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’.