Health and Social Care Integration

Organisational DevelopmentSupport

1. / Introduction
1.1 / This paper sets out a proposed Organisational Development (OD) approach to support the process of Health and Social Care Integration in Fife. The paper draws on evidence from recent research and experience of joint working and integration of health and social care services. The areas covered include background and context; leadership and engagement; OD support, resource implications; and the planning process. OD plans must align with and support service strategies, plans and emerging models of integrated working.
2. / Background and Context
2.1 / Well documented demographic, social and budgetary pressures and increased public expectations continue to intensify demands on services. Thisrequires public services “to work much more closely in partnership to integrate service provision and thus improve the outcomes they achieve” (Campbell Christie, 2011). The Scottish Government (2012) have stated “separate and sometimes disjointed systems of health and social care can no longer adequately meet the needs and expectations of increasing numbers of people”.
2.2 / Within Fife there is a history and culture of effective partnership working involving Fife Council, NHS Fife and other community partners to deliver high quality services with and for the people of Fife. The need to build on this work and continue to develop an ‘assets-based’(people-centred) approach to produce the best possible outcomes for those served is well recognised. The aim being to provide “accessible, seamless quality services, personalised and responsive to the changing needs of individuals, designed with and for the people of Fife” (Fife Health and Social Care Partnership, 2012).
2.3 / The creation of a positive and creative work environment represents “a substantial shift in attitude within many organisations” (Christie Commission, 2011). In Fife, there is a commitment to continue to develop a people-centred culture as an essential underpinning for the sustained delivery of optimal services.
2.4 / A joint “infrastructure” has been established to support the process of integration. The Chief Executives of Fife Council and NHS Fife jointly chair a Programme Board to lead and oversee the health and social care integration programme. The Programme Board has emphasised the need to focus on service delivery and minimise structural change, recognising it is people in Fife who are best placed to determine future arrangements which maximise utilisation of collective expertise, skills and resources.
2.5 / Six ‘workstream’ groups have been established to take forward key aspects of the integration agenda to support the achievement of agreed common aims i.e.
  • Governance and Accountability
  • Finance and Integrated Budgets
  • Whole System Working
  • Outcomes and Measurement
  • Communication
  • Workforce Development
The workstreams are involvedin developing and implementing appropriate arrangements to support and facilitate effective service integration.
2.6 / Research evidence confirms effective leadership, relationships and engagement are key toachieving successful integrated working. The OD planaims to provide a framework to support the realisation of the health and social care integration programme by:
  • supporting key groups and teams and assist strategic coherence across ‘the whole system’;
  • develop leadership capability and capacity; and
  • promote engagement in the development and delivery of integrated services.

