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Culture change needed for population health management to flourish

Cultural changes needed to enable population health managementto flourish
By Ayesha Janjua Associate director NHS Arden & GEM CSU
12 October 2022

We are witnessing a step change in how healthcare is understood, planned and delivered thanks to a combination of system-wide working and growing use of population health management (PHM). PHM is a fundamental enabler to achieving the NHS’s legal duty to improve health and wellbeing, increase quality, and make sustainable use of NHS resources – the Triple Aim.

But PHM is not simply a data solution – it’s a different way of working, requiring a change in behaviour, both within individual organisations and in supporting partnership working across Integrated Care Systems (ICSs). As such, to truly benefit from the insights PHM offers, Integrated Care Boards (ICBs) and their partner organisations will need to consider what organisational, leadership and governance changes might be needed.

Understanding the challenge

System-level working will see different types of organisations working together much more closely, with population needs driving priorities in a more holistic way. Although the potential benefits may seem clear, achieving this in practice is not straightforward. Local authorities, for example, have democratic responsibilities which must be met. Decision-making structures differ between partners, and budgets in most cases are still allocated based on more traditional structures. Inevitably, some partners in an ICB may have more to gain from particular interventions than others.

For systems to embrace new ways of working successfully, they need to recognise the different strengths, priorities and challenges of each partner, and work together on a shared vision that will enable them to collectively improve the health and wellbeing of their populations. Key to this is developing and measuring meaningful outcomes for both patients and clinicians, recognising they won’t always be looking for the same things. But it’s also about changing behaviour.

Organisational development and training will help emerging ICBs understand their current culture, identify and navigate barriers to successful PHM implementation, and develop skillsets that enable successful PHM approaches. At a time when the public sector continues to be under significant pressure, it can be tempting to see this type of engagement and cultural development as a ‘nice to do’ rather than a priority. But in our experience, developing a strong system culture will set the solid foundations needed to enable ICBs to rise to the challenge of delivering personalised, sustainable and cost-efficient healthcare.

Directing resources to deliver greater impact

By working together, ICBs can use the tools within PHM to free up resources to deliver more impactful initiatives by recognising and stopping lower value interventions. This is key in getting clinicians and social care professionals to invest more time in joint working – PHM provides the insight and evidence that demonstrates the benefits of working differently.

Linked to this, we are starting to see a move within some systems towards giving decision-making powers – and accountability – to those in charge of care delivery, based around populations. Rather than planning based on pathways or national targets, in some areas, clinicians and managers are coming together to determine the best course of action and desired outcomes for specific population groups, working out what to start, stop and change based on a much more detailed understanding of patient outcomes. There is huge potential here, but it needs to be properly supported with cultural change, so that recommendations become decisions that are collectively supported and implemented across partners.

Step change in partnership working

At its heart, PHM is a data-driven, outcomes focused approach that will enable systems to capitalise on integrated working to help patients and citizens live healthier lives for longer. But the data is just the start. As NHS organisations, we all need to prepare for the step change required in how partners work together culturally, financially and practically, and be ready to invest the time, support and training to harness the potential benefits that PHM can bring to our communities.

Ayesha Janjua is associate director for leadership and organisational development at NHS Arden & GEM CSU

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