Aim

This chapter covers the processes and steps to take when designing and delivering service change. Key to success is the application of co- production, so this is described along with tips for how to do it well. The service specification is an important document for commissioning, and it is useful for implementing change, so the chapter looks at how to use that tool. The chapter also outlines some of the important factors affecting operational design, such as capacity and demand planning, workforce, and how to integrate with other services.

Service design approaches

When to commission change

When we talk about commissioning change, we generally refer to large- scale changes – not tweaks to existing services. A service change that requires more robust commissioning usually involves a significant change regarding time or cost required or a very new way of working.

And regardless of scale, there are essentially three circumstances when change is appropriate: when there is a gap in provision; when quality of provision and outcomes are poor; and when it is mandatory (see Table 5.1).

Service design or redesign

Service design can be defined as the activity of planning and organising processes, people, infrastructure, communication, and the components of a service, to improve quality, outcomes, the interaction between the service provider and patients, and patient experience. Good service design is required to effectively meet the local needs of the population, the priorities for health and wellbeing, and it must be sustainable.

If the needs analysis has been completed comprehensively (see Chapter 4), the commissioner will have improved their understanding of local needs and priorities. A gap analysis will have shown what is already available, and they will have a good understanding of the current priorities. The next step is to design change for improvement or to meet any unmet need, and implement this to reach the ‘desired state’. These steps are shown in Figure 5.1.

The service design is the approach to address the gaps and reach the desired state. However, commissioners are working within restricted and limited circumstances within the public sector – that is a challenge that is not going to go away any time soon.