1. Transformation in Integration Catherine Blackaby NHS Improving Quality @NHSIQ @CBlackaby #integrationpioneers

2. What do we mean by integration? @NHSIQ @CBlackaby #integrationpioneers

5. Surely it’s easy? X YX Y Just do itEfficient system IHI and RC Lloyd & Associates 2008 @NHSIQ @CBlackaby #integrationpioneers

6. X

7. The 14 Pioneers ICSP Pioneer sites BarnsleySouth Devon and Torbay CornwallSouthend GreenwichSouth Tyneside IslingtonWest Cheshire KentWELC London North West LondonWorcester @NHSIQ @CBlackaby #integrationpioneers

8. The Pioneer Programme 14 areas across England Integrating… – Acute and primary care – Mental and physical health care – Social care – Housing – Third sector – All the care and support needs around the person @NHSIQ @CBlackaby #integrationpioneers

10. Source: The King’s Fund http://www.kingsfund.org.uk/projects/health-and-health-care-london @NHSIQ @CBlackaby #integrationpioneers

11. ?

12. In association with: National partners @NHSIQ @CBlackaby #integrationpioneers

13. https://www.gov.uk/government/publications/integrated-care @NHSIQ @CBlackaby #integrationpioneers

14. Aspiration The pioneer localities will act as “a means of driving forward change at scale and pace from which the rest of the country can benefit” (Collaboration partners) @NHSIQ @CBlackaby #integrationpioneers

16. Six conclusions from previous “pioneer type” programmes in health and social care over the last decade 1.Promising pilot programmes are rarely replicated successfully 2.Issues of spread and scale are typically an afterthought 3.Change is highly context specific 4.People outside the pilot locality do not feel any ownership of, or emotional connection with, the pilot project so change processes have to be “pushed” onto other localities rather than pulled. 5.Pioneer sites have limited ‘bandwidth’ to coach others and spread best practices 6.Very few evaluation studies look beyond the pioneers to issues of scale and spread Source: @HelenBevan @NHSIQ @CBlackaby #integrationpioneers

17. Emerging themes in large scale change FoundationEmerging direction OrganisationCommunity Power through hierarchyPower through connection Mission and visionShared purpose Making sense through rational argument Making sense through emotional connection Leadership-driven (top down) innovation Viral (grass-roots driven) creativity Led by expert opinionAllow all talent Engaged patientsPassionate users Clinical networksMass communities Tried and tested, based on experience Open innovation TransactionsRelationships Source: @HelenBevan @NHSIQ @CBlackaby #integrationpioneers

18. Two kinds of system-level problems A difficulty Broad agreement on the nature of the problem Some understanding of what the solution might look like Clarity about the time and resources required to solve the problem A mess No clear agreement about exactly what the problem is Ambiguity about how improvements might be made Unbounded in terms of the in terms of the time and resources it could absorb, the scope of enquiry needed to understand or resolve it, and the number of people that may need to be involved Source: System Failure - Why Governments must learn to think differently, Jake Chapman, published by Demos

19. "The secret to getting ahead is getting started. The secret of getting started is breaking your complex, overwhelming tasks into small manageable tasks, and then starting on the first one.“ Mark Twain @NHSIQ @CBlackaby #integrationpioneers

20. Necessary behaviours for managing wicked problems Establishing shared goals Build trust Exchange information & other resources Embrace emergence Explore new territory Create new knowledge Facilitate, enable & coach @NHSIQ @CBlackaby #integrationpioneers

21. Closed innovationOpen innovation As a “pioneer” test site, we want to be left alone for a period of time so we can work it out for ourselves As a “pioneer” test site, we seek to continuously get ideas and guidance from leading thinkers and practitioners outside our local area; as a result we sustain our energy for change and continue to implement changes over a longer timeframe We will test our new ways of working internally “to destruction”. When we are confident they will work, we will offer to share our “best practice innovations” with others A wider group has contributed to the innovation process, beyond our host organisation; this means that when it comes to diffusing the learning from pioneer sites, people from other localities already feel that they own it. Spread is more likely to be “done with” not “done to” and to be “pulled” not “pushed” @NHSIQ @CBlackaby #integrationpioneers

22. The power of co-creation

23. How are we doing it? 1.Build the Integrated Care and Support Exchange (ICASE) as a learning community with and around the pioneers 2.Create, capture and spread knowledge, skills and ideas using open innovation and knowledge sharing principles 3.Put the pioneers at the centre of the learning community but with an open innovation mindset 4.Build a compelling narrative that calls people to action and that focuses as much on “big picture” aspirations for change across the country as it does on the specific localities @NHSIQ @CBlackaby #integrationpioneers

