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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X
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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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?
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In association with: National partners @NHSIQ @CBlackaby
#integrationpioneers
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
Slide 26
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 ?
Slide 27
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
?