Using the Scottish Approach to Change

1. this digital resource – we are continually developing this resource to make it easier to find the information and tools you need, quickly and easily
2. our learning community – join our learning community to receive information, advice and peer support on using the Scottish Approach to Change
3. education and training – we are currently looking at what education and training we can develop to support the Scottish Approach to Change. Until then you can find support on the various methods included in the Scottish Approach to Change on our education and training page
4. direct support from Healthcare Improvement Scotland – we are providing support for NHS boards and HSCP who are looking to embed the Scottish Approach to Change. You can express an interest in receiving support by emailing the team at his.satc@nhs.scot. We have a small team, so support is based on availability of our team.

For change to be achieved well, the right enablers must support it. A consistent, structured approach needs to be taken through the change cycle.

Start somewhere, go everywhere

There is no single right way to start using a framework like this. It is designed to help you in whatever way you need it to. Try:

• starting with the Identify or the Understand steps and use the prompt questions to think a bit about what the problem is you are facing, and who you might need to involve to think it through
• conducting a readiness for change assessment to see how well positioned your team, service or organisation is for making a change

Anyone can use it – work with colleagues from a range of disciplines

Anyone can use the Scottish Approach to Change to guide their change. Having extra skills to help with change, especially when it is large or complex, can really help. These include change experts from quality improvement, engagement, strategic planning, service design, organisational development and commissioning.

Doing change differently

The Scottish Approach to Change isn’t just a set of steps to follow. It is an openness to new ideas and innovative approaches – and a belief that we can make things different, with different choices.

It is a commitment to change looking and feeling different.

• change done well feels like
• everyone is going in the same direction
• leaders are focused on removing the barriers you face
• working together to share the load
• working together across public, third and independent sector
• being led by people who use, deliver and support services

Making safe and effective change

Making changes to health and social care services means considering the legislation, regulations, standards, and guidance that apply. These requirements help ensure services are safe, effective, and high quality.

This section explains the why this matters, who can help, what to consider, who you may need to involve, and where to find further information and support.

Why this matters

Legislation, regulations, statutory guidance, and standards are there to help you deliver safe and high-quality services. The purpose of regulation is to:

• Protect people who use services from the risk of harm.
• Ensure services meet high standards and quality is continually improved.
• Protect patient rights – the Patient Rights (Scotland) Act 2011 empowers patients to receive safe, effective, and person-centred care, including access to information.
• Ensure health and social care professionals maintain high standards of training and conduct, behaving ethically and professionally in line with recognised professional standards.
• Provide independent oversight and ensure accountability.

Complying with regulations, statutory guidance, and standards helps to ensure that people who use, deliver, and enable services are protected and that care is of the highest possible quality.

Working with regulators

Regulatory organisations such as Healthcare Improvement Scotland and the Care Inspectorate monitor compliance with legislation and regulations by conducting inspections or other quality assurance activity.

It can be helpful to think about regulators as enablers of change rather than enforcers of the law. External quality assurance processes and inspections can be seen as an opportunity to gain insights and recommendations about what is working well or not so well within your system. This learning can be used to identify opportunities for improvement and change.

When you want to make changes to a service, pathway, or health and social care system it is helpful to work alongside your regulator to think about how you might move towards more innovative ways of working while still meeting regulations, statutory guidance, and standards.

• It is important to understand that there might be different interpretations of how a regulation might be met – just because it has always been met in a particular way does not mean that this is the only way. Sometimes it may be possible to be flexible and proportionate in how a regulation is met.
• At times it may appear that there is a conflict between regulatory requirements, such as a tension between ensuring care is as safe as possible, while also making sure people who use services have choice and control over the care they receive. There is legislation underpinning both and no automatic precedence of one over another.

In these instances, contacting your regulator to work the issue through might be helpful.

Regulations should not be regarded as static and immovable. Sometimes, to make significant change, there is a need to update or amend regulations where there is strong evidence that this is the right thing to do. By working alongside regulatory organisations, it can be possible to find opportunities to change requirements without losing sight of what they were originally put in place to achieve, for example to keep people safe from harm.

Helpful tools and resources

The following tools can help you explore how legislation, regulations, standards, and local processes may affect your change, and identify opportunities to work differently while continuing to meet requirements.

Explore which requirements are set by legislation or regulation, and which are based on local custom, practice, or organisational policy. This can help identify where there may be flexibility to support innovation and change.

See how legislation can act as an enabler for improvement and change. This framework shows how the Health and Care (Staffing) (Scotland) Act 2019 supports safe, effective, and sustainable services.

What to consider

When planning or implementing a change, it’s important to understand how it may affect different aspects of quality, safety, governance, and people’s experience of care. Consider:

• Quality and safety – how will the change affect the quality, safety, and effectiveness of services?
• Workforce and staffing – are there implications for staffing levels, roles, skills, or training?
• Clinical governance and risk – have risks been identified, assessed, and managed appropriately?
• People and communities – how will people who use, deliver, and support services be involved?
• Human rights and inequalities – could the change affect people’s rights, access, or experience of services?
• Information governance – are there implications for data, privacy, information sharing, or record keeping?

This is not an exhaustive list. Additional considerations may apply depending on your organisation, service, and the nature of the change.

Who to involve

There are a number of internal teams or external organisations that you may wish to involve to ensure you have considered all the right things when you are planning or implementing a change. It is helpful to involve people (including those who use, deliver, and enable services, as well as local communities) as part of your change team as early as possible in the change cycle.

This might include:

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Healthcare Improvement Scotland’s Clinical Governance Standards provide a good baseline for the things you need to think about.

The Health and Social Care Standards: My Support, My Life (2018) set out what people should expect when using health, social care, or social work services in Scotland, based on what matters to people.

As part of the understand step, it is important that you do additional research to identify other considerations that may be specific to your organisation or service. NOTE: This is not an exhaustive list.