3. / Engagement
3.1 / Health and social care integration involves a whole-system, values-driven approach based onan enabling permissive environment focussed oncontinuous service improvement according to patient and service user requirements.
3.2 / Clarity of purpose, a compelling strategic narrative, shared sense of direction and stakeholder involvement are critical factors in achieving successful outcomes. Reconfiguration and integration of services is complex and multi-layered, and not susceptible to simple quick-fix solutions. To make integrated working a reality it is essential to continue to develop a conducive culture founded on effective trustful relationships at all levels.
3.3 / Staff need to feel valued and (with service recipients) are well placed to identify how services can be enhanced. Research demonstrates that effective employee engagement drives innovation, efficiency and performance improvements.
3.4 / A particular focus on leadership and cultural development is crucial to a people-centred approach which recognises the quality of services depends on the quality of individuals and teams engaged in service development and delivery.
3.5 / A Professional Reference Group with membership drawn from all key professional groups has been established to ensure multi-disciplinary and multi-agency professional engagement and contribution to shaping the emerging strategic direction.
4. / Leadership
4.1 / Leaders have a key role in leading service development, maximising the contribution of individuals and teams and ensuring,wherever appropriate, individuals are engaged in the process of joint working and service improvement.
4.2 / Senior leaders have a key role in ‘setting the tone’ – creating a positive supportive and enabling culture. Leaders must embody and exemplify through their actions and behaviours the values which underpin effective engagement in person-centred collaborative working.
4.3 / Leadership encompasses a range of strategic and practical functions that extend beyond cultural change and the creation of a shared vision and purpose. To achieve the strategic aims of integration, including the most efficient use of resources and better outcomes for users of services, effective leadership in key cross boundary areas including people and financial management will be required.
4.4 / Professional leadership within the context of clinical and social care regulatory and governance frameworks needs to be acknowledged. Professional leaders will play a critical role in collaborative activity to support the achievement of the seven national Health and Care integration outcomes.
4.3 / Leadership is a visible distributed function required at all levels to support employee engagement, empowerment and innovation, and to ensure services continue to be responsive and flexible in meeting the needs of those served. This requires responsibility and accountability for decision making, problem solving and taking action, being devolved to as close to ‘the point of care’ as possible.
4.5 / Leaders need to be adaptive, relational and collegiate, being prepared to listen, engage in dialogue and inquire rather than prescribe solutions, and be able to coach, mentor and facilitate learning.
4.6 / The position of Joint Accountable Officer will be critical in providing visible leadership, direction, and drive to enable successful integration.
5 / Workforce development
5.1 / Continuing staff and organisational development is key to ensuring the delivery of high quality services. Fife has a strong track record of supporting multi-disciplinary and multi-agency learning and development to underpin integrated service provision and the need to build on this work and continue to develop joint workforce development provision to produce the best possible outcomes for those served, is recognised.
5.2 / The integration of Health & Social care will undoubtedly accelerate the development of integrated community based services and new clinical and care models and pathways. This will require staff to acquire and adopt new skills and ways of working. However it is also important that staff continue to be supported to develop the requisite knowledge and skills to fulfil their role, in line with professional and regulatory requirements.
6. / Support
6.1 / The OD Plan and the planning process must be service-led and owned by service leaders. Notwithstanding the emergent nature of the OD planning process – it is envisaged that a range of ‘OD’ support and interventions will be required to support the process of service integration and improvement.
6.2 / A feature of the approach will be the creation of opportunities for individuals from across ‘the system’ to come together to:
  • heighten awareness of the roles, responsibilities, values, challenges etc of others;
  • develop a clear understanding of priorities for action;
  • co-create joint working arrangements and new ways of working; and
  • share learning and good practice.
Transcending ‘silo thinking’ and understanding the workings of the ‘whole system’ provides a basis to ensure the ongoing development and delivery of high quality, safe, cost-effective services.
6.3 / Support will be available to key groups engaged in service integration and the development of new ways of working e.g. those engaged in Local Management Groups, ICASS, Hospital at Home (virtual ward).
6.4 / A range of support “mechanisms” will be deployed to support those involved in leading change, for example, consultancy, mentoring and coaching support, action learning and formal learning programmes e.g. The Fife Partnership Collaborative Leadership Programme.
7. / Resources
7.1 / The Head of Organisational Development, NHS Fife and the Workforce Development Manager, Fife Council, will play a key role in coordinating the development and implementation of the OD Plan.
7.2 / However, it is important to recognise that direct OD resources, and service based resources, are extremely limited and currently committed towards existing work priorities, including those linked to supporting the delivery of professional functions.
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7.3 / Given the scope, importance and scale of health and social care integration, consideration will require to be given to how existing ‘OD’ capacity can be strengthened commensurate with organisational requirements.
7.4 / It is important to draw a distinction between OD as a ‘process’ and a ‘function’. The former connotes a supportive approach to managing change while the latter relates to those whose formal organisational roles involves supporting change.
7.5 / Given the need for stakeholder ownership and the number of employees affected by service integration, a priority requires to be given to supporting and harnessing internal leadership capacity to support engagement in the process of change.
8. / Planning
8.1 / The OD Plan comprises three interrelated phases which are cyclical and iterative rather than linear and discrete. The three phases are: diagnosis, implementation and review.
8.2 / The diagnostic phase involves engagement with key stakeholders to identify issues to be addressed, to prioritise actions and to determine the targeting of OD activities and interventions. The implementation phase relates to the delivery of agreed OD support arrangements. Finally, the review phase involves an evaluation of progress against intended outcomes. This may well result in further needs being identified requiring the development and delivery of further support.
8.3 / Following endorsement of the approach set out in this paper a more detailed planning and scoping exercise will be required to establish timelines, actions, and resource requirements for delivery.
9. / The Programme Board are invited to:
  • note, and endorse the approaches set out in the paper.

T Boyle / J E Gibson
Head of Organisational Development / Workforce Development Manager
NHS Fife / Fife Council
S Moore / S Manion
Executive Director / General Manager
Social Work Services
Fife Council / Dunfermline & West Fife Community Health Partnership
NHS Fife

30th January 2013

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H&SCI OD paperv4