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Rebecca Harriott (see Directory profile), Consultant, SW AHSN, shares her improvement journey and invites people to join the Q special interest group ‘Redesigning the organisational landscape’, for people working on developing integrated commissioning and accountable care systems (see list of SIGs).

How – and why? –  did you first get involved in improvement; and what has been your journey since then? 

I feel like my whole NHS career has been about improvement as I have always seen my job as finding different ways of working in
order to improve outcomes and save time & money. The name has changed many times though and I variously been called a Director of Modernisation, Provider Development, Commissioning Development, Performance & Development during the myriad of reorganisations I have been through.

More recently I have been involved in the design and set up of the 2 CCGs in Devon and became Chief Officer of New Devon CCG in September 2013. Improvement in this context has been about establishing a new organisation from scratch whilst addressing a significant financial overspend and other performance challenges.

Since December 2016 I have been working with the South West Academic Health Science Network developing a route-map for STPs who are looking to reconfigure their organisational landscape. This was prompted by the need to look at this for the Devon system but I very much hope it is work that will be useful for STPs generally.

We work in a complex and challenging environment and I never fail to be impressed by the determination of individuals to succeed

What most inspires you professionally?

The ‘NHS’ and the values & commitment of people who choose to work in it.

We work in a complex and challenging environment and I never fail to be impressed by the determination of individuals to succeed, often in spite of the system we work within.

Can you share a hard-won lesson you’ve learnt about what makes for a successful (or unsuccessful) improvement project.

My most recent learning was to do with establishing a health and well-being hub in a Devon market town. It took about 3 years and the project was riddled with obstacles such as the provider changing mid-way, properties transferring to NHS property services, lack of information on budgets and costs, lack of trust between key stakeholders and suspicion from the local community. In the end we moved it forward through achieving senior buy-in from all organisations, through establishing a senior, committed, and representative project team with strong expert project support and setting ourselves very clear deliverables and tight timeframes. We built trust through making progress. Reflecting back on what had taken so long I think it was at least in part due to a reluctance by less senior members of staff to escalate problems to others who may be in a better position to fix them. I worry that people see escalation as a sign of failure rather than a request for help.

What change could we make that would do most to embed continuous improvement in health and care?

Ensuring that individuals have time and space to think as part of their working week.

We are very busy with ‘business as usual’ in the NHS and my experience of moving out of my Chief Officer role to lead a specific piece of work is how little thinking time I had to give to complex issues because ‘keeping the plates spinning’ generally took more time than I had. I don’t think I was alone in this experience. This can mean insufficient research, planning and preparation in addressing issues and that is more likely to lead to low risk, pragmatic solutions rather than real innovation. We have the experience and expertise to resolve many of our challenges but our diaries are full of short term imperatives.

Why did you join Q?

I had just moved into a new role and felt it was a great opportunity to develop a new network and draw on the expertise and perspectives of a diverse range of individuals. I also thought I would be able to offer support to other Q members in a way that I would not have felt I had the time to in my previous role.

I like the idea of a largely self-organising but well supported community that empowers individuals who are passionate about improvement. I think it could make a huge difference to the transformation effort – maybe largely unseen but nonetheless effective for that.

What new connections (and collaborations) have you made as a result of joining the Q community – and what have you learnt so far?

I attended the Q launch event for the south west and enjoyed meeting up with some existing colleagues and meeting some new ones. I have also joined the Q randomised coffee trial and had a great conversation with Tracey Webb who is leading on Q labs. I have set up a special interest group related to the project I am leading and am hopeful that many connections will come via that.

I have learnt about communities of practice, the role of improvement games and hackathons. I am learning about communication tools such as webinars in the hope that this will provide alternatives to face to face, telephone and email contact.

Can you tell us about something you’re currently working on?

My focus is on setting out a process that, if followed, will enable the right local solutions to be identified and implemented.

I have set up a Special Interest Group entitled ‘Redesigning the organisational landscape’ and I am hoping to connect with other Q members who are working on developing integrated commissioning and accountable care systems (or organisations). I have some thinking to share that will hopefully save others some time but am very keen to learn about the approaches being taken elsewhere too. Accountable care models are very much in vogue but they take time to design and implement and there is no ‘one size fits all’ answer. My focus is on setting out a process that, if followed, will enable the right local solutions to be identified and implemented. This fits well with the ethos of the five year forward view next steps document which sets out expectations of STPs in moving towards accountable care models.

I will be holding the first meeting of the SIG shortly (as soon as I have worked out the technology!) and would very much welcome contact from anyone interested in joining a first discussion – whether that be just to listen or to contribute more actively.


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