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Principles for change: how organisations can work together to deliver change in health and care estates.

Change is the only constant.

Change in health and care estates has never been quick, but it has always been urgent. The early months of the COVID-19 pandemic showed that when organisations unite around a project, it can be delivered with phenomenal pace.

These Principles for Change, defined by our own experience and those of experts from across our industry, are intended to act as a reminder, or even a blueprint, for how we can make change happen despite the challenges we’re facing. They are the defining factors of the productive partnerships that actually deliver real change to our health and care landscape, and we hope that you will join us in putting them into practice, so that we can make change happen together.

Our principles for change

Find commonality and compromise

Find commonality and compromise

Embrace imperfect answers

Embrace imperfect answers

Take and empower ownership

Take and empower ownership

Build experienced allegiances

Build experienced allegiances

Be bold in activating your ambitions

Be bold in activating your ambitions

 Find commonality and compromise

To enact change in a meaningful way, and reduce siloed ways of working, it’s important for collaborative teams to feel united around a shared purpose.

To achieve this, it’s good practice to define your mission upfront, so that not only can you all agree on the outcome you’re working towards, but you can instil it as your guiding purpose – which all decisions then need to answer to.

In doing so, not only does this enable all parties to better identify and eliminate barriers to progress, but it also helps to set collective priorities, so that wriggle room and compromise can be put in place for the greater good.

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COVID-19 gave us a common purpose. Everybody was solely focused on doing the best they could to respond to COVID-19, putting the usual agendas in a cupboard somewhere and locked them away, and as a result, we made huge progress. That's what we need from the sector long-term as well, the ability to look for common ground, look for compromise, and be pragmatic. Because that's how we will drive change forward.

In the immediate response to COVID-19, It was extraordinary how everyone united behind a common purpose, there was a fire under them. Everybody was prepared to put themselves on the line for the greater good.


Embrace imperfect answers

When faced with complex challenges, it can be easy to fall into the trap of seeking out a solution that solves all issues at once. But the reality is that waiting for a golden bullet can, in fact, stifle progress, as not only is time money, but if we don’t act swiftly, goalposts can keep moving.

Instead, in order to make change at pace, we have to move forward with what we can control. So to avoid stagnation we need to get comfortable with embracing imperfect answers.

By adopting this approach, you not only give room for forward-thinking experiments, but you can ensure that your solutions aren’t coined as a permanent fix, but instead an ever-evolving and agile solution.

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Problems you come across in life are usually fairly wicked in that they are complex, they are multifactorial, they are really, really difficult. So you've got to stop kidding yourself that you're going to find a simple answer to a wicked problem. To solve wicked and complex problems you have to accept wicked and complex answers, that are similarly imperfect to the problem at hand.

Delay is the biggest risk in any development project. Not only does delay equate to significant added cost but delay also attracts new risks that would not otherwise have been an issue. This in turn adds further cost and more delay – a vicious circle. Be bold and brave, embrace the imperfect and get on with it!

There's never a perfect solution, but there is a perfect storm.

Take and empower ownership

Following COVID-19, Matt Hancock has recognised the NHS’ need for “leaders at all levels” who are “encouraged to use their initiative and take ownership of their decisions.” It is also clear that leadership needs to empower those on the ground, by “getting rid of what stands in their way” – and admittedly sometimes what needs removing is our tight grip of control.

By giving those on the ground permission to be accountable, we can ensure that our sector is geared towards action. In doing so we can empower those with the information and skillset to make real change happen by giving them the freedom to be innovative.

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We need to create a culture that encourages people to want to take ownership. In the NHS, some parts of our senior leadership are trained to be quite cautious and to look upwards for guidance. So we want to create that environment, where people feel like they've got permission to be creative, and think outside of the box and find new solutions. One of the striking things about COVID-19 was how empowered the doctors and nurses have felt, because they're being able to be more innovative, and do new things in different ways. I reckon people have been more productive, because they've been more empowered and trusted, rather than being governed from ivory towers by the likes of me.

A Finance Director of a hospital trust with a turnover of over £500m, equal to many large corporate organisations, employing 7000+ staff and being personally responsible for the care of tens of thousands of patients is not allowed to deliver a small and vital capital scheme without toiling through a maelstrom of external approvals. How can that be empowering? This needs to change, or we will lose many of the most commercial and farsighted individuals in the NHS.


Build experienced allegiances

Making change a reality can often feel like leaping into the unknown. So it helps to have someone who is well versed in the journey to help you find your footing and open your eyes to doing things differently.

Building experienced allegiances, and bringing the right people to the table will not only put your mind at rest as you tackle transformation, but ensure things are done as effectively as possible.

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If I were to write a job spec for the perfect partner to unlock change, I believe they would need to have an open mind, creativity, and an enquiring mind. Someone who’s willing to look at things differently but to work within our frameworks and some of our constraints.

We rely on people who have made change happen before, which is why if Prime tells me to go one way or another, I listen. It’s important to work with people you trust.

It’s that absolute openness to say 'okay folks how can we do things differently’.

Be bold in activating your ambitions

In order to make real change happen, not only do we need to rally around big ambitions, but we need to be unapologetic in activating them.

With your goals as a guiding light, it’s important that you never lose sight of what you’re trying to achieve, so that as challenges present themselves, you can go back to your mission and move mountains to make them a reality.

Without this pragmatic and purposeful approach, we’ll be left with lots of big ideas, but nothing to show for it.

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We've found a different way that we probably didn't think was possible before, and it's really important that the sector keeps up with that. And actually what we want from the sector is to be at the cutting-edge of that innovation. To recognise that there are further levels beyond what we're even doing at the moment – so we need to be pushing at some of those boundaries.

It’s the likes of Prime who are the bold frontiersman, pushing the boundaries, and then they bring us along for the ride and we’re delighted to be on that path with them.

We’re looking to find people who can be super ambitious, and follow through on that to make their vision actually happen.

Special thanks to:

Ross Dunworth, Finance Director, Royal Surrey County Hospital
Anne-Marie Nicholson, Partner, PRP LLP
Paul Sheriff, Director of Partnerships, NHS Birmingham and Solihull CCG
Matt Tebbatt, Managing Director and Owner, One Creative Environments
Simon Trickett, CEO, NHS Herefordshire and Worcestershire CCG
Dr. Christina Walding, Management Consultant, KPMG
Michael White, Head of UK Property, Canada Life Ltd

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Together, we solve commercial puzzles, unlock sites and collaborate with partners to ensure that projects are delivered without compromise. Whether you’re hoping to improve your patient experience or unlock new capital, the Prime team always go the extra mile to deliver impact throughout all of our work. We want to enable more hospitals, GP practices and care homes up and down the country to realise their own ambitions and deliver outstanding health and care be enabling them to navigate the complex landscape that can often lead to change paralysis.

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