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Durka Dougall: Transformational change in health and care
DD: Durka Dougall
DD: We at The King’s Fund have been calling since 2012 for transformation and particularly a type of transformation which is a reform from within. So the empowerment of staff and communities to lead transformation. So our report has delved into that aspect of lived experience, something which is relatively less focussed on in the literature.
We’ve picked four sites that were purposely selected to cover primary care, mental health, acute care and community care. So the Bromley by Bow Centre that works in East London in one of the most deprived boroughs to forge new and better ways of meeting the needs of their local communities. They’ve been growing organic solutions, they’ve been building on assets and really creating new and better ways. So they talk about having hundreds, thousands of visitors, endless research and yet, still across the country, they’re seeing what they saw in Bromley by Bow decades ago and they are asking us to review how we learn as a health and care system. Is it that we’re focussing too much on them models and its uniqueness or trying to replicate it directly into a context that won’t directly fit? Or actually, what they say we need to do is focus on their approaches, their principals and their experience for that is what will transform health and care.
Birmingham and Solihull NHS Mental Health Trust, the rapid assessment interface and discharge service. So this team have been working tirelessly to transform mental health care in acute hospitals by positivity, by using data to motivate and inspire staff to be using their insights about human behaviour, to understand what opportunities lie ahead and in that, they’ve achieved a lot, but the fascinating thing that they kept saying to us is, don’t look so much at that, there’s so much more to do and what they flag is that there is a need to unlock the potentials even more in areas like parity, diversity and technology.
Northumbria Healthcare NHS Foundation Trust created a brand-new purpose built facility to transform emergency care across a large geographical area. The fascinating thing about this story was their tireless dedication to quality and what they say is, the NHS is exceptionally risk averse at the moment. It doesn’t want to hear about failures, it just wants success stories and what they’re showing is that they’ve not been swayed by the challenges they faced, that actually the efforts don’t stop when you face a hurdle, and it’s not about praise; those are not endpoints. Both success and failure are points along a journey and the focus should be on quality.
And finally, our model from Birtsog, the Netherlands that was created by a nurse leader. He felt that the political structures, the management structures, the bureaucracy was reducing the autonomy and ability of staff to provide quality care and they created a simple structure of a small self-regulating community nursing team to care for patients in a quality way, supported by clinical coaches, supported by IT and supported by administrative officers. And what they’re challenging us to do, is to look at our systems and ask are they enabling or are they hindering staff to provide quality?
What are the implications for the health and care transformation system? The first take-home message is that we need to transform our approach to transformational change. Rather than looking for single solutions or a roadmap, actually to be comfortable with the chaos. It’s about instead really focussing on our purpose. The second, is that there are opportunities to unlock but that involves understanding lived experience and enabling people to give their very best.
A key message coming from all the stories is that there are barriers to overcome. The structures that currently exist are not always helpful in enabling people to provide quality and to provide transformational change. That’s the funding, the training, the regulation, the organisational cultures, the power dynamics. Simple things and we think three things are key. First, is the provision of support, skills and confidence for individual, teams, organisations and systems. Secondly, we need to look collectively at the structures. We need to think how best we can join up the system, locally but nationally as well and finally, we need a transformational leadership. That’s not a single person, that’s an approach. That’s the ability to work skilfully within this landscape to unlock the potential of people both staff and communities, to provide quality across health and care.