The second step of change moves into the active change cycle and is to “understand” the need for change. It is part of the Planning for Quality domain within a Quality Management System.

Why: Fully understanding both the need for change and the context in which the change is happening is critical in achieving high quality, meaningful change.

What: To understand the need and context for change, engaging with three groups is essential:

• Service users (patients, family, carers, public).
• Service providers (health and care professionals).
• Service enablers (the supporting functions that enable the service to happen, such as administration, eHealth, estates, transport).

It is important to understand the opportunities, barriers and enablers of change. This includes understanding how the change will interact with the wider system it sits in – both the impact of the wider system on the part being changed, and the impact of the change on the wider system. The understand step will vary significantly depending on the complexity of the individual change and its setting. Understanding the need for change is part of Planning for Quality.

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

• Process mapping: visually describes the flow of work to identify the current state of what happens in a process.
• Journey mapping: helps understand, record and share the experience of a person using the service.
• System mapping: provides an understanding of the flow and demand on the system, indicates areas for improvement and enables strategic decision-making.
• Focus groups: facilitated discussions between small groups of people who share experience or knowledge.
• Patient diaries: gathers qualitative information about people’s experiences of using services.
• Five Whys: helps identifying underlying reasons for a problem by repeatedly asking the question “why?”.
• SWOT analysis: identifying the strengths, weaknesses, opportunities and threats surrounding a change and the environment surrounding the change.

The taking a design approach to person-centred services toolkit includes various other tools to support the understand step of the change cycle.