Q Exchange
Further Together: Improving care though a new kind of partnership
- Winning idea
- 2024
What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?
Our three local authorities and University Health Board, which span the central South Wales valleys, aim to work across system boundaries to embed an emerging integrated care system which implements new population health management and urgent response community pathways, supported by a clinical navigation hub. Our communities have embedded deprivation over generations, which results in some of the worst health and wellbeing outcomes in Wales. All partners involved in this project want to start to turn the tide on this.
Through focusing on a shared endeavor of improving patient experience, this project will support the development of partnership working by creating an analytical framework to support a resource shift to the community, based on evidence of impact and connections to other areas or indeed industries working on complex change. We know we need to draw on a range of capabilities and tools, not all of which are available locally.
What does your project aim to achieve?
This proposal aims to enable a change how resources are used across our partnership, free from unhelpful processes and empowering our staff to make brave decisions whilst changing the relationship we have between our partners – improving the health and wellbeing of our population by improving how we work together.
We know that moving resources from secondary/acute services into the community has been a long established ambition with the NHS and social care – but one which has yet to be met. This project aims to develop an analytical framework to facilitate the resource shift needed to enable this – helping us understand where changes need to be made.
Importantly this project also aims to encourage behavioural changes and an emergent learning environment across the partnership, improving the relationships between those working in our services across health, social services and third sector, to build trust, compassion and empathy.
How will the project be delivered?
Months 1 & 2
- Identify an independent facilitator to undertake a discovery phase to develop a strengths based 360 degree view of what is working well across boundaries, building from a strong base and spreading throughout the partnership.
- Identify independent support for the development of the analytical resourcing tool
Months 3 & 4
- Development of analytical resourcing tool using learning from other examples e.g. http://rehabilitation-modelling-resource.pdf (gov.wales)
- Assemble the 360 view from each organisation to embed emergent learning cycles to be trailed in the next phase.
Months 5 to 9
- Use the developed tool to identify resources which could be realigned to support integration
- Small experiments of change around behaviours to test impact. Gather patient stories to embed learning cycles and collectively make sense of the change.
Months 10 to 12
- Evaluation of process of learning and testing change.
How is your project going to share learning?
- We anticipate the benefits of this work would go beyond this remit and benefit all cross-system working opportunities (e.g. mental health, neurodiversity), which would be a strong legacy of this project.
- Sharing of the analytical tool via Q networks and wider across Wales and the UK
- Use established Improvement Cymru links to share best practice and learning
How you can contribute
- Learning about how to undertake relational work across system boundaries which doesn’t apportion blame (perceived or real)
- Learning from areas where a shift in resources towards the community and prevention services has been successful
- Learning from identifying what we have in common and what is already strong about our system to enable others to work similar/same as this
- Learning from how to effectively use patient stories to nudge behaviour change
Plan timeline
| 7 Jul 2024 | Emerging together, identification of support |
|---|---|
| 2 Sep 2024 | Developing together, via the analytical tool and understanding behaviours |
| 4 Nov 2024 | Delivering together – using small scale learning experiments and analytical tool |
| 1 Apr 2025 | Evaluating together – exploring what has made an impact |
Comments
Evelyn Prodger 28 Jul 2024
Congratulations on your win - it's a great project.
We identified some case studies which may be of interest around moving cancer services out of an acute space and into a Community Hospital space during Covid when we did our QExchange Project - you can find some of the outputs here: https://www.communityhospitals.org.uk/quality-improvement/q-exchange-project.html
We also have a Community Hospitals SIG on this website if that is of interest.
Good luck with the project.
Victoria Wallace 7 Aug 2024
Thank you very much for commenting Evelyn - we will have a look at the information you kindly shared with us and see how it can inform our work.
Vicki
Victoria Wallace 4 Jul 2024
Big thank you to everyone who voted for us - we are really chuffed to have gained the support of the Q Community on this and we look forward to learning with you moving forward on this project.
David O'Brien 4 Jul 2024
congratulations. I am particularly interested in your project as I work with colleagues in health and social care to right size community and specialist inpatient care for people with a learning disability. this is a key approach to ensure we see a reduction in pathway of care delays in specialist inpatient care.
Victoria Wallace 4 Jul 2024
Thank you for your interest David - we are excited to have been awarded the funding and will be happy to share our learning moving forward, as well as learning from those already doing similar work. Please keep in touch.
Zoe Silsbury 30 May 2024
Would be really interesting to see this bid come to fruition and see how it can transform CTMUHB healthcare to benefit population health. Good luck
Andrea Davies 30 May 2024
Thanks Zoe, appreciate your support
Andrea
Dr Andrew Pithouse 25 May 2024
It is very encouraging to see such a well-focused project with clear evaluation and pitched at the forefront of team and agency interactions. The cultural and administrative changes needed to build inter-professional trust and to share scarce resources/budgets and agree on joint agendas/outcomes is still a relatively under-developed field of both service optimisation and practice evaluation. This in my view is an essential project that focuses exactly where we need it to - at the everyday world of work and relationships. All too often we search for structural solutions around governance and strategic drive to solve policy delivery problems in health and care, and all too often these fall short of their promise. So gratifying to see the focus of this study on the gritty practice world of complicated occupational systems and complex human needs. Very much hope this is supported as it speaks directly to the compelling challenges in our care and health systems across Wales around joint decision-making, budget re-alignment and integrated working to optimise patient flow as well as prevent admissions to hospital and keeping vulnerable people safe in the community.
