Unsticking Stuckness

Stuck?

Ever feel like Bill Murray in Groundhog Day when you leave an STP or ICS business or Board meeting? Stuck in an ever-repeating time-loop where it feels like you’ve made a breakthrough, there’s massive energy and good-will for change, everyone signs off on the action plan and then you come back next time and nothing has actually changed? Apart maybe from another unforeseen obstacle popping up to add to the risk register or a key ally in a partner organisation just got moved to another job.

Organisational Stuckness (OS) really is a thing and it’s been around since Noah was a lad.

This stuff about Integrated Care isn’t new either. It’s been doing the rounds in the NHS and Local Authorities for over a decade now. Front-line professionals agree it’s a good thing, managers agree it’s a good thing, successive Secretaries of State have agreed it’s a good thing.

So why do systems and organisations keep getting stuck?

Truth is there could be a complex soup of reasons:

• Some structural, such as organisational sovereignty and accountability.
• Some systemic, like PbR and Primary Care payment systems.
• Some cultural, like local democracy versus central government.
• Some about capacity and capability, like leaders, clinicians and managers having the headspace to make the necessary decisions and make the changes stick.
• Some resourcing – working capital or cash for transitions, the austerity pips squeaking in social care.
• Some about the care sector and care home liquidity and closures.
• Ad infinitum.

Pretty well everyone knows what to do. The evidence base and the case studies are there. The plans are in place.

So why do we keep getting stuck and it feels like nothing changes?

The thing is that Health and social care systems are not just complicated, they are complex. And complex systems don’t do what they are told. Complex systems are living things, full of human beings, who adapt and evolve to the environment around them and find their own solutions. Or just resist the solutions others try to impose on them and either improvise their own or dig their heels in.

So what can you do about it?

First up, don’t get overwhelmed and feel helpless. Or angry. You aren’t alone. And there are things you can do (lots of things actually) to help you get unstuck.

Secondly, we don’t want to overwhelm you with articles you won’t have time to read.

We’ve been doing some research with organisational leaders and academics, and this series of blogs aims to help with some ideas and solutions. So over the next few months we will unpack a series of insights with short think pieces (5 minutes reads) regarding:

• Navigating the ICS fog.
• What is the point of integration anyway?
• How can you nudge the right behaviours in the system?
• How do you see what you see?
• What about the Managers?
• How can you design a healthy and adaptive health and care system?
• Practice makes perfect – how can we adopt and disseminate learning and good practice?
• And of course – how could we not cover this one? System Leadership.