What does change involve?

Change requires energy, a vision and action. This is true for any change and CAPA imple- mentation is no exception! Implementation science is a rapidly developing scientific field that looks at effective ways of implementing change. See www.implementationscience.com/. More information can also be found in Implementation Research: A Synthesis of the Literature (Fixsen et al.). Download all or part of the monograph at: fpg.unc.edu/~nirn/resources/detail.cfm?re- sourceID=31


What is clear from research is that having a supportive organisational structure is an important for implementation and maintenance of new, evidence informed practices. Leadership is a key part of this. Higgins el al (2012) have evidenced the importance of an ‘implementation team’ – a minimum of 3 people with expertise to promote effective, efficient, and sustainable implementation, organization change, and system transformation work . The stability of the roles within the team is more important that the people, allowing opportunities for different members of a wider team to become involved, improving the sustain- ability of change as something not dependent on individuals.

The CAPA implementation team needs to ensure service transformation are at clinician, team and organisational level to ensure it is not only implemented but sustained. This requires effective leadership. So how do you decide who will lead?

Effective leadership as defined by the NHS Leadership Academy (www.leadershipacademy. nhs.uk/) means individuals need to demonstrate effectiveness in:

  1. Developing self awareness and managing themselves, continuing to develop them- selves and acting with integrity
  2. Working well with others by developing networks, building and maintaining relation- ships, encouraging contribution and working within teams
  3. Managing services by planning, managing people, resources and performance
  4. Improving services by ensuring service user safety, critically evaluating, encouraging improvement and innovation and facilitating transformation
  5. Setting direction through identifying the context for change, applying knowledge and evidence, making decisions and evaluating impact
  6. Creating a vision by developing the vision for the organisation, influencing the vision of the wider healthcare system, communicating and embodying the vision
  7. Delivering the strategy by framing, developing, implementing and embedding it

We know that is far more likely if three things are in place:

  1. The current situation feels intolerable
  2. You are clear about what you want to be different and
  3. The first steps are clear.

In our experience the more each of these three is felt to be present, and this view is shared by the whole team, the more likely services will want to change and do so effectively. If, as an individual or as a service, you do not feel in a situation that must be changed, then change is unlikely, or hard.


Ensure a leadership team who works well with others, can create and communicate a vision, manage change well and can set the direction. Then go!