Andrea Davies 30 May 2024
Diolch Andrew,
We find that its in the making time for close relational working that develops trust and enables people to take brave regional steps together.
angharad dalton 23 May 2024
I think this is really interesting bid, that has huge potential for the communities involved. I'm keen to know how things develop. Good luck!
Andrea Davies 30 May 2024
Thanks Anghard, sharing the learning from this will be so important as there are challenges that we are all sharing.
Luisa Bridgman 23 May 2024
Great to see CTM looking at evidence based allocation of resources to support community development. Best wishes for your bid.
Andrea Davies 30 May 2024
Thanks for your support Luisa.
shelley Davies 23 May 2024
Really exciting to see the progress being made in the CTM region. This approach is absolutely aligned with the Welsh Government ambitions to develop an integrated community care system for the people of Wales. As referenced by others the ability to 'shift left' with resources and create efficiency in planning and decision making through a genuinely shared approach to resourcing has been elusive to date. We will be watching this project with great interest as it could position CTM as a leading region in terms of resource integration from whom we will be able to gather and share the learning across the rest of Wales.
Andrea Davies 30 May 2024
Diolch Shelly, We are so aware of the health inequalities in our population. With our local authority colleagues, we feel it is our duty to work together to and make brave decisions to improve health and well-being in the CTM region.
Lucy Cartwright 21 May 2024
Really interested to see how this work progresses, particularly in terms of utilising population health management in the identification and tackling of inequality through more effective resource deployment. Really hope Wales can be at the forefront of authentic integration!
Andrea Davies 30 May 2024
Thanks for your comments and support Lucy
Christopher Dawson-Morris 14 Mar 2024
Sounds interesting, the challenge is always matching the analysis to the interventions. How will the analytics better target interventions/monitor interventions not just tell you more of what you know?
Cardiff and Vale Health Board had a good allocative efficiency model when I worked there
Andrea Davies 30 May 2024
Really good question Chris- we hope to get back to you with our insights!
Andrea
Dr Seema Srivastava MBE 14 Mar 2024
I’ll be following your bid with interest. Many ICSs are establishing great relationships, building trust and encouraging creative thinking, through both areas where people feel aligned as well as when there is difference in views. What still feels a challenge is when system decisions need to be collectively made about the finances. Having the dynamic evidence base would help greatly in partners making decisions with a degree of confidence, especially when money is coming out of ‘their’ sector.
Andrea Davies 30 May 2024
HI Seema, we would be really interested in hearing more about your own experiences should we get shortlisted. Will it be ok for us to get in touch?
Andrea
Jason Nicol 12 Mar 2024
Really interesting bid; love the concept of emergent learning cycles. Best wishes, I hope this gets funding!
Andrea Davies 30 May 2024
Thanks for your support Jason
Andrea
Matt Jenkins 29 Feb 2024
To expand a little on the explanation above about the ambition to create an ‘Analytical tool’ to support the development of our integrated system through partnership working, this is about providing a clear evidence base for future resourcing decisions about integrated health and social care in the community.
Our aim is to develop a much more fine -grained assessment of the community capacity we need in a balanced system. Methodologies such as those developed for the Welsh health and care system (for example see "Right-sizing Community Services for Discharge" published by ADSSC Cymru) have helped us to understand the capacity we need at the hospital ‘back door’, and we want to apply this thinking to the wider community realm including prevention and urgent community response pathways.
This rational, data informed approach, will be absolutely critical at a time when our Councils and Health Board face a very challenging budget outlook. It will also help us to build stronger working relationships and a partnership approach because we will share a basis of achieving allocative efficiency across our system, rather than getting stuck on organisational budget positions.
The vision here is to create a dynamic tool, whose parameters we can adjust as the socio-economic circumstances of our population, and their consequent health and care needs change.
Other than this outline, we don’t have a pre-determined approach. If we are fortunate enough to be supported by funding we would utilise this firstly to seek to understand how other organisations/ partnerships, both in our sector and in other sectors, have grappled with this or related challenges. From there we’ll develop our thinking with the intention to create a practical tool that can be used to support decision making and command confidence in the authorising environment of the partner organisations.
Despite a supporting national policy framework and good partnership intentions, the much vaunted ‘shift to the left’ has proven illusive in practice at a national, regional and local level. This project is intended to provide our partnership with the central piece of the integration jigsaw which has so far been missing. If we succeed, the outcomes will be potentially relevant to integrated systems across the UK.
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