One big team: nurturing engagement, involvement, connectivity in ICSs

For this week’s webinar, the latest in GGI’s New NHS ICS Series, we invited two leaders to discuss the challenge of ‘one big team’: nurturing engagement and connectivity in Integrated Care Systems.

Follow the discussion on Twitter: #GGIseries

Opening the event Stephen McCulloch, GGI’s director of engagement and corporate affairs, explained that today’s speakers would be offering their perspectives on engaging residents and stakeholders around an Integrated Care System.

Rory Hegarty, Director of Communications and Engagement, North West London ICS would be providing an ICS perspective and Francesca Hunt, co-owner and managing director of MaST Evolution would be discussing their experience supporting large complex organisations in the private sector effectively communicate and engage key stakeholders during substantial change programmes.

Opportunities

Before handing over to Rory, Stephen provided a helpful introduction to the territory. He suggested that ICSs, as vehicles bringing NHS provider organisations and local authorities into closer partnership and collaboration than ever before, will create new opportunities for patient, citizen and community engagement, allowing them to bring their expertise and networks together. This will have the beneficial effect of mutually widening and deepening the partnerships’ connections with residents and stakeholders.

Stephen emphasised the importance of a required focus on place-level and neighbourhood-level engagement and explained GGI’s whole-system approach – designing their engagement to encompass service providers and residents, together with external and internal stakeholders. And, citing research from the King’s Fund demonstrating that improving staff engagement also improves patient outcomes, Stephen explained that staff engagement should be an early focus – although care must be taken not to overwhelm others with constant messaging. Success will require the leadership of ICSs to:

• Rapidly demonstrate the value that changes are bringing;
• Embed engagement at place- and neighbourhood-level;
• Determine and communicate clearly who has which responsibilities; and,
• Embed a strong understanding of the importance of system-wide engagement.

This includes building awareness among leaders themselves, we were told. They must take care to demonstrate a commitment to authentic engagement, developing consistent narratives with transparent two-way engagement approaches.

Stephen concluded his introduction by observing that new ways of working will be unlocked as partners deepen their coordination and collaboration. Savings in both time and money will be delivered and a better collective approach will lead to more compelling stories being told. With the background explained, he then introduced GGI’s first guest.

Resident engagement

Rory Hegarty, drawing on his experience in North West London explained that his team were learning and innovating as they went and that their emerging whole-system model was pointing the way to what good ICS engagement may look like in the future.

“We talk a lot about principle,” offered Rory, referencing ‘big data’, “We’re very data driven these days, we talk a lot about population data, performance health that sort of thing, and the insights from the conversations we have with local people are data as well ... so we’re working with our business intelligence teams to record those insights and inform decision making.”

Listening to and having discussions with residents was influencing the tone of engagement, said Rory. In the past, methods of gathering feedback may have been top down and exemplified by the question: what do you think of this service moving to this place? Now, new methods of co-designing agendas are evolving because different conversations emerge when the opening question is: what matters to you?

Collaboration shapes agendas

We heard that to create shared and less hierarchical opportunities for involvement, collaboration is necessary if residents are to have access to, and an ability to shape, agendas.

Rory explained how after beginning in 2019 with the question, ‘What would good look like?’ his group ran open meetings, each attended by over 100 people. From those the team assembled a steering group of 20 people. With this group they “co-designed the future” and, at the suggestion of a resident, agreed an Involvement Charter, “underpinning the standards we want to reach with how we work with the public.”

Additionally, vaccine outreach with Imperial, and community engagement with over 300 organisations, have further strengthened the ICS’s understanding of and impact in engagement activities. Supported by a programme of outreach to 2.4 million people, they are about to start quarterly collaborative spaces. Delivered in partnership by the NHS and local authorities, these allow for issues to be discussed in open community conversations.

Rory was also keen to stress the success of their Citizens Panel – 3800 people recruited to represent local demography, used not only for surveys and focus groups but also for engaging with specific groups from within the population.

