Looking back to grow forward - NHS Confederation/media/Confederation...Robin Miller, Senior Fellow and Director of Consultancy, Health Services Management Centre & Fellow of the School

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Looking back to grow forwardEdrych yn ole r mwyn tyfu ymlaen

Robin Miller, Senior Fellow and Director of Consultancy, Health Services Management Centre & Fellow of the School for Social Care Research, University of Birmingham

@welshconfed#wnhsvision16

Robin Miller, University of Birminghamr.s.miller@bham.ac.uk

Looking back to grow forward

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What do want our garden of integration to provide?

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The ‘Triple Aim’ of integration

Berwick et al2008

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I can plan my care with people who work together to understand me and my carers, allow

me control, and bring together services to achieve the outcomes important to me.

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After Fulop et al 2005

Organisationalintegration

Serviceintegration

Functionalintegration

Clinicalintegration

IntegratedCare toPatient

Systemic integration

Normative integration

How do we encourage integration to grow?

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History of partnership working

Cultures of organisations

Individual experience & interests

Understanding of others

Culture & Policy in practice: Care trusts

Less successful

Lack of previous culture of joint working

‘Clash’ in cultures between health and social care staff

Failure to address intransigent cultures

Disjointed policy, employment & performance frameworks

More successful

Transformational leadership set the tone for culture of innovation

Culture that valued professional diversity

Shared cultural artefacts that emphasised commonalities

Willingness to hear difficult messages

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you’ve got to be all things to all people

we pick up on all the things in their life that’s going on

the communication is through faxes and letters so I couldn't tell you what they do well.

I know it’s going to be challenging, I still have to pause and think right, this is going to be difficult.

History of partnership working

Cultures of organisations

Individual experience & interests

Understanding of others

National policies

Broader environment

Representative bodies

Performance & Incentives

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Mason et al 2014

History of partnership working

Cultures of organisations

Individual experience & interests

Understanding of others

National policies

Broader environment

Representative bodies

Performance & Incentives

Co-production with patients / users

Inter-professional teams

Training & leadership development

Encourage innovation & pilots

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Examples from manchester

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Sharing impressions

Sharing

knowledge

Sharing roles, 

values and conflict

Sharing 

plans

The Integrated Care Development Programme

Outcomes: Increased staff competency; Improved partnership working; Greater wellbeing and efficiency

Through: Health & social care teams from a locality working on

shared priority Mixture of taught content, individual reflection, and team

development

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History of partnership working

Cultures of organisations

Individual experience & interests

Understanding of others

National policies

Broader environment

Representative bodies

Performance & Incentives

Co-production with patients / users

Inter-professional teams

Training & leadership development

Encourage innovation & pilots

Outcomes & monitoring

Process & systems (data)

Progression and rewards

Learning and improvement

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Key lessons from North West London

Economies & diseconomies of scale

NHS management tend to dominate

Promise short & deliver long

Constantly adjust central-local balance

Involvement & relationships only go so far

Lay involvement is powerful but can be uncomfortable

Data matters

Formative evaluation helps

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How do we encourage growth and sustain for the future?

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A garden requires patient labour and attention. Plants do not grow merely to satisfy ambitions or to fulfil good intentions. They thrive because someone expended effort on them.

Liberty Hyde Bailey

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Webinar website imageJournal of Integrated care

Practice based journal looking for examples of where integrated care has worked – and where it hasn’t!

For details of the journal see website -http://emeraldgrouppublishing.com/products/journals/journals.htm?id=jica

To discuss an article – jica@contacts.bham.ac.uk

Webinar website imageSummer school – June 2016

The International Summer School Integrated Care©, “Integrated Care in Theory and Practice” is organized by the International Foundation for Integrated Care and provides a one-week intensive training on theory and practice of integrated care

For more details see International Federation of Integrated Care website: http://integratedcarefoundation.org/events/international-summer-school-integrated-care-issic

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