#Quality 2014 transformation in integration 2014.04.10

Transformation in Integration

Catherine BlackabyNHS Improving Quality

@NHSIQ @CBlackaby #integrationpioneers

What do we mean by integration?




Surely it’s easy?

X Y

Just do it Efficient system

IHI and RC Lloyd & Associates 2008


X


The 14 PioneersICSP Pioneer sites

Barnsley South Devon and Torbay

Cornwall Southend

Greenwich South Tyneside

Islington West Cheshire

Kent WELC London

North West London Worcester


The Pioneer Programme

• 14 areas across England• Integrating…

– Acute and primary care– Mental and physical health care– Social care– Housing– Third sector– All the care and support needs around the person



Source: The King’s Fund http://www.kingsfund.org.uk/projects/health-and-health-care-london@NHSIQ @CBlackaby #integrationpioneers


?

In association with:

National partners


https://www.gov.uk/government/publications/integrated-care




AspirationThe pioneer localities will act as “a means of driving forward change at

scale and pace from which the rest of the country can benefit” (Collaboration partners)



Six conclusions from previous “pioneer type” programmes in health and social care over the last decade

1. Promising pilot programmes are rarely replicated successfully 2. Issues of spread and scale are typically an afterthought3. Change is highly context specific4. People outside the pilot locality do not feel any ownership of, or

emotional connection with, the pilot project so change processes have to be “pushed” onto other localities rather than pulled.

5. Pioneer sites have limited ‘bandwidth’ to coach others and spread best practices

6. Very few evaluation studies look beyond the pioneers to issues of scale and spread

Source: @HelenBevan@NHSIQ @CBlackaby #integrationpioneers

Emerging themes in large scale change

Foundation Emerging directionOrganisation CommunityPower through hierarchy Power through connectionMission and vision Shared purposeMaking sense through rational argument

Making sense through emotional connection

Leadership-driven (top down) innovation

Viral (grass-roots driven) creativity

Led by expert opinion Allow all talentEngaged patients Passionate usersClinical networks Mass communitiesTried and tested, based on experience

Open innovation

Transactions Relationships

Source: @HelenBevan@NHSIQ @CBlackaby #integrationpioneers

Two kinds of system-level problems

A difficulty• Broad agreement on

the nature of the problem

• Some understanding of what the solution might look like

• Clarity about the time and resources required to solve the problem

A mess• No clear agreement about

exactly what the problem is• Ambiguity about how

improvements might be made• Unbounded in terms of the in

terms of the time and resources it could absorb, the scope of enquiry needed to understand or resolve it, and the number of people that may need to be involved

Source: System Failure - Why Governments must learn to think differently, Jake Chapman, published by Demos

"The secret to getting ahead is getting started. The secret of getting started is breaking your complex, overwhelming tasks into small manageable tasks, and then starting on the first one.“

Mark Twain


Necessary behaviours for managing wicked problems

• Establishing shared goals• Build trust• Exchange information & other resources• Embrace emergence• Explore new territory• Create new knowledge• Facilitate, enable & coach


Closed innovation Open innovation

As a “pioneer” test site , we want to be left alone for a period of time so we can work it out for ourselves

As a “pioneer” test site, we seek to continuously get ideas and guidance from leading thinkers and practitioners outside our local area; as a result we sustain our energy for change and continue to implement changes over a longer timeframe

We will test our new ways of working internally “to destruction”. When we are confident they will work, we will offer to share our “best practice innovations” with others

A wider group has contributed to the innovation process, beyond our host organisation; this means that when it comes to diffusing the learning from pioneer sites, people from other localities already feel that they own it. Spread is more likely to be “done with” not “done to” and to be “pulled” not “pushed”



The power of co-creation

How are we doing it?1. Build the Integrated Care and Support Exchange (ICASE) as

a learning community with and around the pioneers2. Create, capture and spread knowledge, skills and ideas

using open innovation and knowledge sharing principles3. Put the pioneers at the centre of the learning community

but with an open innovation mindset 4. Build a compelling narrative that calls people to action and

that focuses as much on “big picture” aspirations for change across the country as it does on the specific localities


5. Plan for spread right from the start6. Create a special status for localities that applied but didn’t

achieve pioneer status. Create opportunities for them to progress more quickly and effectively than the pioneers.

7. Clearly define what being a pioneer; create a “compact” (contract) that sets out the “give and get” as a condition of being a pioneer e.g. participation in open innovation processes .


