Tuesday, February 25, 2014
Organisational development of North East Lincolnshire Clinical Commissioning Group
The initial phase of work with North East Lincolnshire CCG (NEL) was one of early governing body development, with a particular focus on distributed leadership and operating as a membership organisation, in line with authorisation requirements. OPM offered learning from elsewhere on these key topics as well as encouragement for new ways of working. NEL were successful in the first wave of authorisation. They now have clear clinical leadership in place and have worked over the past year to balance this with community input and challenge alongside managerial support.
Following a shared diagnostic process with top team members, OPM was invited to further work with NEL to deliver a series of development interventions which were designed to:
- Clarify how the triangles connect with other parts of NEL’s governance structure
- Create a common understanding of the role and remit of the triangles and of each participant’s role within them, with an emphasis on developing mutual respect and an appreciation of the value-adding potential of different contributions.
- Connect the triangles to the wider CCG membership, building skills to create engagement and deliver change.
- Ensure that the managerial and support functions of the CCG are aligned with the work of the triangles.
What we did
To address these aspirations OPM facilitators worked first with the three groups of clinical leads, lay members and managers separately to explore how each group saw the contribution of each of the three roles and what helped and what hindered from their perspective. These group discussions surfaced a great deal of previously unspoken confusion, a lack of clarity about the extent of their discretion to make decisions, some uncertainty about what those in other positions could contribute, and a real acknowledgement of how little conversation had so far taken place about this fundamentally important aspect of the CCG’s operation.
We then arranged and facilitated meetings with the three members in each of the eight service area triangles, invited them to reflect on a share their thoughts about the earlier group meetings, and then worked through a typical cycle of commissioning tasks and their roles and likely contributions at each stage with them. Through this process of more informed, open and focused discussion, differences were discussed and greater clarity about roles, responsibilities and areas for development emerged. Feedback to and discussion with the top team about their role in modelling ‘triangle’ thinking , behaviour and culture set the scene for a whole system workshop which brought all the triangle members together with the senior team to agree the key elements of future work in NEL and the means to their achievement.
From the perspective of early 2014, we feel confident that the challenge and support we contributed to NEL’s organisational development has led to some longer term changes, in line with the CCG’s strategic intentions. The clinical chief officer has recently commented that: ‘The way care is delivered has shifted to be responsive to community wishes and priorities – it’s no longer only about clinical priorities’.
Thursday, February 20, 2014
Breakfast Seminar: Systems Leadership – what is it, do we need it, how do we do it?
Join us for this free seminar where we will discuss how systems leadership could be the key to successful service integration.
As public sector leaders develop radical plans for service integration, ‘systems leadership’ is increasingly at the heart of success. And while it’s hard enough to lead a single organisation well, many of the new experiments involve several organisations pooling resources, people and strategy. At this seminar, we are bringing together leading systems thinkers and practitioners to explore systems leadership challenges.
We will look at the leadership needed to change a whole system, how to do it well and the pitfalls and obstacles to look out for. We will explore:
- System redesign – how do we create the leadership to redesign a system both vertically and horizontally, for example working with troubled families or the work programme?
- Changing thinking and practice across several organisations at many levels and in many places at once. What does this mean for leadership, for organisational development and for culture?
- Health and social care integration – how do we create powerful shared leadership in a fragmented delivery system?
- Relations with communities – public services working collaboratively to support communities in helping themselves.
Learning is gradually accumulating from Total Place, Community Budgets, and now the LGA/NHS system leadership experiments, and the NHS pioneers – so we are building up both a theory and practice of good systems leadership. At OPM we’ve been working with a number of whole systems and are keen to share the learning and to explore the emerging dilemmas. How do you balance experimentation with project management to get change at pace and scale? How do you control potentially escalating transaction costs? How do you cope with system pressures that drive change off course? How do people stay open and courageous when change involves cutbacks? What support is needed?
John Atkinson, leadership advisor to private and public organisations, advising on the requirements of fundamental change. Previously John was a director at KPMG and before that, managing director of the Leadership Centre for Local Government.
Deborah Mckenzie, Director of Organisational Development, Public Health England
Sue Goss, Principal in Local Services, OPM. Author of Making Local Government Work-Networks, Relationships and the Management of Change
Who should attend?
This workshop is for chief executives, executive directors, senior clinicians and managers, politicians and third sector managers interested in improving their own, and their organisation’s capacity for system leadership.
The seminar will be held at Lumen URC, with breakfast served from 8.30am (for a 9am start). The panel discussion and Q&As will be finished by 10.30am, leaving half an hour for networking. If you have any special access or dietary requirements, please let us know and we will do our best to accommodate them.
Wednesday, February 19, 2014
Bath and North East Somerset CCG simulation of the urgent care system
Bath and North East Somerset (BANES) CCG asked OPM to design and deliver a simulation of the urgent care system as part of their planning for winter 2013/14. Senior leaders in the area were aware of the need to establish fundamental change across the whole health and social care system that would help to meet the challenge of rising demand for emergency care in a climate of limited or reducing resources.
A process for thinking creatively, holistically and collectively was needed – where current services and delivery practices would be challenged and ways of improving patient experiences and flows could be explored. To meet these requirements OPM designed a behavioural simulation exercise of the whole urgent care system from primary care, ‘blue lights’ and A&E, to discharge and social and community care services.
What we did
Following desk research, scoping work with CCG and RUH colleagues, a simulation was developed. The event held on 23 July in the centre of Bath, brought together local stakeholders from across the health and social care economy, collectively fast forwarding the local health and social care system. Simulation constructs a plausible but simplified version of reality, sufficiently developed so as to create a clear sense of what a place is like and how different events will impact, but simplified enough to be manageable in a compressed timeframe.
Fifty-one people participated in the event, drawn from across the health and social care system in BANES and Wiltshire.The simulation was designed to provide participants with the opportunity to shape and influence plans for the management of urgent care, and to ensure that the system can respond quickly and effectively to urgent care challenges when they arise.
The simulation succeeded in galvanising the entire system to take more concerted action to improve urgent care planning in Bath. It also confirmed in the minds of all parties that it is the CCG that, as system leader, has the responsibility for making this happen.
Overall there was clear evidence of a wish to move beyond any version of ‘awful is normal’. Escalation processes are of course essential to manage immediate pressures but they do not in themselves establish action plan to manage pressures in the whole system more effectively in future. However, the strong sense that all members of the health and social care community need to work together, with clear leadership, to deliver sustainable hospital occupancy levels, was increasingly evident as the simulation progressed. As a direct result of the exercises a number of tangible improvements to plans have been made.
Working with the whole health and social care system in a local area together for a day, participants are able to explore and shape their plans for the management of urgent care in a way which effectively speeds up the usual processes of arranging meetings, building better working relationships based on an understanding of each agency’s contribution and limitations, and using that time together to challenge the usual ways in which seemingly ‘stuck’ problems may be addressed. While the central focus is on urgent care provision, it is no coincidence that other aspects of integration and improved patient experience also receive valuable attention. We wrote about we learned from the simulation in the Health Service Journal: How simulations can help develop new thinking to tackle winter admissions crises.