I’ve often found myself in ‘no man’s land’ when working between health and social care services, trying to develop transformational ideas and plans that improve services both sectors are delivering on. Luckily, I am ok in that space, a buffer zone of sorts, that helps to translate sector and organisational language into a common tongue; one that enables people to see problems from different vantage points, and most importantly looks to understand and develop the shared impact these have on the populations we serve.
You’ve all heard the excuses…
Looking back, I always seemed to ‘not quite fit in’ with the standardised approaches to improvement of health and social care in the UK. I trained as an NHS audiologist aged 16, before transitioning to commissioning roles, transformation and innovation roles, and finally operational management in a major acute hospital. At each stage I have always looked to work closer with other agencies and organisations, yet this was more often than not met with barriers, whether this be organisational memory (“we tried this before, 10 years ago, and it didn’t work….”), fear (“if we integrate we may lose control and our demand could skyrocket….”), silo’d working (“that’s not in my budget, so it’s their problem….”), processes (“this will be too difficult to work through as a joint procurement….”), or planning (“it will take too long, we need changes now….”). The sad part to this is that those making these excuses forget to focus on the positives of closer working, and that ultimately, if done right, these will improve access to, and outcomes from services, whilst making the lives of users and staff better.
Lets not talk about it…
Integration, ahhhh, so I’ve mentioned it so soon…. This always seems to be a scary word, and I have been in roles where it cannot at any cost be mentioned in planning, meetings, or discussions, despite it being the main desired change. I’ve often joked that the 1st rule of integration is you don’t talk about integration, and the 2nd rule of integration is….. DO NOT TALK ABOUT INTEGRATION!!! Whilst this may appear true in practice, it is not true if you want to do it successfully and sustainably. To really do it well you have to own the fear the word integration distils in people, being upfront about the reasons for considering if and how best to do it. You must understand the worries it may cause staff, addressing these along the way and making sure those affected by these changes are involved, engaged and feel heard. If integration is your aim, it should not be a secret, or an alternative motive, but a clear aim and the reasoning why understood by all.
Problem first, solution second…
Equally, integration should not be the answer to an unknown problem, it may be a solution yes, but on the other hand it may not. Too many times integration is seen as the key without due diligence being done first to understand the problem that needs addressing and what solutions may improve or fix the issue. Involving staff and service users in defining any problem can be of huge advantage here, and I have seen countless times the immeasurable value added from including those delivering and using the services you are trying to improve when developing transformative plans that consider forms of integration.
So what’s needed….
There are a number of personal skills I have found essential for bringing organisations, teams and people together to work differently:
Listening – to the people who want the change (to ensure you understand the problem that needs solving) along with those who have received (or may need to receive) the services, and those providing the services themselves, will give you the best chance at developing plans that are successful and sustainable.
Planning – bring relevant people together to plan the programme of change, using formal or informal change or project management approaches where required. This provides clarity from the start and enables a joint approach to understanding what is needed when and by whom, whilst taking into account any relevant organisational requirements which need considering.
Patience – if these changes were easy, they would have been done. Bringing large numbers of teams and people together to solve difficult challenges takes time, and you have to be prepared for this from the start. No one should promise quick integration, it will only cause worry and disappointment.
Knowledge – of the services to be improved or integrated helps, but it is knowledge and experience of change and integration itself that is key. This provides confidence in the process and end result, offering lived examples that can help encourage others to think creatively and collaboratively when considering change. Quality improvement (QI) skills can also be effective in blurring boundaries between teams and organisations, by providing a logical and standardised approach to change.
Communication – is vital to developing a common understanding of the challenge, and any potential solutions. Understanding the fear that change can illicit in people, especially when the word integration is used, and navigating through this will require the ability to absorb and relay information to and from a wide range of people, always in a calm and empathic manner. The ability to utilise language from all sectors involved in the change will go a long way to generating the good will and buy in required for it to happen.
Passion – for improvement is a must, without it change will not happen! It needs to be ever present and infectious to those you work alongside, keeping the positive impact that successful and sustainable change can bring to peoples lives at the heart of why people need to work differently, alongside each other, in developing transformative plans for how services can look.
Agility – balancing the needs and priorities of multiple teams or organisations will always be challenging, especially with the ever-increasing complexities of health and social care provision. Whilst we have already touched on the importance of planning, we must also make sure we are agile and flexible to any emergent needs of those we hope to keep involved in the changes. If we want systems to work better together, we must learn to understand and support each other as change and transformation is developed; if this means the plan needs modification, or a milestone moved, then so be it… better to keep the programme alive, and people at the table, than let it slowly fade due to rigidity.
Resilience – there will be blockers, challenges and setbacks, this is guaranteed. They may come from people, processes, politics, or just plain luck. You must be prepared for this, and build the resilience needed to diligently work through whatever presents itself. Do not take resistance personally, it is often the fear of change itself at the heart of it. Keep focussed on the goals, with communication channels open, allowing yourself to be flexible where required, and you can navigate through the stormy waters as one.
To conclude…
Integration is just a word, but one we hear a lot, as the answer to many of the challenges we face in providing public services. Done correctly it has the ability to improve services we offer to those we serve; improving access and outcomes, along with organisational efficiencies and staff benefits. It is not easy to do, and won’t produce immediate results, usually requiring specific skillsets and mindsets to get right.
Alternatively, it may not be integration that you need to improve your service offer, joint working arrangements or closer alignment of services or staff may be all that’s required. How you decide this is up to you, but involving those who use and work in the services affected is essential to getting this decision right!
Either way, it is vitally important that we begin getting transformation right between health and social care. With our ageing population, pressures will continue to grow, and as the effect of this will be felt by both health and social care services, the only way to address them will be together.
Ryan O'Shea is an Associate Consultant at Roretti.
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