Have you got the right focus? Behaviours, not structures, are the route to success

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With legislation requiring the creation of around 44 Integrated Care Systems this year, many trusts are turning their attention to forming the necessary partnerships. 

It would be easy to first focus on the partnerships, processes and structures needed to create the new system architecture. But is this the right thing to do?

People, organisations and the health and wellbeing of patients are critical components as the NHS moves to a more formally integrated model. The Covid-19 pandemic has forced collaboration at a scale not previously seen, with boundaries ignored, resources shared, and supplies jointly ordered. Formalising some of these arrangements and creating others is at the heart of what ICS’s are intended to deliver. 

It’s important to draw on current experience. What can we learn about what’s been necessary to get through the past 12 months? And how can we take the best of some of those behaviours and approaches, and use them to make the transition to an ICS model more seamless, and less potentially painful?

Hold on to why

The pressure is on to create the agreements and alliances needed to move to the ICS model by mid-2022. If your instinct is to move swiftly to create a plan for how to make the transition, this misses the critical point – why is the transition necessary? What is it you are trying to achieve?

To not define this clearly at the start of discussions risks creating an approach which focuses on I/we/me/them/us. 

In this situation, process cannot always be king. People are. More specifically, patients are. 

This clear purpose needs to stay at the forefront of all planning, negotiations, and strategies. Every partner needs to believe that, as a system, collaboration improves patient care. 

There are two schools of governance in the NHS – traditional, functional governance, which tends to be fixed, and focuses on process and procedure. And modern, dynamic and bespoke governance, which flexes depending on the circumstances, focusing on getting to the right outcome. Underpinned by the assurance and checks and balances needed.

A modern, dynamic approach to governance is going to be needed for trusts to successfully operate as the integrated care systems they aspire to be.

Collaboration strengthens organisations 

Some might feel threatened by the idea of closer collaboration as the response ICS development. But collaboration is about strength, not weakness. 

Major brands realise this and use their collective presence to leverage even bigger pieces of their market, or of new ones. Think Italian designer Pininfarina-styled Fiats and, at the other end of the spectrum, McDonald’s’ hook-ups with the latest children’s craze in their Happy Meals. 

A great example of brands successfully collaborating is John Lewis and Waitrose. The agreement allows them to share back-office costs and infrastructure. This incredible alignment of values,  combined with distinctly separate offerings, means the two brands can happily co-exist. 

Is the ICS model the healthcare equivalent of the John Lewis and Waitrose partnership? 

Collaboration will allow trusts to assess what services could work better together, sharing resources, processes, or structures to make things better for patients, and the distinct populations they serve. 

We’re helping an NHS client map exactly this; examining ways that services can collaborate to offer better patient care and align their strategies for development. A new model will mean the service caters for a broader geography and more patients, but it will also make it more attractive to new recruits, create joint posts, and could even free up more time to devote to research. 

The ICS model is an incredible opportunity to review the structures within which healthcare is currently delivered. It’s a chance to keep the parts that service patients and staff well, and get rid of the others.

Going into the process with patients, not process, at the heart of decision-making will ensure the redesigned models of care truly deliver. 

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