Creating the right culture for integrated care

Peter Drucker said: ‘culture eats strategy for breakfast’, so what cultural changes should leaders be thinking about as we move into the era of integrated care?

As NHS trusts, local authorities and other organisations continue their work at place and provider level in readiness for April 2022, one of the many things they need to be thinking about is culture.

Throughout our series of illuminations, we have explored intent, mindset, culture and systems as the essential components for change. We’ve written a lot in the past few weeks about intent, mindset and systems, so what of culture?

Much of the focus right now is on ensuring that robust structures are in place to manage this massive change, which is clearly important. However, as we often say at GGI, good governance is about so much more than structures and processes. Culture is one of the things that sets apart governance from good governance. As ICS leaders continue the challenging work of developing their systems, too narrow a mindset of what governance is could be detrimental.

Culture eats strategy

Bringing together health and social care organisations with differing cultures under one system in line with the NHS People Plan – which sets out the ambition of having ‘more people, working differently, in a compassionate and inclusive culture’ – is a significant challenge.

At this time of enormous change, Peter Drucker’s statement ‘Culture eats strategy for breakfast’ comes to mind. Culture can be defined as a set of shared values, goals, attitudes and behaviours that form the foundation on which to build the strategic plan of an organisation. No matter how strong the strategic plan for change, success will depend on culture.

As we highlighted in our illumination on ICS design – good governance will be key, Professor Sir Muir Gray referred to this change as a cultural revolution that offers us all an opportunity to change the way we think and work.

GGI’s experience in change management tells us that if this is done well – with defined and agreed visions, mission and goal supported by a strong communication plan, and staff being provided with opportunities to develop their skills – it can bring about sustained and improved systems that can have positive impact on services.

Vision, mission and values

New ICS organisations have an opportunity to agree on a vision, mission and values that will help to sharpen focus on their direction of travel, the achievements that are expected and how staff are expected to behave. Properly considered and well-crafted, these elements can provide a strong foundation on which to build success.

System leaders should challenge themselves to consider the following questions about their organisation:

• What is our purpose?

• Who owns it?

• Over what timeframe?

• What contribution do we make to the communities in which we operate?

Leaders must play an active role in the development of system culture and agreeing a vision, mission and shared values is key to this. It is from these essential ingredients that the organisation’s culture will emerge.

Leaders should live the culture and extol it; communication teams should proactively reinforce it. One measure of success will be seeing the values codified and reflected in the actions of staff. Culture shapes employee perceptions, behaviours and understanding.

Communication strategy and plan

Our previous Illumination on Creating a common language for integrated care systems highlighted the importance of developing a unified language to support this change.

An effective communication strategy and plan will employ multiple channels to share messages and encourage dialogue throughout the organisation.

The World Health Organisation’s six communication principles are worth bearing in mind here. They stipulate that all communication must be accessible, actionable, credible, relevant, timely and understandable. To that we would add that they should be reciprocal – communication must never be allowed to turn into a monologue.

Done well, communication is an essential part of building an understanding of the need for change and reducing the time it takes to implement it.

Learning and development

Change will bring about new responsibilities for staff and these will need to be supported by opportunities for learning and development. A strong culture provides opportunities and incentives to support staff to develop, which will not only improve retention but also result in improved organisational performance, which in turn supports the delivery of the strategic plan.

This is the perfect time to refresh learning and development plans to ensure that staff are well supported in the new world of integrated care.

Finding the right training and staying on top of the latest developments can be challenging. Last year we launched our Academy - which provides tailored training based on organisational need and environment - to help support organisations with this challenge.

Opportunity, not threat

These changes should be seen as an opportunity, not a threat. They offer a way to improve the health and care system and build workforce capabilities, which creates opportunities for shared ownership of patient care, potentially reducing costs and increasing quality of care and the creation of a more patient-centric view of healthcare delivery.

Illuminations:

• As organisations and structures are formed, leaders must agree on a shared vision, mission and values.

• A clear and concise communication strategy and plan will help to nurture an engaged workforce that embraces change.

• Change brings about new beginnings and new responsibilities which, supported by robust learning and development plans, create capacity and capability in the system.

If you have any questions or comments about this briefing, please call us on 07732 681120 or email advice@good-governance.org.uk.