Leaders for population health often ask, ‘Where is the best place to start?’ Our work with local areas suggests that the answer to this is to understand where you currently are. This means understanding the local population, their needs and the assets that exist locally to help meet these needs. It is easy to overlook existing good work or progress already made and, instead, start by trying to find new ways to deliver improved integration or population health. However, we have found that by starting with a more assets-based focus, areas can create a shared system-level understanding in and across places that is key to furthering population health efforts for the longer term. We’ve been using our Vision for population health framework to help areas prioritise actions on population health and to support people to think through the leadership practices needed to deliver this. Using our framework, areas – such as the Coventry and Warwickshire or Cheshire and Merseyside Health and Care Partnerships – have worked with an extensive range of partners to map assets, and identify existing good practice, skills and passions that lay untapped.
This assets-based approach then allows areas to move forward by considering gaps and opportunities, identifying shared priorities and developing strategies for improving the lives of local people. The areas we worked with agreed strategies including a range of cross-system practical actions that could be undertaken by partner organisations in the short, medium and longer term.
The reality for leaders at all levels as they try to work differently for population health is that they encounter messiness, complexity, uncertainty and may feel confused or under-prepared for the task ahead of them. They may question the adequacy of their training and struggle to apply a wider health and care system view if they come from a specialist background. Leaders may face the strain of trying to find the time and opportunity to contribute their insights while working in under-resourced parts of the health and care system such as public health, charities or social care teams. They may face conflicting priorities: balancing internal organisational goals and objectives while trying to work as a part of an emerging ‘system’. Or they may find it challenging to work in a new way that requires system leadership skills, test-and-learn approaches and an acceptance that there is no blue-print or ready-made solution to use.
This messiness and leadership challenge is a natural part of making progress and is the most common issue we hear about with leading population health. We have found that success is possible when leaders are supported to work through these challenges, developing skills and confidence, and when senior leaders within that system are brave enough to give the support and permissions for staff members to act for population health. For example, leaders across Oldham, North East England and London are working to build their local population health workforce in this way; more than 140 people are working on more than 50 population health improvement initiatives that have begun to unlock cross-system potentials and energies.
Collaboration is key
Many of the factors affecting the health of individuals and populations lie outside the realm of health care services, and effective population health is a collective responsibility. However, in some areas the focus is still on health care – or government-led population health efforts. So, another common question we hear is ‘Who else do we need to involve?’, quickly followed by ‘How should we work together?’ We often find ourselves prompting: ‘Where is the community and voluntary care sector? Or the wider workforce? Where is public health? Where are the police, education, housing? Where is social care?’.
Evidence from our Leadership for population health programme suggests that bringing an extensive range of individuals together early unlocks considerable gains. The collaborative approach needed for population health can be likened to a football game: if the goal is to improve the lives of people in a place, then the various organisations, like players, each have a unique and important role to play. Understanding the role of oneself and others and formulating a co-ordinated approach becomes paramount. Taking the time to build understanding, trust and dialogue across partners is fundamental to progress, though this is not always easy because of different priorities, language, viewpoints and focus. Using this approach, integrated care systems (ICSs), primary care networks, individuals and organisations – for example, Dorset ICS, Northern Ireland health and care partners, and Mid and North East Essex Primary Care Networks – are beginning to create change.
We’ll be exploring these more at our conference in April 2020. We look forward to developing this work further in partnership with you and your teams through our strategy as it moves forwards to support a sustainable and healthier future.