24. 5.Plan for spread right from the start 6.Create a special status for localities that applied but didn’t achieve pioneer status. Create opportunities for them to progress more quickly and effectively than the pioneers. 7.Clearly define what being a pioneer; create a “compact” (contract) that sets out the “give and get” as a condition of being a pioneer e.g. participation in open innovation processes. @NHSIQ @CBlackaby #integrationpioneers

25. Where have we got to? @NHSIQ @CBlackaby #integrationpioneers

26. How are we doing it? 1.Build the Integrated Care and Support Exchange (ICASE) as a learning community with and around the pioneers 2.Create, capture and spread knowledge, skills and ideas using open innovation and knowledge sharing principles 3.Put the pioneers at the centre of the learning community but with an open innovation mindset 4.Build a compelling narrative that calls people to action and that focuses as much on “big picture” aspirations for change across the country as it does on the specific localities @NHSIQ @CBlackaby #integrationpioneers ?

27. 5.Plan for spread right from the start 6.Create a special status for localities that applied but didn’t achieve pioneer status. Create opportunities for them to progress more quickly and effectively than the pioneers. 7.Clearly define what being a pioneer; create a “compact” (contract) that sets out the “give and get” as a condition of being a pioneer e.g. participation in open innovation processes. @NHSIQ @CBlackaby #integrationpioneers X X ?

28. “If you feel entirely comfortable, then you're not far enough ahead to do any good. That warm sense of everything going well is usually the body temperature at the centre of the herd." — John Masters

29. Support programme Support managers Experts for trouble shooting Leadership development Large scale change training Networks and events Communications Learning community development @NHSIQ @CBlackaby #integrationpioneers

30. ICASE www.icase.org.uk #integrationpioneers @NHSIQ @CBlackaby #integrationpioneers

34. A different approach Working with the Innovation Unit – a not-for-profit social enterprise – committed to using the power of innovation to solve social challenges – supporting leaders and organisations delivering public services to see and do things differently to achieve radically different solutions that offer better outcomes for lower costs. www.innovationunit.org @NHSIQ @CBlackaby #integrationpioneers

35. A different approach Working with the Innovation Unit Being steered by sites’ preferences and comments Tailoring a programme of innovative support that can be dynamic and co-produced with the sites Developing a taxonomy for this way of working, where themes become key learning communities @NHSIQ @CBlackaby #integrationpioneers

38. Sarah McBride My ‘other’ vote is about large scale pooling of budgets, including how to get the governance right, and public, democratic and clinical involvement. Thank you! The voting so far (24 hours later) …

41. Next steps for the learning community Selected themes from our first poll: “Innovative commissioning & contracting” and “Workforce Development” Targeted support and face to face events Tweet chats – April Google hangouts – May – Like a group webinar allowing you to chat face to face and share documents and other materials @NHSIQ @CBlackaby #integrationpioneers

42. Next steps for the learning community Selected themes from our first poll: “Innovative commissioning & contracting” and “Workforce Development” Targeted support and face to face events Tweet chats – April Google hangouts - May Challenge prizes Network development Pioneer initiated tweetchats, events and meet ups @NHSIQ @CBlackaby #integrationpioneers

43. The challenges of: – Multiple national programmes – Multiple forums for sharing – Providing flexibility for different levels of engagement – Balancing the expert voice with the voice of those on the frontline Commitment and energy of those involved @NHSIQ @CBlackaby #integrationpioneers Next steps for the learning community

44. Our request to you Post on ICASE – join the conversation! Become part of the virtual user group Tweet using #integrationpioneers Take part in the horizon scanning and hangouts Look out for challenge prizes Tell us what else has worked for you What else should we be trying? @NHSIQ @CBlackaby #integrationpioneers

45. “We can't impose our will on a system. We can listen to what the system tells us, and discover how its properties and our values can work together to bring forth something much better than could ever be produced by our will alone.” ― Donella H. Meadows, Thinking in Systems: A PrimerDonella H. MeadowsThinking in Systems: A Primer @NHSIQ @CBlackaby #integrationpioneers

46. References Wicked problems and the role of leadership – INL 2009 System Failure - Why Governments must learn to think differently, Jake Chapman, published by Demos Integrated Care: Our Shared Commitment May 2013 https://www.gov.uk/government/publications/integrated-care Thinking in Systems: A Primer – Donella H Meadows @HelenBevan enquiries@icase.org.uk @NHSIQ @CBlackaby #integrationpioneers