Tag Archives: collaboration

How do we encourage buy-in to a multi-agency approach from partners?

Simon Pickthall from Vanguard Consulting led a workshop on how to redesign services across different organisations at our event on Designing effective services for frequent users. In this post, Simon looks at how we can work together to improve the services that people receive.

A photo of Simon Pickthall from Vanguard Consulting

Simon Pickthall from Vanguard Consulting

This question is a very common one. Often, people have been trying for years to encourage partners to work together to tackle common difficulties. However, these efforts are often very frustrating, and time-consuming, despite most people recognising it is a sensible idea. In addition, solutions and approaches that have vast academic support over many years are often not taken forward by organisations.

There is a key reason why trying to persuade others to do something different is very difficult – our assumption is that we need to persuade people through rational means.

Examples of rational approaches are reports, meetings, classroom sessions, slideshows, workshops, conversations, etc. They involve talking to another person and trying to persuade them to do something, or stop doing something. These approaches are extremely common in multi-agency discussions, where schedules of meetings are used to take forward thoughts and plans.

The difficulty with rational approaches is that you are either preaching to the converted – making them feel patronised, or annoying people who don’t agree with you. If somebody does not agree, no argument, quantity of data, or research will change their mind. I am sure we have all experienced this during our lives.

An alternative approach is to be coercive – ‘do this or you will receive punishment, more hassle, etc.’. Equally, ‘do this and you will get a reward’ is a form of coercion.

The difficulty with coercion, is that people will only do what they need to do to avoid the punishment or get the reward. You have not changed their viewpoint or created commitment to change. As such, progress can be extremely slow, with very little momentum.

An alternative, more effective way of helping people agree to work together, is for them to share, what we call, a normative experience. A normative experience can be described as experiencing something directly for yourself. For example, running through a series of case files from various organisations showing what it feels like for a person to go through our systems. Visiting people in their home to ask them about their experiences of our various systems is also powerful. For those interested in the origins of this approach, it’s worth reading ‘The Planning of Change‘.

The advantage of normative change is that people tend to have an emotional reaction to what they see and experience. This sticks with them, and produces a powerful commitment to change. As such, the priority of the multi-agency approach becomes higher, as the individuals wish to solve the problems they have witnessed.

Therefore, commitment to the obstacles to multi-agency approaches are tackled more swiftly. Of course, it is important that those with the authority to tackle the obstacles in each organisation undertake the normative experience, and you have a proven Method to undertake the changes that are needed once everybody has agreed. It is no good taking people on a normative experience without a Method to solve the problems they discover. The website below is a great start in exploring Method. In addition, the book Responsibility and Public Services by Richard Davis is a clear and informative blueprint in taking this work forward.

Given this, you may wish to reflect on your strategy for encouraging multi-agency buy-in. You may want to explore moving from attempting to persuade people rationally, to designing normative experiences for the leaders involved. This may have a dramatic effect on the pace of change.

Change Thinking – Change Lives

Simon Pickthall worked in the public sector in Wales for many years before forming Vanguard Consulting Wales in 2007, working with the renowned management thinker, Professor John Seddon. Simon has been fortunate to have worked with many leaders to help them understand their organisations using the Vanguard Method – and improve them as a consequence. Simon was privileged enough to work on the Munro Review of Child Protection, and is committed to helping the public, private and third sectors transform public services in Wales.

Simon.pickthall@vanguardwales.co.uk
07951 481878
www.vanguard-method.com

A special Wales edition of the Journal of Integrated care – so what?!!!

How can we better integrate health and social care? Stewart Greenwell of ADSS (Association of Directors of Social Services) Cymru shares the lessons from the Wales edition of the Journal of Integrated care.

Stewart GreenwellI guess that writing about what you do is common practice in most professional arena, but normally it is for a very limited audience – the employer, sometimes even service users so that they can see what a professional worker is explaining what they saw, what they did and what they intend to do. Writing for an academic journal is a different piece of work – the audience is wider, the rules feel more complex and the writing comes under more scrutiny.

I have always experienced writing as a way of reflecting on what I have done and the special edition of the Journal of Integrated Care focusing specifically on Wales, hopefully will bring some of our efforts in Wales into a wider public arena, from which others, but particularly policy makers and practitioners in Wales, can benefit.

I have always experienced collaboration and/or integration as the natural way of building alliances to ensure that people are not ‘given the run-around’. Sadly my experience is that the public sector has provided that experience for ordinary people, leaving them with the energy-sapping task of finding their way around systems, places and people to try to find a response to a set of circumstances that is troubling them. So by simply reducing the number of doors to knock, telephone numbers to ring and people to talk to, the path becomes less hazardous, less tiring and more likely to lead to success for the ordinary person.

That becomes the rationale for collaboration and integration – to improve people’s lives and only that end makes it worthwhile.

The people who have contributed to the Wales edition had very little experience of writing for the purposes of publication. They had all written for their own agencies, arguing for a change in practice, arguing for an allocation of some additional resources and the many other reasons that we have to put pen to paper (or fingers to keyboard) for our employers.

It has been a struggle, everything took longer than anticipated and there was always another reference to call on. In many ways it reflects the struggle that is captured by many of the authors, to hold on to a belief that what they were pursuing was worth all the effort, to resist the feeling that ‘I don’t really have anything to say that people want to listen to’.

Their efforts, actually our efforts, since it started with us all talking about the idea in a room in a church centre in Shrewsbury – a good start since it reminded us that you sometimes have to break the rules to achieve something – (in this instance choosing to meet outside of Wales!!) were worth it.

The articles highlight the theme of the WAO events on 14th and 22nd October, that integration and collaboration are less about science and more about craft and graft, continually pushing at the boundaries of traditional thinking and reminding ourselves that there is never a reason not to ‘do the right thing’, but there are often many reasons to simply continue to ‘do things right’. The former is about people and the latter often about little more than adhering to process.

