Table 1.

A change management theory applied to network implementation in Tower Hamlets33

StepDescriptionExamples in Tower Hamlets
1Establishing a sense of urgency
  • The change and political context of the NHS create a sense of urgency

  • Polyclinics proposed by Dr Darzi11 and the involvement of consulting companies are specific examples of disruptive events that challenged the status quo

  • Work showing below average performance for detecting and managing some chronic diseases encouraged change

2Forming a powerful guiding coalition
  • Early engagement by senior managers with clinicians

3Creating a vision
  • A clear vision of quality improvement driven through a managed geographic network structure

4Communicating the vision
  • This vision was understood and agreed among all stakeholders at practice, network, and PCT levels

5Empowering others to act on the vision
  • This was manifold including opportunities for local solutions

  • GPs led on developing the care packages

  • CEG developed IT quality improvement tools

6Planning for and creating short-term wins
  • Most targets were seen as clinically important and achievable. Rapid achievement of immunisation targets is a good example of this

7Consolidating improvements and producing still more change
  • The networks survived significant changes in the NHS

  • Further evolution with the GP Care Group and THIPP

8Institutionalising new approaches
  • Enhanced care for chronic disease is now ‘work as normal’

  • Dashboards continue to be used

  • Targeted approaches to outcomes have been maintained

  • CEG = Clinical Effectiveness Group. IT = information technology. PCT = primary care trust. THIPP = Tower Hamlets Integrated Provider Partnership.