Transformation in Integration
Catherine Blackaby
NHS Improving Quality
@NHSIQ @CBlackaby #integrationpioneers
What do we mean by integration?
@NHSIQ @CBlackaby #integrationpioneers
@NHSIQ @CBlackaby #integrationpioneers
@NHSIQ @CBlackaby #integrationpioneers
Surely it’s easy?
X Y
Just do it Efficient system
IHI and RC Lloyd & Associates 2008
@NHSIQ @CBlackaby #integrationpioneers
X
@NHSIQ @CBlackaby #integrationpioneers
The 14 Pioneers
ICSP Pioneer sites
Barnsley South Devon and Torbay
Cornwall Southend
Greenwich South Tyneside
Islington We...
The Pioneer Programme
• 14 areas across England
• Integrating…
– Acute and primary care
– Mental and physical health care
...
@NHSIQ @CBlackaby #integrationpioneers
Source: The King’s Fund
http://www.kingsfund.org.uk/projects/health-and-health-care-london@NHSIQ @CBlackaby #integrationpi...
@NHSIQ @CBlackaby #integrationpioneers
?
In association with:
National partners
@NHSIQ @CBlackaby #integrationpioneers
https://www.gov.uk/government/publications/integrated-care
@NHSIQ @CBlackaby #integrationpioneers
Aspiration
The pioneer localities will act as “a
means of driving forward change at
scale and pace from which the rest of
...
@NHSIQ @CBlackaby #integrationpioneers
Six conclusions from previous “pioneer type” programmes
in health and social care over the last decade
1. Promising pilot ...
Emerging themes in large scale change
Foundation Emerging direction
Organisation Community
Power through hierarchy Power t...
Two kinds of system-level problems
A difficulty
• Broad agreement on
the nature of the
problem
• Some understanding of
wha...
"The secret to getting ahead is getting started.
The secret of getting started is breaking your
complex, overwhelming task...
Necessary behaviours for managing
wicked problems
• Establishing shared goals
• Build trust
• Exchange information & other...
Closed innovation Open innovation
As a “pioneer” test site , we want to be left
alone for a period of time so we can work ...
@NHSIQ @CBlackaby #integrationpioneers
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...
5. Plan for spread right from the start
6. Create a special status for localities that applied but didn’t
achieve pioneer ...
Where have we got to?
@NHSIQ @CBlackaby #integrationpioneers
How are we doing it?
1. Build the Integrated Care and Support Exchange (ICASE) as
a learning community with and around the...
5. Plan for spread right from the start
6. Create a special status for localities that applied but didn’t
achieve pioneer ...
“If you feel entirely comfortable, then you're not far
enough ahead to do any good. That warm sense of
everything going we...
Support programme
• Support managers
• Experts for trouble shooting
• Leadership development
• Large scale change training...
ICASE
www.icase.org.uk
#integrationpioneers
@NHSIQ @CBlackaby #integrationpioneers
A different approach
• Working with the Innovation Unit
– a not-for-profit social enterprise
– committed to using the powe...
A different approach
• Working with the Innovation Unit
• Being steered by sites’ preferences and comments
• Tailoring a p...
CONVERSATION 1
Suzanne Devlin
‘This is the slide set that was shared at the Measurement and Evaluation Session at the firs...
Sarah McBride
My ‘other’ vote is about large scale pooling
of budgets, including how to get the
governance right, and publ...
Tweets about the poll …
Next steps for the learning community
• Selected themes from our first poll: “Innovative
commissioning & contracting” and ...
Next steps for the learning community
• Selected themes from our first poll: “Innovative
commissioning & contracting” and ...
• The challenges of:
– Multiple national programmes
– Multiple forums for sharing
– Providing flexibility for different le...
Our request to you
• Post on ICASE – join the conversation!
• Become part of the virtual user group
• Tweet using #integra...
“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 ...
References
• Wicked problems and the role of leadership – INL
2009
• System Failure - Why Governments must learn to
think ...
#Quality 2014 transformation in integration 2014.04.10
#Quality 2014 transformation in integration 2014.04.10
#Quality 2014 transformation in integration 2014.04.10
#Quality 2014 transformation in integration 2014.04.10
#Quality 2014 transformation in integration 2014.04.10
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Transformation in Integration sponsored breakfast session at the International Forum on Quality and Safety in Healthcare, Paris 10 April 2014

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  • https://www.gov.uk/government/publications/integrated-care
  • #Quality 2014 transformation in integration 2014.04.10

