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Aims
Be brave and willing to test new ideas. Collaborative leadership enables shared responsibility and accountability. This can lead to improved population health across the integrated care system (ICS).
Context
Collaborative leadership forms the basis of effective healthcare systems. But, as described in the Health and social care review: leadership for a collaborative and inclusive future (also known as the Messenger report), this is not always encouraged or rewarded. Accountability is often limited to individual systems. There is frequently no consideration of other, often related, systems. Or the relationships between those systems. See Next steps for integrating primary care: Fuller stocktake report for details.
Leadership that engages with regular feedback from staff can develop a robust, open and honest culture. System leaders should encourage a safety culture across their ICS that:
- learns from mistakes
- offers feedback opportunities to all staff.
Leadership development schemes should be made consistently available for primary care. They should be comparable to those at other NHS providers. If successful, they will:
- promote multi-professional leadership across primary care
- increase diversity across primary care and system leadership.
Key suggestions
- Promote use of:
- cross-service audits
- innovation in cross-service delivery
- Assign an executive sponsor (from any partner organisation) to:
- oversee urgent and emergency care
- provide strategic oversight of the whole patient pathway (including admission and discharge).
- Develop local protocols. NHS bodies, local authorities and other partner organisations should work together to:
- establish the role and responsibilities of each organisation
- set up planning processes to help staff make the right decisions at the right time about people’s short and long-term health needs.
- Show evidence of system-wide collaboration that aims to:
- encourage continuous learning between specialties
- increase safety
- refine and improve care pathways.
- Establish a stronger presence for clinical leadership roles within leadership and operational models. This is vital. Create same day emergency care (SDECs) with effective, responsive clinical leadership.
Examples of good practice and innovation
Same day emergency care (SDEC)
Northwick Park Hospital (part of London North West University Healthcare NHS Trust)
University College London Hospitals (UCLH) NHS Foundation Trust
There are many ways to offer same day emergency care. CQC's UEC systems inspections found some approaches are more successful than others. Northwick Park Hospital and UCLH NHS Foundation Trust use different models for their SDECs. But both are highly effective. Workshop attendees felt that SDEC is more successful when it is:
- flexible and able to adapt to the needs of patients.
- led by the clinical teams that can best support patient demands.
Black Country and West Birmingham Primary Care Collaborative
The Fuller report praised Black Country and West Birmingham Primary Care Collaborative for:
- promoting the interests and sustainability of primary care services
- ensuring a single voice for primary care in decision-making at all levels within the ICS.
The collaborative joins up primary care professionals across the Black Country, including:
- GP practices and federations
- primary care providers and care networks
- local medical committees.
It plays a leading role in the ICS's primary care transformation strategy. It also acts as the primary care Expert Reference Group for their local Integrated Care Board (ICB).
Collaborative leadership
West Yorkshire ICS
West Yorkshire ICS wanted to reduce the number of days people stayed in hospital when medically fit to return home. System leaders formed a discharge group that met weekly to find ways to help people return home safely as soon as they were ready. The group introduced:
- initiatives that shared success across teams and services
- risk appetite assessments in each service to manage local risk
- a transformative culture where leaders share skills and knowledge to improve outcomes.