B1: Collaborating across barriers Dr Frederick Lewis* | Dr Christopher Hilton* | Dr Joanne Watson & * West London Mental Health NHS Trust & Torbay & South Devon NHS Foundation Trust www.menti.com | 13 20 2
www.menti.com | 13 20 2
By the end of the session… • Know more about community out of hospital and integrated models of care • Understand some of the challenges (and successes) of delivering new care models involving multiple partners and complex relationships • Recognise the relevance of leadership skills in different clinical settings • Understand how QI skills can be used as a vehicle for culture change within departments • Generate ideas about how these approaches are transferrable across the NHS in general
Collaboration and Conflict: Real life experiences of leadership in a new model of care Dr Freddie Lewis * and Dr Christopher Hilton * * West London Mental Health NHS Trust Correspondence emails: frederick.lewis@nhs.net, christopher.hilton@nhs.net Follow us on Twitter (@EalingHome_Ward). Watch a video about the service by scanning the QR code
• North west London – context • Home ward Ealing – concept • Relationships – it’s complicated • Observation and formulation – conflict • Techniques to address – QI, collaboration and compassionate leadership • Next steps – accountable care, mental health trusts and community provision
North West London and Ealing
Our service
Relationship status: it’s complicated! Internal interfaces • Lead, partners, s75 arrangement • Subcontractors, agencies • Teams, staff, professional groups, staff-side • HR, finance, clinical governance etc (x5) External interfaces • Acute trust(s), primary care, nursing homes, ambulance service, community trust(s) • Mental health trust • STP • Other community and intermediate care providers • Cross-border interfaces
WLMHT in 2017
Reality of Change
Complex Adaptive (Living) Systems (Atkinson and Rogers 2016)
How to tackle this issue? (Langley et al 2009)
Other Strategies 1 + 1 = 4
Compassionate Leadership Attending Understanding Empathising Helping (Atkins and Parker 2012)
The best care For the At the whole lowest population costs
Experience of care and quality gap The best care Health and For the At the Wellbeing whole lowest gap Finance and population costs efficiency gap
The best care For the At the whole lowest population costs
The credibility gap?
From STPs to ‘accountable care’ • Clinical – whole person • Outcomes focussed • Incentivise best outcomes (financially) • Providers to collaborate to close gaps rather than blaming commissioners or ‘the system’ • Eg: • CAMHS / Forensic New Models of Care • Home ward Ealing • One You Ealing
All sounds familiar? • 5YFV / STP • ~1950 – 2017 in MH • • Care planning Care Programme Approach • • Care coordination Care coordination • • Care closer to home Care in the community / shifting settings of care • • Virtual wards Crisis Resolution and Home Treatment Teams (NSF) • • Integrated care Bio-psycho-social • • Integrated teams / CMHTs co-commissioning • • Extended roles “New ways of working” • • Risk stratification Risk informed triage and care • • Co-production User involvement • • Patient-centred care Recovery model • • GP at centre of care Primary care liaison
#choosepsychiatry
References: Atkinson J and Rogers M (2016). ‘The Big Five’ of Living Systems. Accessed via http://www.heartoftheart.org/?p=2851 on 27th July 2017. Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009. West, M (2016). Lecture: Encouraging staff wellbeing in health and care. Accessed via https://www.kingsfund.org.uk/events/encouraging-staff-wellbeing-health-and-care on 14/12/16. Atkins PWB, Parker SK (2012). ‘Understanding individual compassion in organisations: the role of appraisals and psychological flexibility’. Academy of Management Review, vol 37, no 4, pp 524 – 46. West M, Eckert R, Collins B, Chowla R. ‘Caring to change: How compassionate leadership can stimulate innovation in health care’. The King’s Fund, May 2017.
Find the Similarities
Leading in a Foreign Land Dr Joanne Watson Deputy Medical Director Torbay & South Devon NHS FT
• Recognise the relevance of generic leadership skills applied in different clinical settings • Understand how quality improvement skills were used as a vehicle for culture change within departments • Generate ideas how these approaches transfer across the NHS in general
Story time
Story time • Once upon a time…. • Everyone went about their business…. • Until one day….. • Because of that….. • Because of that….. • Until finally….
Once upon a time
Until one day
Because of that
Because of that Our mission is to provide a service where families receive the safest care- planned, agreed and delivered in full partnership with compassionate staff who strive to achieve the best possible outcomes and experience of care.
Until finally Stillbirths each year from the sentinel year Number of 25 20 15 10 Median Goal 5 0 year 2012 year 2013 year 2014 year 2015 year 2016 year 2017 todate
Leading in a foreign land…
Build the Team….
Navigate- i.e. set direction • Find a purpose and goals which are clear and bigger than the person or organisation Our mission is to provide a service where families receive the safest care- planned, agreed and delivered in full partnership with compassionate staff who strive to achieve the best possible outcomes and experience of care.
Use QI Skills It is the learners who inherit the future. The learned find themselves equipped to live in a world that no longer exists. Eric Hoffer 1902 – 1983
Until finally Stillbirths each year from the sentinel year Number of 25 20 15 10 Median Goal 5 0 year 2012 year 2013 year 2014 year 2015 year 2016 year 2017 todate
Leading in a foreign land… "If your actions inspire others to dream more, learn more, do more and become more, you are a leader." John Quincy Adams
Over to you now…..
• Find someone near you that you don’t know and discuss themes which resonate in the area in which you work (5 min) • Speak to others on your table to identify any common themes (5 min) • Feedback ( verbal and via menti.com )
By the end of the session… • Know more about community out of hospital and integrated models of care • Understand some of the challenges (and successes) of delivering new care models involving multiple partners and complex relationships • Recognise the relevance of leadership skills in different clinical settings • Understand how QI skills can be used as a vehicle for culture change within departments • Generate ideas about how these approaches are transferrable across the NHS in general
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