Managing Change and Complexity in the NHS: Using a pragmatic transformation methodology to facilitate workforce redesign “When it works it works…”

Aiello, M. (2020) Managing Change and Complexity in the NHS: Using a pragmatic transformation methodology to facilitate workforce redesign “When it works it works…”. PhD thesis, University of Worcester.

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Abstract

Purpose of the PhD
➢ To identify and explain common elements in the delivery and evaluation of NHS workforce
transformation projects; elements which can be described as a single framework. The framework must
have application and transferability across UK healthcare systems.
➢ The processual framework requires a philosophical underpinning to assist project teams in responding
to stakeholder and user perception as key drivers in transitioning innovation into NHS core business.
➢ To demonstrate cohesion in the chosen published works against a common theme.
➢ To define the contribution of the programme of work to meet a PhD standard.
Design / methodology / approach
Whilst leading NHS workforce transformation programmes across healthcare systems,it became clear to the
candidate that projects which successfully transitioned from ‘concept’ to core business shared coon design,
delivery and evaluation processes. It was recognised that evolution of the NHS workforce cannot happen
without a combination of project management, acknowledgement of contributory human factors and the
resources to influence perception. These common elements were developed into a single, evidence-based
framework with a defined philosophical underpinning, to support both the integration of innovative
workforce projects and the need to recognise perception as a key driver throughout project design, delivery
and evaluation. The PhD by publication was subsequently undertaken to present and justify the framework
and explain the linked philosophical underpinning.
Findings
Insights gained during the candidate’s NHS Health Education England regional and national programmes of
work led to the recognition of mixed methods evaluation methodology, linked to critical realism and
pragmatism as philosophical underpinning to the processual framework. Taking a hybrid approach of Critical
Realism and Pragmatism might provide a means of translating a complex theory into something relatable
across user and stakeholder groups. Evidence gathered from published HEE workforce transformation
projects between 2014 and 2019 demonstrate that NHS change management requires both a definable
process and recognition of perception (truth claims) as necessary to lever change in an industry where any
change is predicated on the individual and collective will of the NHS workforce to embrace that change.
Originality
The unique contribution to the public body of knowledge will include a processual framework and
philosophical underpinning, demonstrated through examples of its application in NHS workforce
transformation projects between 2015 and 2020. Demonstrating the rationale for both the framework
approach and the philosophical underpinning will provide the practical and academic contributions that this
PhD seeks to achieve. Evidence presented within the narrative is a combination of antecedent research, the
author’s published works and evidence not yet published, held internally by NHS Health Education England.

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