Change in NHS Scotland is hard. Not for lack of effort. Teams are working hard, leaders genuinely care, and organisations have invested significantly in improvement programmes over the years.
The problem is that everyone has been doing it differently.
One team reaches for quality improvement. Another uses service design. Another writes a strategy, sends it by email, and waits. The methods are different, the language is different, and the results are inconsistent. Good work has been done - but it hasn't always added up the way it should.
That's the problem the Scottish Approach to Change was built to solve.
What the Scottish Approach to Change is
Published by Healthcare Improvement Scotland in March 2025, the Scottish Approach to Change is an evidence-based framework designed to give the whole health and care system a common language and a clear pathway for doing change well. It was developed with and endorsed at chief executive level across NHS Scotland boards and health and social care partnerships.
It doesn't replace the tools your teams already use. It brings them together. Quality improvement, service design, strategic planning, engagement practice - the framework provides the connective tissue between them, so that people working across different methods can speak the same language and work toward the same ends.
At its core are five enablers - the conditions an organisation needs to create - and eight steps that map the journey through any change initiative. The five enablers are:
1. Clear Vision and Purpose
Defining what you are trying to do and how you will get there, so that everyone understands the direction and their part in it.
2. Process Rigour
A structured, systematic approach to change - proportionate processes that create action, not inaction.
3. Leadership and Culture
Creating the conditions for change to thrive - setting the right culture from the top, enabling from the ground up.
4. People-Led
Inviting people to design and deliver change together - staff, patients and communities as partners, not recipients.
5. Learning System
Embedding a learning culture that sustains change over time - making what works visible so it can spread.
I'd encourage anyone in Scottish public sector to read the full framework on the HIS website.
From framework to everyday reality
Having a framework and delivering it are two different things.
The five enablers describe what good change looks like. But they don't hand you the mechanism to make each one real. And in my experience, the hardest enabler to bring to life in practice is People-Led.
People-Led means inviting staff to design and deliver change with you - not informing them of decisions already made. It means inviting people to take part and giving them a straightforward way to contribute their experience and ideas.
The challenge is creating the conditions where contributing is easy, ownership is visible, and the loop closes in a way people can actually see. Where staff and leadership work through change together - and the whole team can see what's happening and what's changing as a result.
When that doesn't happen, people stop believing it's worth contributing. That's not cynicism. That's learned experience.
Where Trickle fits
Trickle helps organisations turn employee insight into visible action - so people experience first-hand that they can improve how their organisation works. In the context of the Scottish Approach to Change, that maps directly onto three of the five enablers.
People-Led
People contribute issues, ideas and experience within a defined Sprint - a time-bounded programme anchored to a specific change or improvement theme. Contributions are anonymous if people choose. Impact scoring surfaces what matters most to the wider team. Ownership is assigned and the outcome is visible to everyone.
Learning System
Every contribution moves through a visible lifecycle - raised, championed, in progress, resolved. Sprint reports capture what changed and why. When a sprint ends, the evidence is there for the team, for leadership, and for deciding what to carry forward. The learning doesn't disappear when the programme ends.
Process Rigour
A Sprint gives change a container. Time-bounded, scoped to a department or team, and priced below NHS procurement thresholds. It creates the conditions for action rather than planning - a clear start, a clear end, and outcomes everyone can see.
We also have a supporting role in the Develop and Design step - specifically in exploring proposed options for change with the people whose enthusiasm and buy-in you need. And in the Identify and Understand steps, where what people contribute through Trickle feeds directly into leadership's picture of what actually needs to change.
NHS Lanarkshire: what the evidence shows
NHS Lanarkshire's Women's Services Sprint is documented in full in our case study. A few of the numbers are worth calling out here, because they speak directly to participation and follow-through - which are at the heart of what People-Led is asking for.
Sign-ups reached 167% of the original target. Of the contributions made by staff, 94% were assigned a Champion by leadership - a measure of how relevant and actionable the contributions were, not just how many people took part. The average time from a contribution being raised to it being resolved was twelve days.
Those numbers matter because People-Led isn't just about giving people a voice. It's about what happens next. Staff contributed, saw their contributions taken seriously, and saw outcomes within days - not months. That's what builds the trust that makes the next sprint worth doing.
Contributing was easy - no meetings to attend, no forms to fill in. Impact scoring made it clear what mattered most to the team. And as changes were made, everyone could see them happening in real time. Leaders saw a clear, prioritised picture of what their teams needed. Staff saw their contributions lead to real change. That combination is what made the next sprint an easy decision.
Leadership commissioned seven further Sprints across the organisation.
Why this matters now
The Scottish Approach to Change is fifteen months old. The framework is sound - the question every organisation now faces is how to make each enabler real in practice, not just in principle.
If you're in Scottish public sector and thinking about how to make the People-Led enabler a reality within your organisation, I'd like to talk.
We're exhibiting at the Public Sector Digital Transformation event at Dynamic Earth, Edinburgh on 18th June. Come and find us, or book an online conversation using the link below - we'd be glad to show you how a Sprint works in practice.
Book a 20-minute walk-through