We find the major issue in implementing CAPA is managing change. We know that change is most likely when the present is seen as unbearable, there is a clear vision of change and the first steps are seen as manageable. Change is most likely to succeed if everyone in the team has a shared view of what is unbearable and the vision, and can agree the first steps.

So you, as the change-leader, have to deliver a process which: Explains to the team the model and its implications Allows to address team anxieties and create an ownership culture Plans all the practicalities Sets and monitors the plan with dates to stop drift and… Allows time! In our experience with teams anything from 6 months to 2 years is common from the first thoughts of starting to being up and running.

The first step is to form a leadership team. This should consist of the manager of the team, a clinical leader (or someone representing the team if you have no designated clinical lead) and an admin lead. Set regular meeting times to plan all the other steps and review the process.

There, that’s the first of the 11 components done!

Allow time to address anxieties

As any change involves losses and gains it is worth exploring these in the team. How can people express anxieties? These are ideas:

Gathering anxieties can be done in many ways and each team will find a way that suits them. We find using small discussion groups that then feedback, talking in the large group, using anonymous post-it notes to collect issues can help.

Be realistic, not over optimistic, about the impact of the changes and give people as much control as possible. It may be that the fundamental change is not negotiable (e.g. to start CAPA) but the process is.

What helps Change?

In November 2006 we held a Solutions Workshop at the King’s Fund in London for 60 CAMHS clinicians to help them implement changes in their service, including CAPA. We explored the group’s experiences of change and what things helped. The suggestions could be grouped into these areas:

Engaging with change Be clear about why: reasons for change need to be clearly communicated Ownership: avoid top down change. Engage everyone. Talk about the value gains rather than the facts Team away days: important to have enough to explore why change and what the vision is Time: there must be adequate time for planning and consensus Make use of Stabilisers: explore their good points for not changing.

Planning Planning: there must be a clear plan with someone charged to lead and monitor it Sort out the details of CAPA: especially planning Core and Specific work in team Follow up: and review how it is going.

Anxieties Address anxieties: have strategies to involve and display listening to staff Individual impact- everyone will be affected in different ways. Focus on individual impact- one page summary may help Perhaps preparing some basic job plans for discussion. Often the reality is less anxiety provoking.

Relationships Lunch: have lunch together. Keep the change process human!

Wider Get support: from your Trust, commissioners… Learn from the past: the team will have gone through many changes before, as will individuals. What helped then?

Key message

CAPA is being successfully implemented in all sorts of teams in several countries. It seems to work best when: All 11 Key Components are implemented and Teams feel able to be flexible and creative, making CAPA work for their situation.