TRANSFORMING SURREY'S HEALTHCARE SYSTEM
The challenge
Are you a system leader improving the health and social outcomes for communities and places? How do you ensure that the right leadership, culture and operating models are embedded to ensure that:
the ‘system’ is enabling and driving improvements at place level, rather than operating to a ‘one system’ ‘one size fits all’ structure;
there is connection between ‘top, middle and bottom’ where learning flows and and decisions are made at the right place for the population need;
Leadership at all levels actively unblock barriers to innovation and is able to implement best in class learning;
Intentions expressed in strategy are not disconnected from the realities of practice;
Local eco-systems involving the community, businesses, social enterprise and statutory sector are involved in driving health improvements.
We all know there’s a sweet spot for leaders of system change, and it lies somewhere between ‘people’ and ‘places.’ Read the report below to explore how entrepreneurial mindsets have shifted cultures over time, unlocking new ways of working and delivering real change for communities.
Easy to visualise isn’t it, but it can be a real challenge to make it happen.
A challenge, but not an impossible one.
Most of us will be able to highlight individual projects which have crossed boundaries between strategy and practice and delivered real impact for communities and places, by changing the way people choose to work. But how do you get that learning back into a system?
How do you challenge the cultures of the system to do more of this and spread the knowledge and skills it needs? Then, how do you then create the leadership, the governance, the operating models, the teams, the leadership and management capacities to be able to work in this way? This is where most of us give up and do the best with what we’ve got. Because challenging the way things are done, is hard. We need our top leaders on our side. It takes time. The price for getting it wrong is often high. So what was different this time?
Donna Bradshaw shares the approach we took to system leadership in Surrey and shares our key learnings from the progamme.
In other words, how do you go about creating truly integrated systems which deliver impact at place level?
If you want to operate in a ‘place-based’ way, our 360 Degree Society team can support you at community level but also at system level, through our multi-faceted, tailored OD (Organisational Development) System/Place Programmes. Equally, if you are frustrated by not being able to turn your strategic intentions to action – then it’s worth having a chat with us.
Delivering this degree of transformational change is a huge OD ask, we know, but this is the work that really drives us. We can help you ensure that what your system is being and doing the right things; driving those healthy and vibrant communities.
Of course, you can’t do that without the right culture EVERYWHERE and without the right leadership EVERYWHERE, and that needs building in a multifaceted way.
So let’s look at what happened…
In 2019, we were commissioned by Ashford and St. Peter’s Hospital to take on what would become a seven-year project to build an integrated, 360 degree approach to health in the North West Surrey area and share the learning across a whole system, at the same time the system structures were transitioning from CCGs into Integrated Care Systems. The opportunity was seized to connect the work at Place with ASP, with the early days transition to a new system structure, Surrey Heartlands ICS.
The health innovation work we have carried out over the last seven years in Surrey has become a national gamechanger.
This work is one of a few evidence based examples of leaders working together to overcome complex systems. This work sits alongside other examples from Leeds Teaching Hospitals), the UK Vaccine Taskforce and the devolution of healthcare in Greater Manchester.
It was THE FIRST TIME that the principles developed through 40 years of placemaking work in east London have ever been applied TO A WHOLE INTEGRATED SYSTEM. This work is all underpinned by the operating model work which created the right system environment to enable a place-based model to thrive.
You can read the Surrey Placemaking case study here, and download the full paper.
This paper showcases ‘the people story’ - our approach and capability in terms of system leadership in a health context, but it’s also applicable to the wider public sector. If you’d like to learn more or discuss where you are at with your own organisation, please contact us.
THE BACKGROUND
Surrey were transitioning from a ‘one system’ structure. Like many organisations, they were grappling with how to build a new system structure, an Integrated Care System (ICS) and an Integrated Care Board (ICB) that is supportive of place, and that requires a transition from one type of regional structure into another.
One of the main challenges was how to deliver the OD required to successfully transition, AND build in the system leadership element.
Our People Work with Surrey Heartlands ICS
With work like this, leaders often go into a darkened room, bring in some consultants, agree on the best answer, and then persuade everyone to sign up to the idea. There is no real change and small amounts of innovation happens at the edges and everything stays more or less.. the same.
Here, we had a group of leaders who wouldn’t settle for that. They were genuine about making a difference and this led to an approach where they would all be accountable and for the results.
Firstly, our team gained insights into the challenges and opportunities at Place level from undertaking in-depth diagnostic and immersion events in Woking, Staines, Weybridge and Addlestone. These insights were brought into the newly evolving ICS Executive Team, and outgoing CCG teams and Board.
The 360 Degree Society (then Prospect) People experts facilitated and co-created a multi faceted Organisational Development Programme for the ICS, to operate alongside the work the 360 Degree Society Place experts were delivering. The leaders were listening to this learning and using it to inform action.
