England's A&E departments received a record 2.5m visits this July, while the NHS simultaneously struggled with around 100,000 vacancies. The Government's 10-Year Health Plan – which aims to shift care from analogue to digital, hospitals to communities, and sickness to prevention – couldn't be more urgent.

Ambition alone, however, isn't enough. Unless the frontline workers actually responsible for delivering change are equipped with the right tools, time and training, plans could get stuck in the ‘implementation gap': effective on paper – less triumphant in practice.

The Liverpool Care Pathway, retired in 2014, fell into the same trap. Introduced in the 1990s to extend high-quality, end-of-life care from hospices into hospitals, the well-intentioned framework often led to substandard experiences for patients, independent reviewers found. Healthcare professionals were underprepared and under-supported, thus struggling to exercise the clinical judgement required to make reform work.

Closing the implementation gap

While policymakers can secure support by explaining the purpose behind change, simply telling staff what must be different cannot ensure future policy will perform better. People must also be shown how to bring it to life: interpret new instructions, introduce new ways of working and adapt existing services.

Healthcare professionals must be able to translate reform into unfamiliar decisions and behaviours – all while maintaining their duty to patients and working under significant pressure. Those introducing reform must therefore empower them.

Practical education

The one-off presentations and hands-off modules delivered in traditional education impart news and perhaps build understanding. Practical education develops real-life skills, judgement and confidence, making it possible to change real-life professional behaviours.

Case-based learning, professional discussions and simulations allow frontline workers to safely explore what reform means for them, without risk to patients. These experiences shift the focus from the textbook cases anticipated by new policy to the less usual and perhaps complex situations healthcare providers may encounter in real life. This builds confidence to apply change in practice, even when clinal realities do not quite match assumptions, ensuring reform isn't abandoned when stakes become high.

The improvement loop

Proactive formative experiences likewise create a self-sustaining feedback loop that benefits policymakers.

Some challenges only become visible once a new pathway, technology, or process is used in practice. Questions emerge, responsibilities become clearer and professionals encounter organisational and operational barriers decision-makers were not previously aware of. The practical insights that clinicians gain throughout practical education reveal key areas for improvement, be it unclear guidance, missing resources, impractical assumptions, or unintended consequences. The official approach can then be adapted in response.

The resulting alignment between policy and hands-on experience proves invaluable, too. When healthcare professionals see their judgement meaningfully influence change, they are far more likely to hold themselves accountable for maintaining it.

Measuring improvement

Of course, education must remain continuous to produce sustainable good practice. Its efficacy must also be measured, not in terms of attendance and completion – which can only tell us how many healthcare workers received information – but in terms of how well they understood new policy and evidence, how confident they felt in their ability to apply what they learnt in real-world settings and whether or not they changed their practice.

When such measurement continues beyond initial learning activity, policymakers and healthcare system leaders can determine whether professionals who intended to change behaviours later encountered barriers. This must be accompanied by follow-up evaluation to help identify where change is working, for whom and under what conditions. Leaders must know where implementation is stalling and what further support professionals might need.

Turning ambition into lasting change

The ambitions within the 10-Year Health Plan for England and other healthcare reforms will ultimately be judged, not by the strength of policy, but by the improvements it produces.

Frontline teams are not the final link in delivering this change. They are key – interpreting, adapting and determining how well policy works in practice. Closing the implementation gap by involving them from the outset allows leaders to prepare for the realities of delivery and respond to what experience reveals, ensuring reform isn't just handed down and considered complete. It must be tested, measured, and improved iteratively, wherever policy meets patients.