Shaping leadership for place: Results from a system diagnostic across 3 Integrated Care Partnership systems

Abstract

Introduction: The Five Year Forward View (2014) makes the case for the radical transformation of health and care in England, including disjointed care, increasingly elderly population with multiple co-morbidities driving demand and a financial imperative to use resources effectively. Further publications describe how Integrated Care Systems (ICS), (population ~300,000-2.7million) and component Integrated Care Partnerships (ICP), (population ~300,000); involving providers and commissioners, will take collaborative responsibility for managing resources, delivering standards and improving health outcomes for a defined population. Description of practice change: AQuA has worked with many system leadership teams across several localities in NW England, supporting them with the design and implementation of place based care. Latterly, we have supported 6 emerging ICP Boards as they collaborate to transform services for their population. Aim & theory of change: AQuA has developed a three stage approach to supporting systems with the implementation of place based care; shaping leadership, creating direction and shaping delivery. The shaping leadership stage has a system diagnostic and a series of development sessions supporting executive leaders. The diagnostic includes semi-structured interviews with leaders to understand current position, engagement and commitment. Leaders also complete the AQuA Integrated Care Assessment Framework (ICF), showing how the system rates itself against 8 key enablers. The assessment is completed intermittently to assess progress. The content of the development sessions is dependent on the diagnostic outcome, often including: Clarity of vision, design principles and delivery timescales Building on existing relationships to consolidate outcomes and agree how the work happens Cultural expectations and system behaviours Dedicated support for providers to enable them to respond to care model To date we have supported 6 emerging ICP boards, 3 of whom completed both diagnostics. The data from the interviews has shown consistent themes, including: Lack of coherent vision and objectives Committed organisations but with caveats (what will it mean for me?) Emerging system leadership skills Tension between leading systems and organisations Opportunities to focus on prevention and wider health determinants Regulation gets in the way of doing the right thing for people Data from the ICF (amalgamated for all 3 sites), figure 1; demonstrates low scores across all 8 domains, with leadership and culture showing a slightly higher score than others. The plot graph (figure 3) shows the spread of responses for each domain. NB Data shown in attached file Targeted population & stakeholders: AQuA supports stakeholders from across the system, including providers, commissioners, Local Authority, voluntary and community sectors and patients and citizens. Highlights: Despite the national policy direction of health and social care integration, systems have some way to go. They welcome the critical challenge provided by the diagnostic and tailored support to address the issues. AQuA’s support to emerging ICPs will enable them to deliver the radical transformation needed to respond to the challenges. In the words of one system leader - “It’s the right thing to do but it’s easy and it’s not quick. It needs to be driven by leaders, relationships and TRUST”

Keywords

• integration
• place
• system leadership