"The man who removes a mountain begins by carrying away small stones" William Faulkner
I was put on the spot this week and asked “if you (Scott) were leading a PACS or MCP what would you do?” A great question, which I am happy to answer.
Firstly, and most importantly, I would engage every affected stakeholder in developing the vision and the plans for implementation.
For regular readers, you will know my view is that securing your organisation for the future means taking a new approach to engagement, where everyone affected is engaged right at the start. Inclusivity of all stakeholders involved in the process is essential, and this inclusivity needs to be from the very beginning. Whether 9, 90, 900 or 9,000, it matters not; it is possible to engage every stakeholder and give them a voice and ownership of the process and outcomes.
Whilst challenging, this ensures that the vision created is one that has been developed by all those who have a role to play, whatever that role, leading to buy-in and ownership of what you create as a “community for change”, bringing about a critical mass for driving successful change and projects. Furthermore, the process ensures that the teams have the capacity and resilience to meet future demands and challenges in a constantly changing world.
This can be achieved through 3 workshops, with 2 mini workshops between the three main workshops for those who miss or cannot attend the main workshops.
Workshop 1 – Winning Hearts and Minds
Workshop 2 – Developing the Vision
Workshop 3 – Implementation
If you want to know more about the content of the main workshops, please email me.
Between the main workshops, we hold mini workshops, to ensure that those not able to participate in the main workshops have an opportunity for input; these would usually be a two-hour session, and the outputs of the mini workshops are fed into the start of the next workshop. These ensure the ownership of the vision and support the need for critical mass in acceptance and implementation of the plans by involving as many of the stakeholders as possible.
For an MCP or PACS to work change is not just necessary, it is an imperative, that you take a new approach to change; one that will give you the results and the sustainability that you need, whilst teaching you the skills to move forward.
To further explain: this approach avoids the current top down approach used in the NHS, which almost invariably fails. That process is based on a once successful management approach, where a parallel organisation exists – the steering group or subcommittee approach - with the chosen few making decisions for the many, and then only engaging with stakeholders once the direction or initial plans have been created. It is no longer fit for purpose.
What you will find is that where people are not involved right from the beginning, they are more likely to resist and obstruct change, even when the ideas are good. People recognise that they are being sold something rather than being asked for their input from the start.
Into these workshops comes the opportunity to support the development of several of the “10 essential jobs in creating an MCP”
• Build collaborative leadership
• Create a dedicated ‘engine room’ to drive and manage the local transformation programme
• Establish a transparent governance structure
• Understand the different needs of your diverse population
• Establish the financial case
• Design and document each of the specific component parts of the care redesign
• Learn and adapt quickly
Additionally, and key in developing an MCP or PACS, there are numerous basic services (if you want a list please email me) that can easily be shifted from in hospital to out of hospital delivery.
What these basic services achieve in that shift is properly resourced work being implemented by General Practice – who I know will find the staff, the capacity and the skills to deliver, if the work is properly resourced.
These services also build a platform for changing the way practices work together, through hub and spoke, with integrated and multidisciplinary teams, underpinned by inter practice referral.
The goal of achieving one, high quality and standardised approach without unwarranted variation, is deliverable through these projects, which provides a platform for the larger and more complex system-wide changes required. Indeed, if you cannot quickly get basic services shifted from in hospital to out of hospital care as part of the development of your MCP or PCAS, I hold out little hope for you delivering the large scale, complex changes that will ultimately be required.
Too often, before they attempt anything, I see people waiting until “everything is perfect”, which of course it never will be. The time is here and now to take a low risk approach to shifting basic services, that should sit in General Practice (with proper resourcing) and start to build your PACS or MCP model from the font line, through formal engagement right at the start.
If you still have doubts, I refer you to an excellent blog from Roy Lilley, who talked about Positive Deviance;
'...based on the observation that in every community there are certain individuals or groups whose uncommon behaviours and strategies enable them to find better solutions to problems than their peers, while having access to the same resources and facing similar or worse challenges.'
The solutions are there in the existing worksforce; however, to access them you have to be prepared to ask.