As a political science graduate from the London School of Economics, and currently on the NHS Graduate scheme, I wanted to understand how change can happen on the frontline. I chose to gain experience as a Consultant because I wanted to see how the private sector works with the public sector. I specifically chose IMPOWER as its EDGEWORK® framework resonates with my own experiences and challenges that I have encountered during my early career within the public sector. Additionally, I was keen to understand how applied behavioural science can be used to help those on the frontline.  

Whilst on my placement with IMPOWER, I spent two months working with the Manchester and Trafford Local Care Organisations. This project worked with three hospitals within Manchester. The aim of the project was to deliver sustainable change to improve discharge and flow which will enable better outcomes for patients, as well as improving ways of working on the frontline.

This involved a behaviour-led approach to transformation. We worked with staff to enable them to embed a “Home First” focus and ensure that discharge planning is considered throughout the entirety of the patient’s journey. To achieve this, this meant improving collaboration between staff and empowering them with the right knowledge, tools, and resources. For example, developing an understanding of community offer, technology enabled care, and reframing how we assessed and engaged with patients through strength-based practice training.

My three key takeaways:

The effectiveness of simplicity in complex, siloed systems

Throughout my time working within the NHS, I have found there to be many hugely complicated and messy system processes that have been attempted to be remedied with further complicated, messy interventions. However, I have learned that by reframing the problem, often complex situations do not require a complicated approach – but a basic one which analyses the root causes of the issues – and this was the very premise of the Back-to-Basics project.

The use of behavioural science

Changing ward culture requires an element of behavioural science and I learnt about this through the adoption of strengths-based practice. Strengths-based practice means viewing the patient in a more holistic perspective, drawing on their strengths, what they can do, and what support they do have. Simple behaviour changes in the language used towards patients transforms attitudes and empowers the patient, allowing them to return home sooner and achieve better health outcomes.

Effective culture change is ground up

During my placement, I understood that the most useful tool for embedding cultural change is working with the frontline teams, understanding their frustrations, and supporting them to make these changes. It is essential to have buy-in from those who are expected to support the transformation as they are the allies who will then champion this change. This helps to drive change throughout the wards as they can apply this practice consistently, influencing and teaching others. Also, other ward staff hearing about the benefits of change from a fellow medical professional, who is also their colleague and can provide compelling examples and patient stories, is invaluable.