How to identify and develop specific change ideas

There are different approaches you can use with the team to help them come up with change ideas to test. Often a combination of approaches is needed, as you will need to develop changes to address most or all of your drivers.

Using your understanding of the current system

There are many tools that you can use for understanding how your system is working.  Process mapping (flow charts) is very useful for this. By observing and discussing the current flow it can trigger ideas for improvement – for example to remove steps in the process.

Following one service user through their journey can help you identify change ideas that would help achieve improvement for a wider group. Also, service users might have suggestions for improvement that staff have not thought of, or their feedback might trigger ideas.

Cause and Effect analysis is used to explore and record likely causes of problems. This discussion can generate ideas for change.

Exploring why people might behave in certain ways using the ISM model can also help you come up for changes.

Learning from others

Benchmarking is learning from how others do things. This can be informal by simply observing another team’s or organisation’s approach and processes.  A formal process provides a structure to support this and can be used to compare how things are done differently (practices) alongside key process measures so that the impact can also be compared.

A Benchmarking process is likely to include:

1.         Identifying a team or organisation that’s performance you would like to emulate

2.         Make initial contact to arrange a visit and agree how you will learn and share with each other

3.         Plan to gather the information you need: the questions you want answered and how you will get the data you need. Check this with your team for their input.

4.         Conduct the visit

5.         Share the information gathered with your team and discuss what it means for you

6.         Identify change ideas that you would like to test

It is recommended that the benchmarking process is conducted as a PDSA so that you learn about, and continuously improve the process.

Published evidence and improvement case studies that are shared can also help you to learn from others.


It may be that your system understanding and research have not provided you with enough change ideas and you need something new. There are a range of approaches and tools that can help you get started with this.

Creative thinking involves stimulating different ways of thinking to generate new ideas and possibilities. Without new thought patterns we often revert to coming up with similar ideas to what has already been tried. There are a range of techniques available to help provoke new thought patterns that can be used with teams. It is important when working with teams to encourage as many ideas as possible initially (divergent thinking) and then to hone these down to the ones the team agree are most likely to impact (convergent thinking).

Change concepts are used to help us focus in on specific approaches that might help our improvement efforts based on our context. Thinking about the concept can help stimulate thought on what specific changes can be made. There are 72 of these and they include concepts as diverse as “change the order of process steps” to “reduce demotivating aspects of the pay system”.  The full list of concepts can be accessed through the Institute of Healthcare Improvement Mobile App. This also describes each concept in detail and when it might be useful.

Using technology - how might new technology might be applied within your system. For instance, by automating processes or using new equipment. While technological innovation can lead to successful fundamental change, care should be taken. Do not automate a bad system and remember that technology that is unreliable is worse than none.

Behavioural insights and Human Factors. The EAST Model focusses on how we might achieve behavioural change. The model looks at how we can make behaviour change Easy, Attractive , Social and timely for those we want to influence. Considering how people and processes can interact is important and may help you to think of ways that you can make this more reliable. Please click here to view our Human Factors page.