With all activities underpinned by the Involvement Charter, suggested Rory, the involvement of the community at a grassroots level was essential to making sure residents can set the agenda. And in his experience there are, perhaps, four key steps to success:

1. Involve: Understand who should be involved at the planning stage. For everything that we do, who do we need to reach and what do we need to discuss?
2. Coordinate: Understand how things will work together. What does coordination look like, across governance and engagement, across different parts of the NHS, across local authorities and more widely with the voluntary sector?
3. Deliver: At the neighbourhood, place and system level, working closely with primary care to help them better understand their populations.
4. Keep talking: Maintain a dialogue, keep communities up to date, report and listen regularly to create a circle of engagement.

This move away from a ‘you said, we did’, style of engagement, enthused Rory, will be a constant act of discipline for his team. As he ended his presentation, he highlighted that his team’s emerging model is intended to let the public set the agenda “more than they’ve ever been allowed to in the past.”

‘Three brilliant enablers’

The next speaker introduced by GGI was Francesca Hunt, co-owner and managing director of MaST Evolution. An expert in system and culture change, Francesca offered her perspective from outside the NHS, where her team design hybrid strategies to achieving large scale shifts in culture and behaviour.

Francesca was quick to recognise that the transition from a CCG model to an ICP model will require a huge piece of cultural and strategic realignment but that there are lessons to learn from within industry.

It is vital, said Francesca, that leaders rapidly communicate the how and, “the very crucial why” of the shifts that are occurring – so that all the people making something happen understand what they have to do and how they fit in.

The MaST team have identified “three brilliant enablers”:

1. Show the quick wins. Within 2-3 months of a large change, publicly clarify the benefits and show it working well.
2. Be clear on changes to roles and responsibilities. Make sure changes are consistently communicated, explain new structures and their relationship with existing ones.
3. Get everyone involved. Foster a ‘one big team’ collaborative culture where open channels of communication are used in ways appropriate to staff at all levels of the organisation.

Engagement comes from genuine understanding

As studies have shown, continued Francesca, an individual’s level of active engagement is directly linked to how well they understand why they are being asked do something.

Consequently, while some systems have been demonstrating collaborative engagement at senior levels, those organisations scaling to engage much more broadly are seeing immediate system-wide benefits.

At this point, Francesca introduced two video case studies, within which staff from MaST Evolution’s client organisations attested to the system-wide benefits of internal engagement.

In the first organisation, a jaded intranet with which no one engaged has been replaced by a peer-to-peer network. This can still disseminate organisational information but is also highly effective at allowing staff to share their day-to-day experiences. Connections have been made from shopfloor to boardroom and the new engagement methods are driving transformation. In Francesca’s second case study, an IT leader explained how, within his company, broadcasts and briefings have become two-way conversations, making it easier for changes to be discussed with the workforce.

A controversy

During Francesca’s presentation, she was abruptly interrupted by a member of the audience. Much to the surprise of other delegates, he in turn was countered by his own colleague. A back and forth ensued - concerning the benefits of management, governance and engagement - which Francesca had to bring to a halt prompting GGI chief executive Professor Andrew Corbett-Nolan to respond: "I was rather enjoying that barney".

These delegates were, in fact, actors planted in the audience. Their interaction effectively emphasising the many perspectives that emerge during communicating system change. With the chair forewarned, Francesca’s poised responses ensured that members of the audience remained convinced the interruptions were genuine. The sleight-of-Zoom underlined her point that sensitively addressing these perspectives means developing genuine understanding through clear, simple and consistent messaging placed in appropriate channels.

With most staff having a phone in their pocket, stressed Francesca, simple methods of delivering consistent messaging are more available than ever before.

GGI Chief Exec Prof. Andrew Corbett-Nolan said: ‘I was rather enjoying that interruption.’

The importance of common language

With the speakers’ excellent presentations concluded, the panel remarked upon the importance of using shared language to develop mutual and inclusive understanding.

They highlighted that within an ICS context the words ‘citizen’ and ‘public’ are gradually falling out of favour and being replaced with the word ‘resident’ which is considered a more inclusive term.

The panel agreed that in any change context a shared language increases the likelihood of success. And, as with all engagement practice clear, consistently used, commonly understood ways of communicating are key. They must be open to all levels of the system and collaboratively developed. This will help to build a one-system approach that fosters the culture necessary to deliver and sustain positive change.

Keep an eye on our events pages for further information about the next webinar in our New NHS ICS series. Or, to make sure you don’t miss the details of this or any other GGI events, you can subscribe to our weekly newsletter by clicking the button at the bottom of the page.