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Culture change: health and social care integration
Alison Petch
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RiPfA Change Cards
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Organisational culture - drivers ‘can do’ culture perceived interdependence values difference collective responsibility
publicly demonstrated everybody’s agenda willing to share/adopt good
practice organic, flexible, delegated
responsibility
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Organisational culture - barriers sees institutional and legal
barriers isolationist senior figures disown
common purpose competitive rigid bureaucratic controls,
‘everything has to be checked’
values uniformity
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Change management - drivers driven by champions task focused sustains and rolls out good
practice commitment and flexibility
to solve ongoing problems rewards success managed as a whole system dedicated resources for
development
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Change management - barriers presses on regardless not willing to devolve
responsibility bogged down in
organisational problems blames, only sticks focuses on projects,
mainstream unaffected when champions leave,
innovation dies
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Cross profession engagement - drivers sharing information and
skills for the bigger picture open, honest, transparent
communication shared records – creative
use of IT centred on user need ‘we all own this’ accepts challenges to
mindset and learns ‘we will find a way’
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Cross profession engagement - barriers lack of trust tribal, protectionist ‘WE own this’ ‘not invented here’ ‘this is my turf’ threatened and restrictive
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Place ie local context Local needs assessment Agreed, comprehensive vision,
owned at all levels Use of budgets to reflect local
priorities Build on existing good working
relationships Community engagement and co-
production Outcomes-based commissioning Timescale appropriate to locality
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Integrated health + social care teams Shared commitment to goals
and objectives Interdependence of outcomes Clarity on role and
accountability, including leadership
Cultural congruity Focus on quality + innovation True co-operation Interprofessional trust and
respect
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LeadershipLong-term commitment,
enthusiasm, involvementTrust and respect of peersShared vision and goals
across partners, communicated to all
Proactive promotionBuilding commitment,
understanding, shared culture
Achieving outcomes
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Time
‘change did not occur overnight; time was needed for formal partnership agreements to be translated into changes in attitudes, culture and ways of working amongst front-line staff’ Hultberg et al, 2005
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Key questionsWhat is the vision for integration and how can it be
shared?How can effective leadership for integration be
developed?How can a culture that promotes integration be
developed and nurtured?How can traditional professional rivalries be
overcome?How can integration be effectively implemented for
the local context?What can make integrated budgets work?
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