Managing transfers of care - A High Impact Change Model: Enablers 1-4

To ensure an effective, smoother and faster implementation of the above changes, it is important to be aware and conscious of the enablers for change of your organization. For further information on the background of the tool, and the purpose and principles which underpin it, please visit the Managing transfers of care - a High Impact Change Model.

Four key enablers to be mindful of are:

Exceptional system leadership and a consistent culture are essential to embed the right ways of working across a system.

‘Making it Real’- I/We statement 
I respect the values of the organisations that support me, and see those values reflected in the behaviours of the professionals caring and supporting me.
We work in partnership with others to make our local area welcoming, supportive and inclusive for everyone. 

Tips for success:
 

• Ensure there is a strong organisational belief system rooted in maximising long-term independence and quality of life – all leaders are able to coherently articulate and embody those beliefs.
• Recognise that services in health and social care are on an evolving journey - encourage and support cross-organisational working and positive team-based risk taking, and critically analyse the success of these endeavours.
• Review the strengths and development opportunities within the existing workforce. 
• Gather feedback to support change – understand what perspectives colleagues hold, why they hold the perspectives they do and what changes they would like to see.
• Have an active future leader development programme which actively identifies future leaders and invests in their skill development. Particular focus should be given to ensure that the workforce have a curiosity and competence around data.
• Proactively seek to strengthen cross-system productive partnerships – for example by actively seeking feedback from partners and acting on the feedback received. 
• Celebrate success and encourage teams when the right behaviours are seen.
• Be purposeful in what culture you want to set within your organisation and plan carefully how to achieve that culture. It can be helpful to survey and/or engage your workforce to understand how they perceive the current culture and what organisational culture they aspire to. It is useful to measure this regularly rather than only annually.
• Ensure that there is the appropriate governance structure in the system to effectively manage discharges. This should include at the very least representatives from health and social care, as well as key providers of community services. It is helpful to identify an executive lead to provide strategic oversight. In addition, the governance structure should include effective escalation mechanisms and reporting to relevant boards on current performance and challenges.
   

Maturity levels
 

High Impact Change Model - Enabler 1 maturity levels
 

Systems have a joined-up data picture that is a single source of truth and drives decisions. Emerging digital opportunities should be embraced, whether through the use of technology, systems, data or analytics; this requires creating an environment that promotes digital innovation, alongside a clear understanding of the impact on the end user of any investment.

‘Making it Real’- I/We statement 
I do not have to tell my story multiple times as all professionals had accurate and up to date information about my care. We make sure we share information about what we do and how people can access our service with other relevant organisations so we can all work more effectively.

Tips for success:

Data:
 

• Ensure there is a single source of truth: there are consistent reports that are widely shared and acknowledged across organisations. For this to be valuable, it is important that these reports are actively and confidently used in decision making and strategic forums.
• Remember that data will be essential both for everyday operations and for understanding and driving improvements, both at a strategic and detailed level.
• Explore opportunities to share data and information across different organisations, through data sharing agreements or other appropriate information governance arrangements. Remember that there should be proportionate information governance to enable this. The sharing of information will enable a richer end to end system performance, a more accurate view of demand and capacity, and will mean that people going through the process do not have to tell their story multiple times.
• Ensure operational staff have relevant training to be able to make best use of the insight provided in dashboards and digital tools.
• In addition to local data sets, it is useful to have an awareness of national data sets that may be helpful to understand the local system’s performance in the national or regional context.
   

Digital foundations:
 

• Remember that digital solutions can include a range of categories, including technology, hardware, systems, digital tools, external interfaces, analysis and business intelligence, management information and digital infrastructure.
• Create an environment that fosters digital innovation: prioritise pace and action above perfection. For example, focus on the measures needed rather than generating a suite of dozens of key performance indicators (KPIs) or a strategy to reach a future state with a range features & capabilities.
• Ensure that the right infrastructure and analytics exist to be able to securely collect, store, analyse and structure the information. It is important to make sure there is access to experts in digital procurement.
• Recognise that digital solutions should only be introduced as a means to an end; they should not be the end themselves. As part of this, remember that people should be at the heart of the design of any digital tools.
• Recognise that digital solutions will never replace the professional judgement and skillsets of practitioners, and this should not be the ambition.
• At a person level, explore the use of assistive technology including safety gadgets, tracking devices, alarms, and cameras to ensure a person is safe and has good engagement with local communities. This is particularly important for people with a diagnosis of dementia.
   

