Tricordant Collaboration Series Spring 2021: Lenses on designing the future Integrated Care System.

Framing the Challenge

Alastair opened the webinar by briefly outlining the recent Government ‘Integration and Innovation: working together to improve health and social care for all’ white paper proposals around the creation of integrated systems in England, using some direct quotes:

•  Why? “’Triple aim’ for NHS organisations to support better health and wellbeing for everyone, better quality of health services for all, and sustainable use of NHS resources.”
• What? “Statutory Integrated Care Systems (ICSs)…flexibility for local areas.. place-based joint working…. improvements in data sharing”
• How? “Integration within the NHS to remove some of the cumbersome boundaries to collaboration and to make working together an organising principle,” “greater collaboration between the NHS and local government, as well as wider delivery partners, to deliver improved outcomes to health and wellbeing for local people…. duty to collaborate with each other”.

He also pointed out the white paper’s mention of the importance of creating the right cultural conditions for thriving.

The Organisation Design Lens

He outlined seven key challenges from the organisation design lens.

1. Why, why, why? -Ensure shared clarity of purpose around the needs of patients and communities.
2. Dual purpose design –resourcing multiple purposes
3. Mind the gaps –understanding and respecting difference.
4. Design Principles -translating strategic clarity.
5. Identify and manage the tensions –or they will manage you.
6. Make the right thing the easy thing –enabling processes.
7. Build trust momentum –growing systems leadership.

For more details behind these, download our white paper on ‘Organising for Integration’.

The Funding Lens

Jacqueline Mallender, a world-renowned Health Economist, outlined how Healthcare systems around the world design Provider Payment Mechanisms around five main design principles.

The challenge is to ensure money is transferred from a payer to a provider as fair and sustainable compensation for the delivery of healthcare (and related) services. Each has advantages and disadvantages. The key is to find the rightblend and combination to drive the system behaviour you want to solve the key problems. Jacqueline summarised the keys to aligning funding flows for integrated care as:

• A shared vision for the ICS and the role of each place within that vision underpinned by a shared analysis of the problems that needs to be addressed within and across place.
• Total financial transparency.
• Costs to all agencies are properly understood.
• The relative value contribution of services across the health and care system are properly mapped out and agreed so it can be seen how investing in one area can result in large value improvements further along the value chain.
• Everyone works on the basis that it is a public £1.
• Overall budgets for health and local government are aligned from the very top.
• Social Care funding gets sorted.

The Clinical Leadership Lens

Dr Nicola Decker, an experienced GP clinical leader, shared her early thoughts on the challenge of ICS leadership which she sees as creating an environment where people feel they can be their best, quoting Simon Sinek.

• A team effort to create the right conditions for every person and organisation to contribute and influence.
• Build trust (it’s about relationships)
• Embed a culture of learning (psychological safety) and accountability throughout Hampshire & IOW.
• HIOW to be the best place to live and work!

She outlined how she saw this could be achieved through building everyone’s sense of belonging and contribution. She explored how Covid had accelerated the system development as it was and is an ‘adaptive’ change to use Ronald Heifetz term.

• It is fundamentally different –our repertoire of usual responses won’t work.
• It requires new approaches and innovation.
• It requires a change in our values, beliefs,and assumptions on how care is delivered.

She summarised her ‘lens’ for building an ICS as;

• Be authentic –role model!
• Spot the networks and work with them (and the influencers)
• Support the “boundary spanners” –who will connect the different networks.
• Listen (it’s about people), Communicate, Learn and Share
• Trust and be trusted (as a clinical leader/ as a person-your authentic self)

Her closing message was ‘It’s about people’. We need to ‘be human’ (not heroes)!

Discussion and summary

After a further discussion in plenary and small groups, Dr Roger Greene, summarised the webinar. He noted the 3 different lenses interplay closely–the systems levers such as funding influence, the behaviours, which influence the relationships, which influence how well the structures work. This echoes the alignment expressed by the Tricord model.

The big themes were about:

• finding the WHY? and common purpose.
• Building trusting relationships.
• Design with autonomy.

He noted that the cost of collaboration can be high so it must be made to count. It has an opportunity cost as well as a direct cost. So too must change: the fear of change as well as the scale of change impacts on success.