Balancing the hard stuff – why our learned approach to change won’t work this time

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Faced with delivering a project with multiple moving parts, many partners and a fixed end date stipulated by government, it’s natural to plan to mitigate risk and ensure delivery. But what if the activities that are the most mission-critical can’t easily be put down on paper?

You don’t need me to point out that the formation of new Integrated Care Systems is a challenge across the NHS. People and organisations are working hard to create the systems and processes needed so they are ready to operate from Day 1. Meetings are planned, committees convened, and huge amounts of energy are being poured into setting up new frameworks and structures. And rightly so. But that’s not the hard stuff.

The really hard stuff is the things that are tricky to quantify. It’s the relationships between the new partners. It’s the dynamic rapport between previously sovereign organisations. It’s not the official terms of reference, but the subtle, intangible ways of working when groups come together to try to get things done. It can be more about what is said, and what goes unsaid, than what’s written down.

Getting the balance right

We often talk about thevaluecircle’s work being bedded on the foundation of Mechanics&Dynamics™. Mechanics are the mechanical parts of an organisation – the structures, processes, and procedures. Dynamics relates to the people who operate the systems – including culture, relationships, trust.

Both mechanics and dynamics need to be in balance for any organisation – or partnership – to be a success. So while there’s plenty of advice on re-designing services, co-creating care pathways, and board structures, that stuff that should be easier to get right.

Trickier, and requiring much more energy and attention from senior leaders, are the relationships needed to make the new processes and procedures a success. There’s no one-size-fits all approach or set of advice we can give you to get that right because it depends on the existing dynamics and how far they need to be shifted.

But there are some fundamentals which will set you on the right path.

Creating a new way

Everyone will come to the new ICS with their own experiences, beliefs, and values. Every executive at the table will bring their own, and every partner represented should have a good sense of their organisational values and mission. Co-creating a shared narrative which can steer the work of the ICS but also recognise the partners’ individual cultures will be critical. Simple to say, not so simple to do.

As ICSs represent a fundamental shift to better wrap care around individuals, rather than creating a system that people have to navigate their way around, the challenge is an even bigger one. The health and social care delivery system is being re-designed. Making that happen mechanically is a huge challenge in itself. If you try to achieve it without getting the dynamics of the partnerships right, you’re already setting yourself up for failure.

Talking about the power of relationships might seem ‘fluffy’. But going one degree off course at the start of a long journey can totally change where you end up.

The old rules no longer apply. Doing it alone. The positional power of large health trusts. The ability to manage finances locally. They no longer exist. The money can’t be managed by individual organisations and (if they ever were) health inequalities cannot be fixed alone.

A move from competition to collaboration is what’s happening. But for that collaboration to be authentic there needs to be some exploration of shared values and purpose. All of the systems and procedures in the world can’t deliver that for you.

I’ll credit the insight of Duncan Jenkins, Director of Pharmacy and Pop. Health at Dudley Integrated Healthcare with a phrase that really sums this up. “We’re moving from a system of care managed by correspondence to one where care will be managed by conversations.”

Common ground?

This might all sound really hard. Maybe even too hard. Because we’re talking about revolution, not evolution.

But what’s in our favour is, despite all of the disparate visions, the different values, and the diverse cultures, health and social care organisations and the people within them do share the core fundamental beliefs.

People who work in health and care organisations want to make things better for patients. It’s the essence of why we do what we do. Whether you’re a surgeon, a porter, a healthcare assistant, or an executive, you will share that drive to have patients at the heart of all decisions. It’s a great starting point and a reason to believe that ICSs will be successful as long as the hard conversations take place.

Sometimes, success depends more on how you behave than on anything that can be written down.

1 Comment

  1. A fascinating blog and a somewhat utopian view of the new NHS re-organisation. My heart hopes your views are reflected in reality. My head tells me there will still be organisational power struggles, still protection of individual budgets. Being a veteran of several similar re-organisations, the names may change (health authorities, primary care groups, primary care trusts, clinical care groups et al), but essentially those running them don’t. The nature of how they work doesn’t, it’s so engrained; to be fair they tend to be of continual survival mode. As the saying goes it’s just like moving the deckchairs on the Titanic.
    The number of moving parts has increased, which means more leaders with more ambitions, more pressures and of course more egos. I hope, as you say, revolution starts on July 1st, but I fear it is going to need patient evolution; unfortunately history points to that patience running out before the next grand reorganisational idea is implemented.

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