence available on the use of change management / organisational development models to support implementation, it is diffuse and little known within social care.
This project aimed to address the gap in knowledge regarding organisational change in adult social care through a literature review and discussions with key stakeholders. The study found little empirical evidence to guide how change can be successfully achieved within social care organisations. It identified four approaches which are potentially relevant to manage change within adult social care services: action research, appreciative inquiry, lean, and soft-systems methodology.
Key points from the review included:
- Successful management of change is a core requirement of the role of all adult social care managers in all settings and sectors;
- Change management is less researched in adult social care than in some other industries and sectors, including health care, and lessons may not be always be simplistically transferrable due to the different contexts, challenges, stakeholder and cultures;
- Organisational change often involves asking people to accept new arrangements that they may not be familiar with or indeed initially endorse. Agreed underlying principles are important to guide practice in such circumstances and to ensure that the values that undermine social care practice are maintained;
- Organisational change and the setting of outcomes from such change should be co-produced with those who will access the services concerned;
- A successful change process can be a means to develop trust between stakeholders and gather learning for future initiatives;
- Action research, Appreciative Inquiry, Lean and Soft-systems Methodology are approaches which have potential relevance within adult social care services, but none are likely to work in all contexts. There are a range of management tools which can support their successful implementation;
- Sufficient capacity and resilience of the team leading the change, good project management, and support from senior management are vital for any change approach to succeed.
The study has led to the production of a compendium for organisational change which includes a directory of change approaches and change management tools, and fictional case studies to illustrate how the four identified key approaches could be deployed within adult social care.
Dissemination
Articles have been submitted to peer-reviewed journals (awaiting decisions).
Published articles
- Freeman T, Miller R, Davidson D, Glasby J (2014) A Social Care Compendium of Approaches to Organisational Change, Health Services Management Centre, Birmingham.
http://www.download.bham.ac.uk/socsci/hsmc/hsmc-flip-book/ssrc-hsmc_flip.html - NIHR School for Social Care Research (2014) Managing change in social care, Research Findings 47, NIHR School for Social Care Research, London.
http://www.sscr.nihr.ac.uk/PDF/Findings/RF47.pdf
Presentations
- Tim Freeman, Managing organisational change, NIHR School for Social Care Research Annual Conference, 24 March 2015.
http://sscr.nihr.ac.uk/PDF/AC15Presentations/TimFreeman.pdf; https://youtu.be/UDCnWG1-vgA - Peter Hay, Ewan King, Robin Miller, Launch - Managing change in social care: New tools and approaches, Community Care Live Birmingham, 12 May 2015.
Public involvement
The study team consulted with senior managers in developing resources arising from the study. They also sought their views on change management approaches.
Impact
The full report of this project is a compendium of change in social care which includes reviews of relevant approaches and interventions and examples of how they can be applied to common change scenarios encountered by adult social care managers (http://www.download.bham.ac.uk/socsci/hsmc/hsmc-flip-book/ssrc-hsmc_flip.html).
This compendium has been developed into an interactive, online tool and video by the Social Care Institute for Excellence (SCIE) as part of their resources to help the social care sector implement the Care Act. SCIE and the research team spoke widely to managers and people who use services and they created four case study scenarios of managers in different social care contexts together with a compilation of change approaches. The tool is available athttp://www.scie.org.uk/publications/elearning/organisational-change-in-social-care/resource/index.html and was launched at Community Care Live Birmingham on 12 May 2015.
This project was funded by the National Institute for Health Research School for Social Care Research (project number T976/T11-084/UBTF).
Department of Health Disclaimer
The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School for Social Care Research, NIHR, NHS or the Department of Health.