Digging Deep - what really makes change happen in care and health
When NWADASS invited me to work with them to capture learning about workforce integration across health and social care I immediately knew based on my experiences of working with integration that I wanted to get into the people aspects of change. I’ve seen so much frustration arise when places have focused purely on changing processes and implementing re-structures as the pace of change has slowed and the emotional toil of uncertainty has reduced productivity. Where I’ve seen real change happen, at pace, is where people working in different teams, professions and organisations have been empowered, enabled and equipped to come together, get to know and understand each other better, share challenges and ideas and start to try something new.
The implementation of blended roles in Tameside has involved change across district nursing, care at home and home care services and commissioning approaches with broader reach into GP services, social work and hospital care. So straight away this is complex because of the range of employing organisations, professions and different ways of working involved. My interest was immediately sparked when I heard that several other councils had begun their journey towards blended roles at the same time as Tameside and yet Tameside had, when I began this work, been the only North West council to successfully implement. I wanted to get to the heart of what it was about Tameside’s approach that had made the biggest difference.
Kath Smythe Collective’s Four Es Model of Change
Informed the design of the methodology.
Part of my brief from NWADASS was to develop a methodology that would enable the learning to be captured in a way that would be useful and practically helpful to other councils looking to make similar change happen. One of the great things about this project is that NWADASS gave me time to step back, reflect and really think carefully about how to do this. Often as a consultant, there’s a big focus on moving straight to implementation. The value that NWADASS placed on ensuring the methodology was right, in my view, has resulted in a much better quality blueprint product.
What did I do and how did I develop the methodology? I got myself a whiteboard and posted onto it a set of questions that I wanted to be able to answer, questions like:
What is a blueprint and what does it need to do?
What principles should be guiding how the learning was captured, for example, what sort of evidence should we be capturing? How could we ensure we were contributing to as well as capturing change?
Who should we involve, and how?
How could the latest research, evidence and learning about change help to inform the methodology?
How could we ensure we captured the learning from different parts and at different levels within the health and social care system?
How do we best enable others to learn? How do we make the learning participatory? And practical?
The process of working through these questions and bringing information, thoughts, ideas and research together into what was effectively a storyboard enabled me to then share this with other people in the NWADASS network so we could work together to further explore and develop. I talked to workforce leads, other change makers, senior stakeholders, colleagues at Tameside. Together we took the time to explore the thinking and evolve the methodology.
Storyboard capturing early thinking ideas that shaped the methodology
This meant that when the time came to start to capture the learning, there was a great level of buy-in. I was able to talk with district nurses, care staff, managers within care agencies, commissioners, senior leaders and all have been open and honest in talking about the inspiring journey they’ve been on together. People were excited about being able to explore and share the learning in ways that get beyond a dry capture of here’s the steps we followed and into the richness of these are the relationships that formed, this is what surprised us, this is what we were fearful about, this what we learned along the way, this is what helped us, this is what got in our way, these are the stories that demonstrate the impact we are making. Similarly, colleagues in other councils, interested in exploring a shift towards blended roles responded by coming together into a community of practice. Through this community of practice we’ve been able to take time and space to share the learning in an iterative way as it’s emerged, explore what the implications of the learning are for other places, consider different options for how blended roles could work in different places and help each other to understand how to navigate the blended roles journey.
“This is the closest to perfect example I’ve seen in person of modern change theory into practice - relationships, empowerment, culture, experimentation”
I have to say I’m pretty chuffed that I got to work on this project. I’ve learned so much from the people I’ve worked with on it and I hope that by bringing some different thinking, I’ve enabled the learning that is shared to be both rich in content and practical in application. I hope we can continue to be courageous in finding new ways to discover and learn what is really effective in making change happen in health and social care. Equally, I hope that enabling, equipping and empowering staff to come together across organisational and professional boundaries and start to experiment with different ways of doing things - that ultimately results in better lives for people - can become the norm of how we make change happen.
To find out more visit North West ADASS website and go to the Workforce Integrated Blueprints section