Where have we got to?


How are we doing it?1. Build the Integrated Care and Support Exchange (ICASE) as

a learning community with and around the pioneers2. Create, capture and spread knowledge, skills and ideas

using open innovation and knowledge sharing principles3. Put the pioneers at the centre of the learning community

but with an open innovation mindset 4. Build a compelling narrative that calls people to action and

that focuses as much on “big picture” aspirations for change across the country as it does on the specific localities


?

5. Plan for spread right from the start6. Create a special status for localities that applied but didn’t

achieve pioneer status. Create opportunities for them to progress more quickly and effectively than the pioneers.

7. Clearly define what being a pioneer; create a “compact” (contract) that sets out the “give and get” as a condition of being a pioneer e.g. participation in open innovation processes .


X

X

?

“If you feel entirely comfortable, then you're not far enough ahead to do any good. That warm sense of everything going well is usually the body temperature at the centre of the herd."— John Masters

Support programme

• Support managers• Experts for trouble shooting• Leadership development• Large scale change training• Networks and events• Communications• Learning community development


ICASE

www.icase.org.uk #integrationpioneers


http://www.icase.org.uk/

A different approach • Working with the Innovation Unit

– a not-for-profit social enterprise – committed to using the power of innovation to solve social

challenges– supporting leaders and organisations delivering public

services to see and do things differently to achieve radically different solutions that offer better outcomes for lower costs.

• www.innovationunit.org


http://www.innovationunit.org/

A different approach • Working with the Innovation Unit• Being steered by sites’ preferences and comments • Tailoring a programme of innovative support that can

be dynamic and co-produced with the sites• Developing a taxonomy for this way of working,

where themes become key learning communities


CONVERSATION 1

Suzanne Devlin

‘This is the slide set that was shared at the Measurement and Evaluation Session at the first Pioneer workshop on 11th December 2013 in London.’

Dec 12, 2013

Abraham George

‘Suzanne, thanks for this. I believe the work PH has done here in Kent using the Risk Stratification approach to understand service utilisation and costs is a significant stepping stone towards developing whole systems approach for monitoring and evaluating the Integration Pioneer programme. As mentioned in the presentation I would like to explore further with the experts / organisations. How do I go about this?’

3 days ago

Jo Frazer

‘Hi Abraham, we can discuss on Monday as I'll be gathering comments on proposed measures and make sure you're linked in to ongoing work on evaluation.’

3 days ago

Abraham George

‘Thanks Jo’

Sarah McBride

My ‘other’ vote is about large scale pooling of budgets, including how to get the governance right, and public, democratic and clinical involvement. Thank you!

The voting so far (24 hours later) …

Tweets about the poll …

Next steps for the learning community• Selected themes from our first poll: “Innovative

commissioning & contracting” and “Workforce Development”

• Targeted support and face to face events• Tweet chats – April• Google hangouts – May

– Like a group webinar allowing you to chat face to face and share documents and other materials


Next steps for the learning community• Selected themes from our first poll: “Innovative

commissioning & contracting” and “Workforce Development”

• Targeted support and face to face events• Tweet chats – April• Google hangouts - May• Challenge prizes• Network development• Pioneer initiated tweetchats, events and meet ups


• The challenges of:– Multiple national programmes– Multiple forums for sharing– Providing flexibility for different levels of

engagement– Balancing the expert voice with the voice of those

on the frontline• Commitment and energy of those involved


Next steps for the learning community

Our request to you

• Post on ICASE – join the conversation!• Become part of the virtual user group• Tweet using #integrationpioneers• Take part in the horizon scanning and hangouts• Look out for challenge prizes• Tell us what else has worked for you• What else should we be trying?


“We can't impose our will on a system. We can listen to what the system tells us, and discover how its properties and our values can work together to bring forth something much better than could ever be produced by our will alone.” ― Donella H. Meadows, Thinking in Systems: A Primer


https://www.goodreads.com/author/show/307638.Donella_H_Meadows

https://www.goodreads.com/author/show/307638.Donella_H_Meadows

https://www.goodreads.com/work/quotes/3873538

References• Wicked problems and the role of leadership – INL

2009• System Failure - Why Governments must learn to

think differently, Jake Chapman, published by Demos• Integrated Care: Our Shared Commitment May 2013


• Thinking in Systems: A Primer – Donella H Meadows• @HelenBevan• [email protected]




mailto:[email protected]

Healthcare

#Quality 2014 transformation in integration 2014.04.10