Overall approach to the high impact change model

The high impact change model offers a practical approach to managing patient flow and hospital discharge. The model identifies eight system changes which will have the greatest impact on reducing delayed discharge.


The high impact change model is not designed to be a performance management tool. Instead it takes as its starting point a recognition that even the best-performing systems will be experiencing challenges in relation to hospital discharge.

The model is underpinned by a sector-led improvement approach which emphasises the importance of triangulating both hard and soft types of data to tease out local stories within a culture of openness and trust. The model supports genuine, honest reflection and discussion between trusted colleagues within local health and care systems.

If you would like to share learning from your own practice, have additional material to contribute or updated information on any of the current examples, please contact [email protected]

Some things that people have told us – about what works and how to overcome the challenges

  • cross system leadership that champions the necessary culture change, supports risk-taking and empowers staff to make changes happen
  • involving partners as equals from the outset so that changes are co-produced, with shared funding and shared risks
  • developing a shared narrative or vision across the system that is person-centred, not process-centred
  • establishing a no-blame culture and encouraging a learning and enabling environment that fosters innovation.