WHO Bulletin: Improving the quality of health care across the health system (3) Large scale change

4 December, 2018

Dear Siân,

Thank you for pointing us to this resource https://www.england.nhs.uk/wp-content/uploads/2017/09/practical-guide-la...

Can you (and others on HIFA) say a bit more about how you have used 'Large scale change' principles in your work, and in what context?

I was interested to read the introduction:

'Large scale change (LSC) is the process of mobilising a large collection of individuals, groups and organisations toward a vision of a fundamentally new future state, by means of:

- Key themes that can make a big difference

- A shift in power and a more distributed leadership

- Comprehensive and active engagement of stakeholders

- Mutually reinforcing changes in multiple systems and processes.'

'The ten key principles of large scale change are:

1. Movement towards a new vision that is better and fundamentally different from the status quo.

2. Identification and communication of key themes that people can relate to and that will 02 make a big difference.

3. Expect LSC to be complex with multiple stakeholders, agendas (both hidden and open), points of view, needs and wants, details, and systems that need change.

4. Framing the issues in ways that engage and mobilise the imagination, energy and will of a large number of diverse stakeholders

5. Mutually reinforcing change across 05 multiple processes/subsystems.

6. Continually refreshing the story and 06 attracting new, active supporters.

7. Emergent planning and design, based on 07 monitoring progress and adapting as you go.

8. Many people contribute to the leadership of 08 change, beyond organisational boundaries.

9. Transforming mind-sets, leading to 09 inherently sustainable change.

10. Maintaining and refreshing the leaders’ 10 energy over the long haul.'

I suspect the same principoles could be applied in many contexts:

1. Communities of purpose (such as HIFA) that are seeking to promte large scale change (improving the availability and use of reliable healthcare information). CoPs such as HIFA already have many of the above characteristics - how could our impact be further strengthened?

2. Global health policy

3. National health policy and practice.

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 18,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG /orcid.org/0000-0001-9557-1487 neil@hifa.org