What is the challenge your project is going to address and how does it connect to your chosen theme?
Services can default to assessing, diagnosing and treating individuals (or their conditions) rather than understanding them as people in the context of their community and relationships with others. We can miss the strengths and capabilities of people and communities by focusing on illness and disease.
In Results through relationships (improving personalised care towards the end of life), we saw that we can tend to focus on facts rather than stories; services and organisations rather than community; interventions rather than support; reacting to a crisis rather than planning ahead. Transactional care costs more and tends towards outcomes no-one wants.
Improvement is often seen as different from managing services or usual work; there can be an emphasis on learning and improvement by individuals or teams, rather than on learning as a system or across organisational boundaries.
We need to let go of some of the things we do now as well as embrace new ways of working.
What does your project aim to achieve?
We aim to evolve a more sustainable relationship with people and communities that:
– makes the most of everyone’s strengths and capabilities
– builds everyone’s confidence and capabilities
– makes it ever easier to understand and do what matters, removing barriers and enhancing our flexibility to respond to changing situations
– embeds learning into everyday practice
– makes responsibility clear.
Continuous improvement becomes part of every day work, with shared reflection and sense-making at every level of the system embedded in simple deliberate routines and governance structures.
As we learn more about what matters and what works well, it becomes easier for us to do that more of the time.
This will positively impact people, communities and staff:
– A focus on what matters to us now and in the future; flexibility to change plans as things change
– We take responsibility for decisions that are ours to take and are supported to act in ways that are risk aware, not risk averse.
How will the project be delivered?
1) An engagement event included people with lived experience, voluntary and charitable sector, commissioners, and staff working in health and social care. A system leadership team for personalised care has been established to work with a larger reference group.
2) We will support primary care networks to develop capacity and capability for change, with systems leadership development anchored in an action learning approach, whilst intensively supporting two exemplar primary care networks to accelerate the learning.
These will act as “whole system” prototypes – suspending the usual rules in favour of simple principles (‘do the right thing’). Foundations will include establishing shared values, measures and methods for sense-making.
Learning will be available “on pull” – access to training and resources for coaching, motivational interviewing, shared decision making, personalisation etc.
3) Strategic projects to amplify enablers and remove barriers to scale and spread will be initiated.
What and how is your project going to share learning throughout?
Our experience of prototyping is that this approach will generate valuable learning of wider relevance.
The leadership team will ensure that learning is captured and shared, connecting whole system players (including commissioners, managers etc.) to harness learning across the system, so that improvements become hard-wired into our practice.
We will develop an information hub – where learning, progress, success, failure, tools, other resources can be published and accessed.
We will ‘work out loud’ with a simple routine of sharing stories about what we are learning to bring it to life (e.g. blogs, vlogs, sketchnotes etc.).
The overall programme is part of the evolution of Dorset as an integrated care system. Dorset is a demonstrator site for personalised care, with partial funding through NHS England Personalised Care Group in 2019/20. If successful, additional funding through Q will enable us to go further faster with more intensive support within and across primary care networks.
How you can contribute
|1 Jul 2019||Preparation, creating capacity, governance structures|
|16 Sep 2019||Intensive work with exemplar primary care networks|
|4 Nov 2019||Prototyping within exemplars|
|4 Nov 2019||System leadership development throughout|
|6 Jan 2020||Responding as a system to learning through prototypes|