I was\u00a0once\u00a0invited to a leadership training programme while\u00a0chair of the negotiating team for the BMA Junior Doctors’ Committee;\u00a0facing\u00a0my own team were colleagues from NHS Employers.\u00a0The\u00a0negotiation,\u00a0for a new national deal, was\u00a0a\u00a0successful\u00a0one, although\u00a0events in\u00a0recent years make that hard to believe.<\/p>\n
The focus of the training was\u00a0\u2018principled\u00a0negotiation,\u00a0based on\u00a0Getting to Yes: Negotiating an agreement without giving in\u00a0by Roger Fisher and William\u00a0Ury.<\/p>\n
Essentially it boils down to this: rather than trying to\u00a0\u2018win\u2019\u00a0the negotiation (traditional\u00a0\u2018positional\u00a0bargaining\u2019), you\u00a0will deliver\u00a0long-term\u00a0success if you attempt to understand the issues faced by both sides\u00a0and\u00a0using this\u00a0as a basis for working together to achieve\u00a0mutual gains.\u00a0Basing negotiation on\u00a0\u2018understanding\u2019\u00a0also helps develop\u00a0long-term\u00a0trusted relationships, something that will be essential for stakeholders across integrated care system.<\/p>\n
“The best decisions can never be made in isolation\u201d\u00a0Dr Masood Ahmed, Chief Medical Officer for NHS Black\u00a0Country\u00a0and West Birmingham CCG<\/p><\/blockquote>\n
\nIntegrated care means integrated decision making\u00a0<\/strong><\/p>\n
Across the rapidly moving parts that make up\u00a0an\u00a0ICS, plans will change, often out of necessity and, inevitably,\u00a0unforeseen circumstances. Secondary care,\u00a0primary care,\u00a0mental\u00a0health, social\u00a0care\u00a0and\u00a0other\u00a0community providers on\u00a0integrated care boards (ICBs)\u00a0will be\u00a0looking to make collective decisions\u00a0based on individual and shared priorities.\u00a0Uniting these goals\u00a0in a health and care ecosystem still reeling from the pandemic will be easier said than done.<\/p>\n
If ICBs can truly unite around the obvious\u00a0shared\u00a0goal,\u00a0i.e.\u00a0better\u00a0patient outcomes, the focus will shift to the citizen and population rather than the organisation\u00a0or provider;\u00a0purpose rather than position. This\u00a0could\u00a0mean changing suppliers, how staff work, strategy, and everything in between.<\/p>\n
The end goal isn\u2019t everything. Crucial to determining the quality of care delivered, and outcomes eventually achieved, is the decision-making process prompting these changes. If we as leaders cannot make better decisions then we are bound to fall short, no matter how good our intentions are.<\/p>\n
Good decision making must be based on collaboration and the best decisions can never be made in isolation. If there is only one takeaway from this article, let it be that. To build and grow ICSs in a meaningful way, health and care leaders must listen to all stakeholders \u2013 including staff and citizens. This is all too often lost within the NHS (and indeed, the wider health and social care landscape) when executives make decisions based on their own experience, the data presented to them and what they believe to be the right call, without a broader perspective.<\/p>\n
\nEstablishing a meaningful vision for decision making\u00a0<\/strong><\/p>\n
Decisions need to be made with a clear vision in mind: getting to a\u00a0\u2018win-win\u2019. In the NHS, vision can\u00a0often\u00a0be seen as a\u00a0tick-box\u00a0exercise included in a master plan, rather than a central priority. Sure, it\u2019s great to talk about\u00a0visionary objectives and\u00a0it’s\u00a0great to use this vision to get employees and patients excited. But for most, can we say that our organisational vision truly translates into action? Does it have an impact? Does it guide us? Is it really driven by our values?<\/p>\n
My\u00a0own\u00a0system, Black Country and West Birmingham,\u00a0has developed stronger\u00a0system-level\u00a0decision making by\u00a0setting\u00a0a\u00a0realistic vision\u00a0\u2013 something\u00a0tangible yet\u00a0ambitious\u00a0that staff can work\u00a0towards\u00a0and stakeholders can support.\u00a0The introduction of primary care clinical leadership executives (PCCLEs), for instance,\u00a0was\u00a0driven by\u00a0the idea that\u00a0primary\u00a0care expertise should be leveraged in a way that uses\u00a0both\u00a0clinical acumen and leadership\u00a0ability\u00a0for maximum impact and patient benefit.<\/p>\n
