The first step of change is to identify the need for change. This takes place within the “current state” before the active change cycle begins.

Why: Identifying the need for change is a key part of continual improvement and responding to external factors. It supports improvement and developments in the delivery of high quality, up-to-date and relevant services.

What: A number of different processes could trigger the identification of a need for change. For example, quality control monitoring could identify a problem such as an increase in waiting times to access a service or a reduction in service user satisfaction. Planning mechanisms could identify a need for change through population health data, responding to a national patient safety alert or a government directive.

How: Examples of tools that support identifying the need for change:

• Routine service feedback: Comments cards and forms are a simple way for service users to write down their feedback. Feedback from service providers (eg, staff surveys) also provide insight and support a positive culture.
• Strategic Gap Analysis: helps identify the gap between the current status and the future status, in short to look for what’s missing
• Ongoing public, patient and community engagement: a self-assessment tool to identify key aspects for achieving high quality community engagement Quality Framework for Community Engagement and Participation
• Quality control measures from routine service monitoring against standards or quality metrics
• External quality assurance.