    1. 1. Transformation in Integration Catherine Blackaby NHS Improving Quality @NHSIQ @CBlackaby #integrationpioneers
    2. 2. What do we mean by integration? @NHSIQ @CBlackaby #integrationpioneers
    3. 3. @NHSIQ @CBlackaby #integrationpioneers
    4. 4. @NHSIQ @CBlackaby #integrationpioneers
    5. 5. Surely it’s easy? X Y Just do it Efficient system IHI and RC Lloyd & Associates 2008 @NHSIQ @CBlackaby #integrationpioneers
    6. 6. X @NHSIQ @CBlackaby #integrationpioneers
    7. 7. The 14 Pioneers ICSP Pioneer sites Barnsley South Devon and Torbay Cornwall Southend Greenwich South Tyneside Islington West Cheshire Kent WELC London North West London Worcester @NHSIQ @CBlackaby #integrationpioneers
    8. 8. 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 @NHSIQ @CBlackaby #integrationpioneers
    9. 9. @NHSIQ @CBlackaby #integrationpioneers
    10. 10. Source: The King’s Fund http://www.kingsfund.org.uk/projects/health-and-health-care-london@NHSIQ @CBlackaby #integrationpioneers
    11. 11. @NHSIQ @CBlackaby #integrationpioneers ?
    12. 12. In association with: National partners @NHSIQ @CBlackaby #integrationpioneers
    13. 13. https://www.gov.uk/government/publications/integrated-care @NHSIQ @CBlackaby #integrationpioneers
    14. 14. Aspiration The 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) @NHSIQ @CBlackaby #integrationpioneers
    15. 15. @NHSIQ @CBlackaby #integrationpioneers
    16. 16. 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 afterthought 3. Change is highly context specific 4. 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
    17. 17. Emerging themes in large scale change Foundation Emerging direction Organisation Community Power through hierarchy Power through connection Mission and vision Shared purpose Making 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 talent Engaged patients Passionate users Clinical networks Mass communities Tried and tested, based on experience Open innovation Transactions Relationships Source: @HelenBevan @NHSIQ @CBlackaby #integrationpioneers
    18. 18. 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
    19. 19. "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 @NHSIQ @CBlackaby #integrationpioneers
    20. 20. 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 @NHSIQ @CBlackaby #integrationpioneers
    21. 21. 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” @NHSIQ @CBlackaby #integrationpioneers
    22. 22. @NHSIQ @CBlackaby #integrationpioneers The power of co-creation
    23. 23. How are we doing it? 1. Build the Integrated Care and Support Exchange (ICASE) as a learning community with and around the pioneers 2. Create, capture and spread knowledge, skills and ideas using open innovation and knowledge sharing principles 3. 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 @NHSIQ @CBlackaby #integrationpioneers
    24. 24. 5. Plan for spread right from the start 6. 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 . @NHSIQ @CBlackaby #integrationpioneers
    25. 25. Where have we got to? @NHSIQ @CBlackaby #integrationpioneers
    26. 26. How are we doing it? 1. Build the Integrated Care and Support Exchange (ICASE) as a learning community with and around the pioneers 2. Create, capture and spread knowledge, skills and ideas using open innovation and knowledge sharing principles 3. 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 @NHSIQ @CBlackaby #integrationpioneers ?
    27. 27. 5. Plan for spread right from the start 6. 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 . @NHSIQ @CBlackaby #integrationpioneers X X ?
    28. 28. “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
    29. 29. Support programme • Support managers • Experts for trouble shooting • Leadership development • Large scale change training • Networks and events • Communications • Learning community development @NHSIQ @CBlackaby #integrationpioneers
    30. 30. ICASE www.icase.org.uk #integrationpioneers @NHSIQ @CBlackaby #integrationpioneers
    31. 31. 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 @NHSIQ @CBlackaby #integrationpioneers
    32. 32. 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 @NHSIQ @CBlackaby #integrationpioneers
    33. 33. 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’
    34. 34. 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) …
    35. 35. Tweets about the poll …
    36. 36. 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 @NHSIQ @CBlackaby #integrationpioneers
    37. 37. 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 @NHSIQ @CBlackaby #integrationpioneers
    38. 38. • 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 @NHSIQ @CBlackaby #integrationpioneers Next steps for the learning community
    39. 39. 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? @NHSIQ @CBlackaby #integrationpioneers
    40. 40. “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 @NHSIQ @CBlackaby #integrationpioneers
    41. 41. 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 https://www.gov.uk/government/publications/integrated-care • Thinking in Systems: A Primer – Donella H Meadows • @HelenBevan • enquiries@icase.org.uk @NHSIQ @CBlackaby #integrationpioneers

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