This mindset helps place the population at the heart of decision making. It\u2019s too easy to pay lip service to organisational vision, but when this approach is implemented effectively, it can transform the way\u00a0one\u00a0makes\u00a0decisions.<\/p>\n
Vision-driven building supports the idea of making decisions based on first principles\u00a0\u2013\u00a0understanding the\u00a0\u2018what\u2019\u00a0and\u00a0\u2018why\u2019\u00a0of what we\u2019re trying to achieve. In a reactive world, where everything is moving at breakneck pace, it\u2019s easy to get caught in the moment and make decisions on the fly. This happens in too many organisations, and\u00a0stakeholders\u00a0end up with choices being made without the long\u00a0term\u00a0being considered.<\/p>\n
We avoid this\u00a0by placing\u00a0vision\u00a0and principles\u00a0at the heart of these choices,\u00a0bearing in mind\u00a0the need for\u00a0better decision making\u00a0for\u00a0both the short and long\u00a0term. When we determine our vision, we\u2019re using first principles. When we make decisions that align with our vision, we\u2019re being driven by\u00a0the \u2018what\u2019 and \u2018why\u2019,\u00a0striving for outcomes that give short-term benefit and build towards long-term\u00a0transformation of health and care\u00a0for our communities.<\/p>\n
Our PCCLE for\u00a0digital\/IT, one of the few primary care chief clinical information officers (CCIOs) in the country, approached the issue of patient information visibility with the aim of tackling the existing issues of duplication of tests, delays in diagnosis, harm from medication and inappropriate admissions to hospital.<\/p>\n
The understanding that improving patient information sharing\u00a0is key to fixing\u00a0these issues, while\u00a0consulting with secondary care, mental health, ambulance service, social\u00a0care\u00a0and voluntary sector colleagues,\u00a0supports\u00a0an informed approach to the procurement of a\u00a0shared\u00a0care\u00a0record that will create lasting change across the system for all stakeholders.<\/p>\n
If we approach decision making this way, it allows function to then lead form. How we make these changes, and how we improve things for our citizens,\u00a0can be driven by how we see the future, and what we want to achieve. Initiatives are underpinned by solid principles\u00a0that\u00a0are substantial, accountable and considered, and have definite benefit.<\/p>\n
Gone are the sometimes shimmery yet ineffective programmes, and in their place we have people and processes that can make a real, lasting impact. Our PCCLE for dementia was brought in with the ambition to use her field of expertise to benefit our population. She has achieved this by helping to create stronger pre and post-diagnostic support, leading to reduced risk of crisis management (which can invariably lead to hospital admission but also keep a patient well for longer in their own home). By letting function drive form, and taking a problem-solving approach, her work has led to immediate patient benefit as well as long-term improvements for our system.<\/p>\n","protected":false},"excerpt":{"rendered":"
Dr Masood Ahmed, Chief Medical Officer for NHS Black Country and West Birmingham CCG, reflects on how a shared vision helps health leaders make better and more collaborative decisions. <\/p>\n","protected":false},"author":51,"featured_media":3149,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[26,36],"tags":[],"class_list":["post-3146","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-thought-leadership","category-workforce"],"acf":[],"_links":{"self":[{"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/posts\/3146","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/users\/51"}],"replies":[{"embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/comments?post=3146"}],"version-history":[{"count":2,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/posts\/3146\/revisions"}],"predecessor-version":[{"id":3148,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/posts\/3146\/revisions\/3148"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/media\/3149"}],"wp:attachment":[{"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/media?parent=3146"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/categories?post=3146"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/tags?post=3146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}