This OD Programme comprised of
OD diagnostic to include insights from Place based work and a recent cultural review, and policy landscape requirements;
Definition of system leadership requirements to support ICS Executive recruitment;
One to one coaching of ICS executives;
CCG Board Programme for the exiting CCG Board, including transition to new ICS/B system;
Place mentoring of ICS CEO;
A year long programme of team coaching and development for ICS Executive Team, which included Directors of Place. This included:
Team building, trust building and the Aston team Journey towards high performing team;
Defining the desired system/place culture(s) and behaviors;
Articulating roles of system/place, including the tensions, challenges and opportunities;
Establishment of place/system principles to apply in a county wide integrated operating model;
Application of system thinking using real system challenges that cross multiple boundaries and have place diversity;
Setting the principles, direction and delegations for the Operating Model Programme;
In partnership with the NHS Transformation Unit, the design and delivery of the first Integrated Operating Model (System/Place) at County level in England;
Action learning/ learning by doing and system leadership masterclasses involving people working at all levels of the system, and across organizational boundaries;
Specific development with directorates of the system e.g. Chief Medical Officers Directorate.
Much of this was delivered around the Covid pandemic and required much flexibility and re-focus throughout as staff were often re-prioritised into urgent care work.
Rather than being a traditional, hierarchical and top-down approach, the process itself instead became an enabler of place. The OD programme involved over 200 staff. This deep engagement of staff throughout the system is a fundamental design principle of all our OD work and our team have decades of expertise to ensure that this can be done, even in turbulent times.
Our 360 Degree Society partner, Prospect, did much of the OD work in parallel to the placemaking work happening in Ashford and St Peter’s Hospital (the work described in the Surrey Placemaking paper). This meant we were getting the learning from the actual ground level - we were learning by doing.
The OD foundational interventions took place over four years and helped to embed the structural, leadership and cultural change.
We created the space to look deeply at the objective of a place based operating model.
This led to a new ethos emerging of communities and not services.
Fig. 1 North West Surrey Alliance model of services diagram
Out of which we were able to identify the cultural conditions which needed to be embedded.
Fig. 2 North West Surrey Alliance Conditions for Success
So what? What are the implications for system leadership?
Through the 360 Degree approach, we were able to make connections between the top, middle and frontline - a golden thread that connected, in real time, the strategic thinking to delivering the practical doing. This meant that people were engaged with the change and, through choice, made it real by working differently and establishing innovative ways of funding important operational programmes through the workforce transformation fund. This led to pilots such as Health and Social Care Academy pilot and started to solve an important systems problem – in this case, the retention of social care staff.
The collaborative approach has also enhanced relationships between sectors – trust and communication have improved, creating a foundation for tackling other systemic issues beyond workforce. It was a huge, multi-leveled, multi-intervention organisational development programme. This means that wherever we are in a system, a place, or a piece of work, the first thing we say is ‘this all needs enabling’. The machinery needs to enable this, not get in the way, not create siloes and not be a barrier.
Our key learning includes
What is happening at Place illuminates the requirements of system leadership, culture and operating model structures;
An external OD partner with the right expertise is invaluable in helping a system to co-ordinate and combine policy and structural change, place based health improvements alongside developing the people skills and leadership needed;
Engaging people, even in times of uncertainty, is crucial – they often know the issues and frustrations and possess the ideas and creativity that can drive improvements for populations;
You have to be brave – face up to those aspects of long standing culture and behaviors that block rather than enable the right changes to happen;
Recognise what happens best at system, and what happens best at place – and that this may differ from Place to Place – use date and intelligence to understand this, not history or politics;
Through the OD work, we were able to radically reinvent the business model for health so that the approach was financially sustainable, as well as improving staff morale, retention and recruitment.
Key Takeaways for UK Healthcare:
Integrated Leadership for Integrated Problems: Systemic problems such as staff shortages span both the NHS and social care, so solutions require leaders from both to work collaboratively. This model of collective/systems leadership is crucial when addressing complex systemic challenges like staffing or delivering cancer care, where no single organisation has full control.
A clear takeaway is the importance of viewing staff as a shared regional asset. Investing in training (academies), career progression, and well-being across the system not only attracts new recruits but also improves retention – which is often more cost-effective than constant recruitment.
“The ambition of our partnership approach has been to stimulate system wide innovation by adopting a 360 degree programme approach. Our endeavours have tackled institutional barriers and encourage innovative ways of thinking in proposing new community-based integrated healthcare facilities. The 360 Degree Society Team have been instrumental in harnessing the latent power of collective determination focused on integrating people and places. We’re ready to embrace the next stage of our journey and to continue to deliver meaningful change and deliver real impacts for the people we serve”. Daniel Mouawad, Chief Executive at Spelthorne Borough Council
Work with us
Through our 360 degree approach, we can help you do the practical job of OD but also to actually embed it and change the culture. We can help you build a new set of leadership values and capacities, and coach them through the tensions in your system.
“Prospect were our strategic OD partner for Surrey Heartlands as we transitioned from CCG to ICS, and delivered Governing Body and Executive Team development programmes, one to one coaching, staff development workshops and facilitated and programme managed our Operating Model project. I found them to be credible, expert, flexible and effective and would highly recommend them as an OD partner’. Executive Director, Surrey heartlands ICB.
Want to know more?
Find out more about how we embedded system and culture change by reading the Surrey Placemaking case study or downloading the Surrey Placemaking report for more information.
Also check out Greater Manchester (opens case study), and in Lancashire (opens case study) where we have carried out similar pieces of work on a smaller scale.
LET’S START A CONVERSATION
Get in touch to explore how we can share the learning and continue to transform outcomes for communities