We recently interviewed Preeti Sud, director of strategy and innovation for Mid and South Essex NHS Foundation Trust. Preeti spoke with us about her insights on change management and digital strategy.
As head of the strategy unit, Preeti described how her team support the trust with strategy and also with innovation. This includes work with what Preeti refers to as “the hardcore tech” along with programmes taking a more strategic focus, such as their quality learning system, which is about using evidence-based approaches to make the organisation more quality-focused.
Population health management
When asked about her work on population health management (PHM), Preeti noted the difference between making an impact as a secondary care provider, and “purest PHM” which tends to have a greater focus on “primary prevention perspective”.
Her team are involved in “a lot of projects” in this area, Preeti said; one team is exploring work around PHM and health inequalities, with emphasis on equity of access, outcomes, experiences and the social determinants of health. “It’s about thinking: what we can we do as a secondary care provider to make an intentional positive impact, not only on the health and wellbeing of our patients but also of our staff?”
Preeti’s team also work on building predictive models through their analytical skills, which has seen them deploy predictive models in critical care, around demand and capacity.
She added that one team member is seconded to the ICS to support the work that they are doing across the whole pathway under the stewardship programme, “which is about all of us acting as the stewards of the resources that we have within the system.” Preeti noted that her trust is the only acute provider within Mid and South Essex, and as such it is all the more important that the work the strategy unit is doing be shared across the system.
Asked about her experiences working on large-scale transformation, Preeti noted that she used to work for NHS England and has experience of working across the system.
“Most of the transformation programmes have been across boundaries,” she said. “I think, when we’re looking at large scale transformation, we need to get the exam question right. We need to spend a lot of time understanding what the problem actually is, and spend as much time as we can on that. We often have people who think that they understand the solution, so they start looking looking for solutions before they understand what the root cause is.” In addition, she said, there can be a challenge around getting the right voices heard, with the voices shouting the loudest not always being the ones adding the most value to the conversation.
Preeti voiced her agreement for the the idea of spending 90 percent of time on planning and 10 percent on delivery. She noted that her team spend a lot of time focusing on the problem and understanding where it sits within the wider system.
Another aspect to consider, Preeti continued, is that when you are starting out with a strategic programme, sometimes you may be ahead of the curve. Innovation programmes within organisations have often been thinking about particular project, problem or solution “before the organisation has understood what it is, which means that initially a lot of time goes into raising awareness. Then you also have to try and find little actions that help show people what it is all about. You need to do something very small, very meaningful, which a staff member will be able to see and understand what you mean or why it’s important.”
Transparency also plays a key role in encouraging engagement, she said. There can be confusion around how much information can or should be shared. “I’ve learned this by working with leaders who do this very well – the more transparent you you are, the more you get engagement. It’s about showing people your scars, to show them that you understand.” It’s not always easy, she acknowledged, with different areas of care sometimes sceptical about how well other teams understand their experience. But ultimately, Preeti’s advice is to be “very transparent, very open, not only about your experience but also about what the problems are.”
Data is also key. “Data plays a very, very important role – I can’t emphasise how important it is to start a piece of work by looking at the data. We have a small, well-formed group of analysts who work within the team and they bring different skillsets; we have some who understand PHM, some who understand hospital data, some who understand out-of-hospital data. We recruited them for their skills and background. You need to make use of these skills, do some of the data pieces of work and show people an area that has a really big impact. It’s more effective than trying to explain a problem to someone.”
Whilst data is vital to getting these projects off the ground and securing engagement, Preeti conceded that it can also be a barrier. “If you don’t have the data, you can’t convert it into the right kind of insights.”
Another challenge can be the fact that people get tired of change, and suggestions for a large-scale transformation can lead to objections or immediate disengagement. The way to try and overcome this, according to Preeti’s experience, is to try and show people how the work will improve something or tackle a known problem that they face in their day to day professional lives.
Capacity is also an issue, whereby teams that are being asked to make change may already be relatively overwhelmed with other aspects of service delivery improvement or other projects. Preeti emphasised the importance of showing people how they can make small changes and incorporate these into their work routines
Finding early champions is integral to success, Preeti continued, along with thinking about how change will be sustained and who will sustain it. From the very first stages of the transformation project, she highlighted how it is important to constantly be considering whether an approach or change can be embedded and how this will take place, looking at the current context or environment to identify the likelihood of a project doing well. “You have to think about this right from the start, otherwise you will end up with a product or a way of working which is completely against the working environment, the commissioning intentions, the future direction of travel for that organisation, or so on.”
Making change management successful
“There’s a heart and a mind piece to making change management successful,” said Preeti. “The mind piece is the technical side: do you have the capability and capacity, do you have the right resources? The technical side needs to be right, because you can’t expect the same nurse to learn 15 different kinds of change projects, especially when they are delivering care to the patients on a day-to-day basis.
“The heart piece is around transparency and engagement. It’s about getting the engagement right from the start. Change will work if you have brought in the people who need to do the change, who need to be part of the change, right at the very start.”
Sharing drafts with people and getting their feedback on initial project ideas are two ways Preeti suggests to get people on board early on. Doing this, she said, is likely to offer better results than going to people with the final plan and simply telling them that that is how change is going to happen.
Getting the context right can be difficult in change management, Preeti acknowledged, and that is where she feels that external organisations struggle; because although they have got the technical bit right, they haven’t got the context and engagement – the heart piece of work – right. She pointed out that it is important to bear in mind that organisations have been undergoing constant change, particularly since COVID, and it is an ongoing journey.
Measuring impact of change
In terms of how to measure the impact of a strategy, Preeti advised that organisations should think about data from the start and establish a baseline.
In addition, she discussed how her team is currently working to try and capture stories of change; it is hoped that this will help them in better understanding the effects of change on the ground.
“In a lot of strategic operations, it has to be one conversation at a time,” Preeti said. “People will participate in change if they feel engaged. It’s about finding various opportunities to have those conversations with them, without creating extra work or having three more meetings a month.”
Taking pride in projects
So what project is Preeti most proud of, on a personal level?
“I’m looking forward to the work we will do on the quality learning system,” she shared. “We are going to put insights into the hands of our 16,000 staff; so we are going to make it very easy for people to see key quality indicators on a day-t0-day basis. It is an uphill climb, but that’s what I’m looking forward to.
“In terms of a project which I’m really really proud of, during COVID I got reassigned to set up the staff testing at the end of March. As innovation sits within my team, we spoke to a couple of innovators and identified an opportunity which meant that we could very quickly convert into a staff booking app for covid tests. This meant that staff could book their tests and get their results through the app. We did that in five days, and that system got used across the whole east of England. I’m very very proud of that digital intervention – not only did we have to set up something from scratch, but it also led onto other things. We started doing COVID risk assessments for staff online, and we do a lot of things digitally now because of that project, as people saw the benefits of being able to work online.”
Looking to the future
Asked about future projects, Preeti elaborated on the quality learning system programme and its potential impact for the organisation.
“It’s a way we can bring evidence right to the frontline on a day-to-day basis,” she said. “It’s about real-time or as near to real-time data that we can give to every staff member in the organisation. It’s not about giving people thousands and thousands of indicators, but a select few indicators which can give insight into the health of the organisation on a day-to-day basis, and anybody can look at it.”
Preeti is hopeful that this will empower doctors, nurses and others across the organisation to identify areas for improvement, initiating change and conversations. She concluded with another hope; that the programme will help her trust in becoming a learning organisation, encouraging change through-positive behaviour.
Many thanks to Preeti for taking the time to join us and share her thoughts.