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Transformation in Integration Catherine Blackaby NHS Improving Quality @NHSIQ @CBlackaby #integrationpioneers

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What do we mean by integration? @NHSIQ @CBlackaby #integrationpioneers

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Surely its easy? X YX Y Just do itEfficient system IHI and RC Lloyd & Associates 2008 @NHSIQ @CBlackaby #integrationpioneers

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The 14 Pioneers ICSP Pioneer sites BarnsleySouth Devon and Torbay CornwallSouthend GreenwichSouth Tyneside IslingtonWest Cheshire KentWELC London North West LondonWorcester @NHSIQ @CBlackaby #integrationpioneers

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The Pioneer Programme 14 areas across England Integrating Acute and primary care Mental and physical health care Social care Housing Third sector All the care and support needs around the person @NHSIQ @CBlackaby #integrationpioneers

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Source: The Kings Fund http://www.kingsfund.org.uk/projects/health-and-health-care-london @NHSIQ @CBlackaby #integrationpioneers

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In association with: National partners @NHSIQ @CBlackaby #integrationpioneers

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https://www.gov.uk/government/publications/integrated-care @NHSIQ @CBlackaby #integrationpioneers

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Aspiration The pioneer localities will act as a means of driving forward change at scale and pace from which the rest of the country can benefit (Collaboration partners) @NHSIQ @CBlackaby #integrationpioneers

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Six conclusions from previous pioneer type programmes in health and social care over the last decade 1.Promising pilot programmes are rarely replicated successfully 2.Issues of spread and scale are typically an afterthought 3.Change is highly context specific 4.People outside the pilot locality do not feel any ownership of, or emotional connection with, the pilot project so change processes have to be pushed onto other localities rather than pulled. 5.Pioneer sites have limited bandwidth to coach others and spread best practices 6.Very few evaluation studies look beyond the pioneers to issues of scale and spread Source: @HelenBevan @NHSIQ @CBlackaby #integrationpioneers

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Emerging themes in large scale change FoundationEmerging direction OrganisationCommunity Power through hierarchyPower through connection Mission and visionShared purpose Making sense through rational argument Making sense through emotional connection Leadership-driven (top down) innovation Viral (grass-roots driven) creativity Led by expert opinionAllow all talent Engaged patientsPassionate users Clinical networksMass communities Tried and tested, based on experience Open innovation TransactionsRelationships Source: @HelenBevan @NHSIQ @CBlackaby #integrationpioneers

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Two kinds of system-level problems A difficulty Broad agreement on the nature of the problem Some understanding of what the solution might look like Clarity about the time and resources required to solve the problem A mess No clear agreement about exactly what the problem is Ambiguity about how improvements might be made Unbounded in terms of the in terms of the time and resources it could absorb, the scope of enquiry needed to understand or resolve it, and the number of people that may need to be involved Source: System Failure - Why Governments must learn to think differently, Jake Chapman, published by Demos

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"The secret to getting ahead is getting started. The secret of getting started is breaking your complex, overwhelming tasks into small manageable tasks, and then starting on the first one. Mark Twain @NHSIQ @CBlackaby #integrationpioneers

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Necessary behaviours for managing wicked problems Establishing shared goals Build trust Exchange information & other resources Embrace emergence Explore new territory Create new knowledge Facilitate, enable & coach @NHSIQ @CBlackaby #integrationpioneers

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Closed innovationOpen innovation As a pioneer test site, we want to be left alone for a period of time so we can work it out for ourselves As a pioneer test site, we seek to continuously get ideas and guidance from leading thinkers and practitioners outside our local area; as a result we sustain our energy for change and continue to implement changes over a longer timeframe We will test our new ways of working internally to destruction. When we are confident they will work, we will offer to share our best practice innovations with others A wider group has contributed to the innovation process, beyond our host organisation; this means that when it comes to diffusing the learning from pioneer sites, people from other localities already feel that they own it. Spread is more likely to be done with not done to and to be pulled not pushed @NHSIQ @CBlackaby #integrationpioneers

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The power of co-creation

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How are we doing it? 1.Build the Integrated Care and Support Exchange (ICASE) as a learning community with and around the pioneers 2.Create, capture and spread knowledge, skills and ideas using open innovation and knowledge sharing principles 3.Put the pioneers at the centre of the learning community but with an open innovation mindset 4.Build a compelling narrative that calls people to action and that focuses as much on big picture aspirations for change across the country as it does on the specific localities @NHSIQ @CBlackaby #integrationpioneers

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5.Plan for spread right from the start 6.Create a special status for localities that applied but didnt achieve pioneer status. Create opportunities for them to progress more quickly and effectively than the pioneers. 7.Clearly define what being a pioneer; create a compact (contract) that sets out the give and get as a condition of being a pioneer e.g. participation in open innovation processes. @NHSIQ @CBlackaby #integrationpioneers

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Where have we got to? @NHSIQ @CBlackaby #integrationpioneers

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How are we doing it? 1.Build the Integrated Care and Support Exchange (ICASE) as a learning community with and around the pioneers 2.Create, capture and spread knowledge, skills and ideas using open innovation and knowledge sharing principles 3.Put the pioneers at the centre of the learning community but with an open innovation mindset 4.Build a compelling narrative that calls people to action and that focuses as much on big picture aspirations for change across the country as it does on the specific localities @NHSIQ @CBlackaby #integrationpioneers ?

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5.Plan for spread right from the start 6.Create a special status for localities that applied but didnt achieve pioneer status. Create opportunities for them to progress more quickly and effectively than the pioneers. 7.Clearly define what being a pioneer; create a compact (contract) that sets out the give and get as a condition of being a pioneer e.g. participation in open innovation processes. @NHSIQ @CBlackaby #integrationpioneers X X ?

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