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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