Maturity levels
 

High Impact Change Model - Enabler 2 maturity levels

The right workforce needs to be recruited and retained by making working in the health and social care a desired and rewarding career.
 

‘Making it Real’- I/We statement 
I have considerate support delivered by competent and compassionate people. We feel supported, enabled and have the right capacity to deliver the best care for people, and feel that working in health and social care is a rewarding career. 

Tips for success:
 

• Deliver an attractive career structure by putting in place the right practice, processes, and professional supervision to create a safe and stimulating environment for staff, whilst wrapping around pastoral care to help with the emotional demands of working in health and social care.
• Strengthen the local health and social care organisations’ local brand and leverage this to attract the future workforce.
• Undertake a strategic workforce planning assessment to consider some of the long-term changes to the types of roles, skills, capabilities and capacity that will be required. Consider the use of blended roles across different organisations as an opportunity to enabler further system working.
• Ensure there is a clear training offer and / or development pathway accessible to all staff. Wherever possible this should be offered as a joint training regardless of employer type.
• Train those working closely, supporting or providing care for people with dementia so they know how to best support people with the diagnosis.
• Engage the existing workforce in any workforce planning activity.
• Identify and eliminate drains on team capacity –issues such as sub-optimal systems, processes and planning can mean teams spend time on activity other than delivering health and social care. 
• Ensure the right management structure and management training is in place, so that staff receive adequate supervision and support.
• Staff engagement is a key performance indicator and requires regular measurement. Measure engagement and feedback more regularly than annually and ensure that whenever changes are occurring that will impact parts of the workforce they are appropriately engaged.
• Measure and understand the drivers of any local retention problems – a helpful way to do this is by carrying out surveys or leaver interviews with colleagues leaving the workforce, and by engaging the active workforce in solutions. It is also important to understand whether retention challenges are affecting some areas of the organisation more than others, and what is driving that.
• Whilst developing multi-disciplinary teams, determine the best working arrangements for staff and engage the workforce to understand what this looks like for them. This could mean co-location of staff, working together using virtual systems, or finding other ways of effective collaboration.
   

Maturity levels

High Impact Change Model - Enabler 3 maturity levels
 

Systems need an effective strategic commissioning function to work with providers to achieve the best outcomes for people. The function should be jointly led, and effectively identify need, allocate resources and commission providers to best meet that need, within available means.
 

‘Making it Real’- I/We statement 
I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and personal goals.
We work in partnership with others to make sure that all our services work seamlessly together to enable the best outcomes for people, within available organisational means.
 

Tips for success:
 

• Ensure evidence used by commissioners includes analysis of the local population’s needs, understanding that a modern population often has multiple needs.
• Recognise that to optimally commission the best services for people, it is necessary to go beyond what the market is currently able to supply. Build up a picture, based on a detailed understanding of people’s individual strengths and needs in an unconstrained environment, putting to one side the context of what services are currently provided.
• Working collaboratively with other commissioning organisations within the system enables multiple needs to be met. In the optimal cases, this leads to commissioning operating across a large population and at a strategic scale.
• Actively engage and co-design with providers, practitioners and the people accessing services to arrive at the best commissioning strategy.
• Alongside value for money, also recognise the need for sustainable profits. Explore different ways to maintain a healthy thriving care provider market.
• Recognise the role of commissioning in actively developing the care market to be able to deliver the provision the population requires. This is often detailed work, operating alongside providers to support them to design and develop the processes, systems, ways of working, and capabilities they may need to deliver a new model of care. Ensure this activity is appropriately resourced, with the right balance of operational, strategic and change management capabilities.
• Ensure that commissioning functions have live data and evidence on which to base their decisions, working in partnership with business intelligence teams and operational teams that understand the population’s needs. Refer to ‘Enabler 2: Digital and Data’ for more on the capture and leveraging of data.
• Ensure analysis has been completed to understand the local impact of self-funders

Maturity levels
 

High Impact Change Model - Enabler 4 maturity levels

For each of the focus impact areas, it is important to consider a series of questions when planning the change. There are two categories of questions to consider: