The third step of change is to develop and design the change. This is the first of the steps that sits within the “Improving for Quality” domain of the Quality Management System.

Why: This step sets a clear direction of travel for the change work, providing clarity about what the change is trying to achieve and how the change will happen. Without this step, change processes can lack ownership, direction and momentum, and fail to achieve outputs.

What: Initially, the aim of the change should be clearly and succinctly defined. Next, potential ways to achieve the change should be developed using a co-design approach with the three groups identified within the “understand” step: service users, service providers and service enablers.  Changes should be designed by considering the wider system factors that will impact on the change: both enabling or preventing it. Finally, the tools and theory that will underpin the next phase of testing the change should be identified. Governance processes including preparing a business case to proceed with the next stage of change are essential, as is the importance of effective leadership and building the will for change: this is covered in the Essentials for change below.

How: Examples of tools that support developing and designing a change:

• Discovery conversations: involve people with lived experience in the design and delivery of change and work Care Experience Discovery conversations
• Expert Reference Groups: engage professionals and teams in developing aims and designing changes
• Involving people in Options Appraisal: inform decision making by taking people through a proposed process stage by stage, and assists in ensuring all relevant factors are taken into account.
• Economic or Cost Benefit Analysis: comparing the benefits of an action with the costs related to it
• How Might We: turns insights into opportunities for design and enables exploring solutions in a variety of different ways.
• Equality Impact Assessment: identify potential disadvantages of change to provide an opportunity to take action to remove or minimise the adverse impact.
• Prioritisation Matrix: helps rank ideas in an order of importance using pre-defined criteria and weightings.