Delivering service change in the NHS is rarely simple. Even with the best intentions, programmes can stall, lose focus or create avoidable tension. Based on years of experience working alongside NHS teams, here are five of the most common pitfalls we see and practical ways to avoid them.
1. Unrealistic timescales and optimism bias
Too often, teams underestimate how long meaningful change really takes, particularly when statutory consultation and governance are involved. Deadlines get tied to contract cycles or financial years, rather than to what’s realistic for effective engagement and implementation.
How to avoid it: Start by mapping the full process from case for change through to implementation. Build in time for approvals, scrutiny and recovery from inevitable delays. Resist arbitrary deadlines and be transparent about dependencies and risks early on. A realistic plan builds trust.
2. Weak or unclear case for change
If you don’t start with a shared understanding of the problem, you won’t get the outcome you need. Teams sometimes launch into consultation reactively, responding to a single issue rather than articulating a clear, evidence-based case for change that patients and staff can understand.
How to avoid it: Spend time up front defining what’s driving the change and what’s genuinely open for influence. Test your narrative: does it explain the problem, the options and the benefits clearly? If not, pause and strengthen it. The clarity you build at the start will save months of confusion later.
3. Blurred governance and unclear accountability
Service change can stall when it’s unclear who’s responsible for what. Ambiguity between providers, commissioners and partners can lead to unilateral decisions, gaps in approvals and even legal challenge.
How to avoid it: Set out a clear governance and decision-making framework at the outset. Identify who owns each part of the process, from engagement planning to final decision-making. Involve all relevant stakeholders early, including finance, IT and clinical leads, so they understand their role and can flag issues before they become blockers.
4. Thinking of involvement and consultation as a numbers game
Counting responses is not the same as understanding them. Focusing on total numbers rather than representativeness risks missing the voices of those most affected, particularly communities experiencing health inequalities.
How to avoid it: Prioritise depth and diversity over volume. Use data monitoring to understand who is responding and who isn’t. Target engagement towards those most impacted and make sure their experiences are captured meaningfully. Quality of insight, not quantity of responses, is what makes consultation credible.
5. Keeping information to yourself
Perhaps the hardest pitfall to avoid is fear. Fear of it not being perfect, saying the wrong thing, or losing control of the narrative. Too often, teams delay conversations until they feel “ready”, missing the chance to co-create understanding with staff, patients and partners.
How to avoid it: Share early, even if the answers aren’t yet clear. Build open, trusting relationships with partners and the public. Transparency doesn’t weaken your position, it strengthens confidence in your process. When people feel part of the journey, they’re more likely to support the destination.
Final thought
When service change goes well, it’s rarely because the process was perfect. It’s because the relationships were good. Trust, realism, and openness are the foundations of any successful change.
At Olovus, we’ve seen again and again that when NHS teams create space for honest conversation, internally and with the public, everything else starts to fall into place.
We’ve seen these challenges play out in real time, and we know how to help you avoid them. If you’re in the thick of service change (or about to be), get in touch. Let’s talk about how to make it work better for your team, your system and the people you serve.
Blog by: Caroline Latta
