Where is our 'i' space?

Public services across the UK face an unprecedented level of challenge. Changing demographics, squeezing budgets, confused customers all feature in many places. Lot of subject matter experts around to tell us what works and what we need now is combine them with real world scenarios and make improvement happen on the ground for our people. We need to give birth to a new, joined up public service wide 'i'.

'i' stands for improvement. It also stands for ideas, innovation, integration, and involving others. With organisational changes everywhere, there should be a common understanding that all improvement needs change but not all change leads to improvement. Whether it is a large scale change in a policy or a process, in health, social care or more generally any public service, innovation and improvement needs to be at the heart of everything we do - simply because tomorrow's problems cannot be solved by yesterday's solutions. How do we, as leaders and followers, communicate our collective vision for our population and progress made to achieve them ? 'i' space could be part of the solution in articulating our public value, mobilise people and develop innovation capability.

'i' space can be a wall, corridor, board or a room conducive to encourage ideas and to plan, do, study and act on the promising ideas.  Some of the best performing and forward thinking health and care systems have their 'i' spaces everywhere - in fact, every space has an 'i' corner. The pictures below is an example of how the 'Qulturum' in Jonkoping County Council does it - it has plans and progress made by all organisations in the county mapped on a wall - it is not a dashboard for monitoring performance, it is rather a story board where people from various organisations come together to share their learning, generate ideas for innovation and plan next steps. 

Where is our 'i' space for Lancs? What can we do to build one together?

Practising Population Healthcare in the UK

Having been appointed to practice population healthcare in Lancashire, it was scary to know from Sir Muir Gray  that this might be the first ever Director of Population Healthcare role in UK's history! Call it 'no pressures' or 'sky is the limit' (I'd prefer the latter)', its a privilege and a joy to be serving our communities in this new role. Population healthcare is the art and science of achieving better health outcomes and improved care experience at a population level with a focus on maximising the value of resources invested in health and care systems. The health and care systems across the world are striving to achieve the 'triple aim' of improving health and reducing inequalities, improving the experience of care received by patients, carers and families and improve costs per capita. If you haven't heard about Triple Aim - here is an example youtube video on how they do this in Kent. It was very evident when I visited Jonkoping, Sweden along with colleagues in the NHS, that the current system we have built over the years is like the Choluteca bridge that leads to nowhere. This is a bridge built in Honduras by the US Army in 1930s that got hit by Hurricane Mitch in the 90s. The bridge survived but the river changed course! Our care systems are like this bridge. We need to re-orient them to be fit for purpose and 'innovation' needs to be at the core of everything we do as we move into the next phase of system reforms. 

Choluteca bridge before Hurricane Mitch

Bridge after Hurricane Mitch!

There are five things that evidently need to happen when it comes to system transformation in achieving Triple Aim - whether it is health care or social care:

1. Promising safety and embedding prevention in everything we do

2. Sincere engagement with staff, service users, families, and communities

3. Accelerating the pace of quality improvement

4. Reducing unwarranted variation and removing waste

5. System wide integration beyond the traditional walls of health and social care and building bridges with other sectors 

At this stage, colleagues say to me "mmm....but where is the capacity and do we have the capability; it isn't a core public health business, is it?" I believe addressing the Triple Aim is a core business for the public health profession, as it is for any other discipline in the health and care sector. The current healthcare public health capacity and capability inherited from the NHS by the local government should be developed to address Triple Aim. Public Health needs to achieve a balance to act across the four translation zones contributing to research, policies, service development and achieving population impact.

In order to achieve this, we need to complement the specialist public health expertise with  improvement leadership and expertise that are not regularly taught through the specialty curriculum. 

I am fortunate to have experienced some of this through working with the Institute for Healthcare Improvement and Advancing Quality Alliance. I believe there is a gap in our system - building improvement capability in our managerial and clinical staff - that can be addressed without much additional costs if there is a will to join up health and social care workforce development. We need a 'Qulturum' or 'Centre for Value Improvement in Health and Care' for Lancashire that spans across health and care commissioning and provider landscape. This will unite the system to build improvement and innovation capability to achieve a common vision of making Lancashire a better place to live, work and enjoy. Everyone working in the health and care sector (and all other sectors) should have two jobs - job 1 is to produce reliably good quality care, job 2 to continuously improve job 1. We need to think systems of care for our population and not institutions providing/commissioning care! It is a shared improvement leadership responsibility of all public health, social care and NHS leaders serving a given population to make this happen. It is one of the golden keys to unlock the solutions to address Francis report's recommendations, Winterborne View incident, rising demand in A&Es etc. Perhaps the developing Academic Health Sciences Network and Strategic Clinical Networks can work with the Health and Wellbeing Boards and their partners to achieve this.

So, what else is the role of shared leadership for achieving Triple Aim? Tom Nolan, Senior Fellow at IHI defines this as building will, generating or finding better ideas and models, and ensuring impeccable execution. This framework, Will-Ideas-Execution is key to the leadership to address Triple Aim. I will just talk about building will through four questions in this blog post.

Building 'will' starts with understanding the results of how we perform today. It is key to undertake the challenging work of innovation and culture change. The questions go like this:

1. Do we really know how good we are?

2. Where do we stand relative to the best?

3. What do we know about the variation within our system?

4. What is the rate of improvement over time?

I think we have some fantastic assets across public health, social care and the NHS that can help answer these questions in a robust way. Critical appraisal, driver diagrams and run charts, community engagement, dialogue cafes, storyboards and networks spring to mind. 

What do you think? Please share your thoughts by clicking 'Add a comment' below.