1. www.changemodel.nhs.uk Questions from a patient or carer perspective
‘We’ is inclusive of patients, carers and staff working across health, social care and voluntary organisations and defines the group of people when ‘our’ is used in ‘our shared purpose’.
The NHS Change Model is made up of eight components that all need to be used in an aligned way to support effective change.
Under each component questions have been developed to help those who are using the model when implementing change to help understand or inform the thinking around the planned change. The set of questions below have been developed from a patient/service user/carers perspective when thinking about local change programmes. The examples of questions given below are intended as a starting point and can be amended and built upon.

2. What outcomes do we seek?
Priority area:
What outcomes do we seek?
Our shared purpose
Key question
Are we co-designing our shared purpose with all the relevant groups? (clinicians, patients and their families, partners across the health and social care system, local business community and community group)
Leadership for change
How do I become part of the shared leadership of change?
Engagement to mobilise
How can we get to the point where patients mobilise their power to drive change?
Spread for innovation
How do I get any part of the system to listen to what other organisations are doing well and replicate the good practice?
Rigorous delivery
What is our road map for improvement and change (achieving our shared purpose) and how will we know how far down the road we are?
System drivers
What are the incentives for us to support this change?
Improvement methodology
How are we enabling patients to challenge our improvement method?
Transparent measurement
Transparent measurement will help us answer the 'so what' question, are we measuring the planned and the actual impact of our change?

3. Our Shared Purpose: Developing and agreeing a shared purpose is the fundamental place to start in using the change model in any change process.
Key question: Are we co-designing our shared purpose with all the relevant groups? (clinicians, patients and their families, partners across the health and social care system, local business community and community group)
Supplementary questions
Do we (the NHS and patients and the public) jointly own our purpose and how do we know this?
Do we have plans in place to ask and have we listened to the public about what improvements they want to see?
How are patients and public helping to frame the question- what is the problem we are trying to solve?
How can patients help describe the problem we are trying to fix in a way in which it will be clearer and more easily understood for other patients and the public?
How am I showing that I am placing equal value on everyone who will be involved in designing, delivering and benefiting from the change?
How will relationships with patients and the public work during this change process?
How is the power in the relationships being shared equally throughout the change and in all decision making processes to make 'no decision about me without me' a reality?
What do we need to do to assure ourselves (including patients and the public) of the following:
we have a shared purpose
we are doing this together
we are building meaningful relationships

4. Leadership for change: A truly patient-centred NHS will require involvement of patients not just in their own care but in changing the way care is received by everyone. Patients and the public can guide us to the most effective service models from their perspective but need to be empowered and supported to lead. Key question: How do I become part of the shared leadership of change?
Supplementary questions
How are we enabling shared leadership?
How are we enabling patients who want to become leaders to drive change?
How do I (as a leader) demonstrate that I value my staff and users of the service?
What support do people need to lead change?
How do leaders communicate the need for change in a way that creates trust?
How do I challenge leaders on the need for change in a way that creates trust?
How do I (as a leader) guarantee that the patient voice will have equal value in the change process?
How are we able to demonstrate where the public are influencing decisions?
How will people tell the difference they have made to the change, the influence they have had?

5. Engagement to mobilise: This is about stakeholder engagement and involvement but it’s also about asking individuals to take action – to be part of the change, to collaborate in designing and delivering the future Key question: How can we get to the point where patients mobilise their power to drive change?
Supplementary questions
What is the quality of the engagement practice?
Are patients key leaders and equal constituents of change?
What is the patient’s role and how will we support them as leaders to make their voices heard?
How will we recognise that patients are still connected or have become disconnected from the change process?
How will we measure the quality of patient engagement in this change?
How will we know that our efforts to engage and mobilise patients have been successful?

6. Spread for innovation: This is as much about copying good practice from elsewhere as it is about sharing what is going well for us with others. We all need to share what works, learn from others and spread good practice as well as having new ideas. Key question: How do I get any part of the system to listen to what other organisations are doing well and replicate the good practice?
Supplementary questions
Do we understand why experience changes from great to poor in different parts of the system?
As a patient, how do I get my voice heard when the service in one setting is so much worse than somewhere else and I can see some ways the service could improve?
What are we doing to spread the good practice?
How are patients involved in leading the spread of innovative practice?
How are patients and public being supported in the use of spread and adoption approaches and tools?
How do we reward people for spread and adoption of innovative practice?

7. Rigorous delivery: To ensure that the changes we plan get delivered we must have ways of making sure that the change is happening and early warning systems for any problems or barriers to our agreed plans for change. Key question: What is our road map for improvement and change (achieving our shared purpose) and how will we know how far down the road we are?
Supplementary questions
Are we really just trying to hit targets or do more?
How can we use the system drivers that we have to make sure the change is sustainable?
What are we going to do together to review and realign if we are going off-track?
How will we know they are still the right milestones for our change, including for patients?
How can we make sure we all (including patients) believe that we are making progress?

8. System drivers: The NHS is a complex system with many different parts interacting. Part of the system is the incentives (for example payment systems for providers of care) and sanctions (for instance standards of care and penalties for failing to meet those standards). The incentives and sanctions can drive together to promote change (though sometimes they don’t) and they can operate on a personal or a system level. Key question: What are the incentives for us to support this change?
Supplementary questions
What is the problem we are trying to fix?
What are the real reasons for change?

9. Improvement methodology: The evidence suggests that using an evidence-based improvement methodology improves the likelihood that a change programme will be successful. There are a number of improvement methodologies available (Lean, model for improvement etc) and they will often include elements from other parts of the NHS Change Model e.g. measurement, engagement, leadership. All elements of the model work best when integrated together. Key question: How are we enabling patients to challenge our improvement method?
Supplementary questions
How are we helping patients understand more about improvement science and the change model to become effective ambassadors for change?
How are patients’ experiences reflected in our approach to change?
How do we know we are using the right evidence based improvement methodology for our change?
How would you describe the NHS Change Model? – think about other innovations in the community that are non NHS.

10. Transparent measurement: If you don’t focus on measurement you won’t know whether progress is being made on the processes we follow and impact being made. We should not be surprised about what we agree to measure, as it should be linked to our shared purpose. Key Question: Transparent measurement will help us answer the 'so what' question, are we measuring the planned and the actual impact of our change?
Supplementary questions
How are we being honest and transparent with patients and staff to help us all understand the whole picture and create a shared ownership for the change needed?
What are we going to be transparent about?
What information are we going to share with whom during this change?
How will we know when our shared purpose has been fulfilled? Or how will we know that we are on track to achieve our shared purpose?
How will we be clear about what is driving the need for change and what contributes to the need to improve quality of care or outcomes and the need to save money?