Paul Corrigan has been working closely with vanguard leaders over the last few years as they work to implement new care models. In the first in a series of posts, Paul considers some of the challenges leaders face when implementing change and how they are learning from each other.
First, a declaration of interest. I am writing this post not as a disinterested observer of the development of multispecialty community providers (MCPs) but as someone who has had two years of meetings with MCP leaders. I hope what is lost because of partiality is outweighed by what is gained from active involvement, as I speak from the experience of working with real people trying to change real practice in real places in public services.
While I am generally optimistic about change, real change has false starts and bouts of despair, as well as the exhilaration of progress. These posts will describe the real hard graft of change, warts and all. Real change in public service is hard both in strategy and daily grind, and anyone who pretends differently is selling those that lead change short.
These posts are reflections on the last two years of meetings held with the 14 MCP vanguards to discuss the tactics and strategy of creating and maintaining new care models. The idea of the meetings was based on the belief that each leader who attends has the capacity to teach and to learn on each occasion. If you learn something then it’s easier to teach (and vice versa).
Given that the aim is for each leader to teach and learn, we felt it was important for each session to concentrate on a single topic. We started by asking each leader to report to the group on the experience of what, in the last couple of months, is different for patients? Everyone agreed that the new care models were developing something new, but outside of all of the changes in process, have the public noticed any difference?
The first and recurring problem is what do you call people? Everyone in the room was used to calling people ‘patients’, but we also recognised that social care must be a significant part of new care models and they call people ‘service users’, while local government and the voluntary sector call people, ‘people’. After a few months of hyphenated and stumbling descriptions, it was established that people may be the best descriptor.
Beyond that difficulty, concentrating on what was different for people was both a problem and a relief for leaders. A problem because the day-to-day experience of leading change can remove leaders from what is happening with people. Leading across very different organisations seems to mean an exponential increase in the number of meetings you have to get to and lead. Initially they are all pretty important. But changing the emphasis to the difference all of this makes to people is initially difficult.
But still, as the meetings progressed, leaders could describe how a small group of people were now getting some more coordination in their care. When leader A was describing that in detail, leader B would then say: “We tried to do that at B but it didn’t work. Please slow down and go through exactly how you at A made that change.”
This would lead to some detailed descriptions of how change had been created which would leave leaders from C and D asking even more detailed questions, so that by the third and fourth meetings about what the differences were for people, we couldn’t get through all our exemplars.
This caused me to reflect hard on how we normally expect people to learn about best practice and how different this method was. In helping people to learn, we try to boil things down to three slides of bullet points.
But what if you don’t boil it down to a series of bullet points? What if you ensure that new practice is described in all its hesitations and messiness, and even more importantly, it is messily described to someone who is also trying to do the same set of changes (and knows that in an hour’s time, they are going to have to describe their own hesitations and progress).
The description of change becomes very detailed and very real. The person describing knows that their interlocutor is trying to do much the same and will be able to detect any gloss or pretence.
Putting leaders who are trying to achieve the same set of improvements for the public in a room with each other and talking about something that everyone can recognise has proved to be a good way of teaching and learning about the realty of change. Every leader becomes a teacher, and every leader becomes a student.
Professor Paul Corrigan is working with NHS England to help develop new models of care, with a particular focus on multispecialty community providers. He is a non-executive director at the Care Quality Commission and adjunct professor of public health at the Chinese University of Hong Kong and of health policy at Imperial College London. Follow him on Twitter @Paul_Corrigan
Sharing the learning
The NHS Confederation is working with NHS Clinical Commissioners, NHS Providers and the Local Government Association to help spread the learning from the vanguard programme across the health and care sector.
As part of this, we are holding an event on 28 November in London which will offer insight into the outcomes and lessons from the vanguards, and explore how they can inform broader transformation work around the development of sustainability and transformation partnerships and accountable care systems.
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