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Insight: Celebration of integration

Insight: Celebration of integration
4 June 2014



Partnership working and cultivating good relationships between individuals and organisations are key to the design and delivery of integrated care.
Every clinical commissioning group (CCG) shares a common challenge to manage the tension between improving outcomes and managing cost and investment, while facilitating the delivery of integrated care and transforming patient care across organisational boundaries and CCG geographies. 
The solution to each is common too. They require the establishment of effective relationships at leadership level, partnerships between organisations and collaboration between clinicians and carers. These capabilities are not wide spread currently and commissioning support services (CSSs) should evolve to support their development.
However each CCG in practice is different. They each have their own personality and service, demographic and geographic nuance. Many leaders have not been directors before. The quality of relationships across their health economies and with their neighbours varies too. This influences their vision and leadership style. It is a fragmented market and both providers and buyers of CSSs therefore need to be alert to the specific needs of each CCG, its leadership style and have an agile approach to work with local leaders to best influence local outcomes. We think this is going to require genuine healthcare transformation experience and high levels of consulting and coaching skill and an approach that embraces locality, capability, integration and collaboration.
As capabilities grow, CCGs will begin to seek increasingly greater levels of transformation as they pursue their visions with greater confidence or as a result of increasing external pressures. As the partnerships develop in their economies they will engage their communities and economies more to achieve bigger goals in more complex challenges. We see local leadership being the key driver of better outcomes. We see the CSSs market extending to support these leaders to be ever more successful as inspirational and effective leaders by providing more pervasive tools that maximise the influence they have on health outcomes and behaviours across health and social care.
We had been working for one of the large independent providers of consultancy across the Department of Health (DH), strategic health authorities (SHAs) and primary care trusts (PCTs) and saw in the new system that local health economies, led by CCGs, were going to need to work together to deliver safer better services in a different more integrated way at lower cost. We had a specialist proven capability that facilitated integration and partnership-oriented working in the NHS and would naturally improve outcomes in the new system. We knew at that point we had a proposition and created DR Associates.
We provide a specialist transformation capability that facilitates health economies to work together to design and deliver better services and achieve better health outcomes. 
We design and facilitate multi-stakeholder transformation events to engage health and social care and local authorities together with commissioners to co-create service improvement or reconfiguration strategies and plans. Our approach generates very high levels of clinical and community engagement and leadership and we have helped commissioners, clinicians and chief execs work together to implement a full spectrum of quality improvements and service transformations.
We assist CCGs to work with their many stakeholders to: 
 – Create a vision for whole-system transformation.
 – Develop and implement commissioning strategies for service improvement or reconfiguration.
 – Respond to national strategies or guidance, eg. 111, the quest for quality in care homes, vulnerable older people, or technology-enabled care services.
The high levels of collaboration and engagement we design into our transformation programmes significantly increase the level of integration and partnership in the health economies we work with. It’s been quoted by clinicians that we build them the clinical movement and voice they need to transform the system.
We aspire to help a commissioning support unit (CSU), a community or group of CCGs and trusts to develop this capability as a transformation tool in their local health economies. We further believe some economies and CSUs would benefit from making this capability a strategic asset by developing a physical centre of excellence, like the Innovation Center at the Vanderbilt Center for Better Health in Nashville USA, where community and clinical leadership work in partnership with insight from best practice to improve health outcomes.
We have highly experienced consultants and facilitators that have led whole-system transformation in healthcare, developed commissioning plans and supported many implementations. We are structured to offer our significantly experienced resources to a number of key clients who want to engage their economies in a collaborative way and potentially develop a partnership with us. We see ourselves more as collaborative workers than management consultants.
Our facilitation team has delivered over 60 significant whole-system transformation or pathway improvement events in the NHS, social care and DH over recent years. 
These events, in particular, give CCGs and CSUs the opportunity to significantly engage their stakeholders and positively influence the quality of outcomes. They will also achieve them faster with less effort.
Providing a collaborative transformation service that improves outcomes for CCGs and CSUs is key to our business premise. 
The relationship between price, value and outcomes in our proposition is different to other providers. We have high levels of expertise and a powerful ability to influence leadership. We have an approach that generates enormous levels of engagement and commitment to succeed. We create a coalition across organisational boundaries focused on the patient and better outcomes. It makes any strategy easier and more cost effective to implement. One reason we broke away from the larger professional services firms was because we thought the commercial model was inhibiting us from working the most productive way with our specific skill set.
We also partner with Zero Tolerance Healthcare. They provide the skills and experience of the medical director and the chief exec and have access to significant system and clinical leadership capabilities. We developed our partnership working to influence clinical leaders to collaborate with commissioners to implement a clinically led vision improving the quality of health and social care in the North East. We created a clinical movement and designed a healthcare transformation programme that focused on the patient and improved the quality of care in many pathways and redesigned and reconfigured more integrated services across organisational boundaries. 
More broadly we have been following the development of the lead provider framework from the beginning, from the perspective of a committed small or medium enterprise (SME) and plan to partner with CSUs and the major players in the independent sector. The independent sector is our heritage and we have both the service capability and healthcare experience that will be beneficial to the propositions of virtually all the future lead providers. We have a unique capability to get the organisations in any health economy to work together in partnership to deliver better integrated care. If a CSU could internally develop this capability, like the Vanderbilt Innovation Center and Center for Better Health in Nashville, they would develop a significant capability to facilitate the transformation of their economies. 
Dan Rixon is the founder and director of DR Associates

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