However the process was energising and in the end, successful. It shows the character and
strength of the best practice, the importance of leadership that is unrelentingly determined and the most critical of all, that a focus on what makes a difference to people’s lives pulls you through and beyond the doubters and the resistors!!

Improving GP Care by Aligning Evidence, QI Methodology, IT and Contracts: A New Model for Wales

In the latest All Wales Continuous Improvement Community Awards blogpost, Dr Alastair Roeves of Aneurin Bevan University Health Board tells us how they made the most of resources at their disposal to improve their work.

Aneurin Bevan University Health Board / Bwrdd Iechyd Prifysgol Aneurin Bevan

Atrial Fibrillation is an arrhythmia resulting from irregular, disorganised electrical activity in the atria of the heart; it commonly occurs in association with risk factors, such as hypertension, diabetes and ischaemic heart disease. Evidence has shown that timely management benefits patients.

QP Pathways are clinical components of the GP Contract, designed to reduce unnecessary hospital admissions and outpatient attendances.

An Atrial Fibrillation QP pathway was produced to enable GP Practices in Gwent to implement care bundles, using Quality Improvement Methodology, when identifying, diagnosing and managing patients. It was supported by a guide developed by the Primary Care Quality team in Public Health Wales.

The QP Pathway is optional and was offered to every GP practice in Gwent. Nine practices volunteered to work as a collaborative and implement the care bundle approach to Quality Improvement. Each practice also had to use the Atrial Fibrillation module for Audit+ so the data could be analysed by Public Health Wales.

Each practice was required to show improvement in 3 out of 5 care bundles:

  • Opportunistic screening of over 65s
  • Assess symptoms
  • Perform CHADS2 / CHADS2VASc Score to assess risk of CVA
  • Manage rate and rhythm
  • Check BP, pulse, review medication, undertake anticoag risk assessment

The practices met as a collaborative on 3 occasions and agreed to share practice data between themselves and also share learning from the improvements they had put in place.

Data was extracted fortnightly by Audit+ software, analysed by Public Health Wales and supplied as run charts

Baseline data for each bundle was given to practices at the first collaborative meeting at the end of November 2013 and further data showing improvement was shared at the second collaborative meeting on 30th January 2014. Discussion between the practices identified changes they had made to improve compliance with the bundle. One practice has increased the percent of target population screened from 2 – 10% and there is evidence of improvement in all practices for the recording of pulse rate and rhythm.

Collaborative Graphical Information Software

In our latest blog from the All Wales Continuous Improvement Community Annual Awards 2014, Kevin Williams from Neath Port Talbot County Borough Council tells us about their Graphical Information Software and the importance of collaboration.

NPTCBCStaff from our ICT Division, in conjunction with counterparts from the City & County of Swansea, have recently picked up a prestigious award from the Association of Geographic Information, an award contested across the whole of the UK Public Sector.

When the ICT Division decided to replace its high-cost proprietary Graphical Information Software (GIS) with a low-cost, high functionality open source alternative, the team’s aim was simple; to increase the availability of GIS to staff and our citizens for less cost. As a result of the benefits this project delivered, a great deal of interest was shown by neighbouring authorities including Swansea, Carmarthenshire, Pembrokeshire and Ceredigion. This resulted in a regional project tasked with identifying areas where cross-boundary collaboration would prove advantageous in identifying and delivering efficiency savings, increasing GIS usage and service improvements. This project was part funded by the existing regional programme and operated under the governance of the Central and South West Wales Shared ICT Services Board.

Early findings concluded that each local authority goes about the same tasks but nearly always in a slightly different manner, with GIS proving no exception to this rule. When the group first formed, it became apparent that each authority had differing proprietary GIS solutions but all had the same problem. How to expand their systems without being tied to a commercial vendor with ever increasing costs?

Having concluded the project, it is clear that the benefits realised are not restricted to the savings on licence fees and the elimination of maintenance agreements, although at half a million pounds over five years these estimated savings are substantial, but that by adopting the OpenSource solution within our authorities, GIS usage is now limitless. Removing the financial constraints can empower anyone to access their data in a spatial manner, enabling quicker and more informed decision making and ultimately improving council services.

Working collaboratively on this project has also helped forge new working relationships and assisted in breaking down the boundaries regarding creating shared services between local authorities. It was this work that the awards committee were so taken with, which resulted in the recognition of innovation and cross sector working. Kevin Williams, who led the project for NPT, has now been invited to sit on the panel of AGI Cymru, representing the OpenSource GIS.

Working together: National Issues Committee Wales Fire and Rescue Services 

The winner of the Outstanding Change Leadership award at the All Wales Continuous Improvement Community Annual Conference was the National Issues Committee. Christian Hadfield tells us more about their work.

National Issues Committee LogoAll three Fire and Rescue Services in Wales have made the commitment to ensure the people of Wales continue to have a first class Fire and Rescue Service to be proud of, one that is based on continual improvement and providing a value for money Service. Today’s economic pressures place new challenges on all organisations, the Fire and Rescue Services in Wales intend to meet these challenges head on. And in doing so established a National Issues Committee, which has just celebrated its second birthday of successes.

The National Issues Committee is a dynamic leadership team consisting of Chief and Deputy Chief Fire Officers and Chair and Deputy Chairpersons of each of the three Fire and Rescue Authorities, their aim is to build on and optimise collaborative working opportunities for sustained service improvement, efficiencies and economical benefits, whilst keeping the communities of Wales safe.

Key collaborative areas have been identified as potential opportunities to meet these challenges. Project leads have been nominated to focus on these key areas and feedback to the National Issues Committee on realising new opportunities. The next few years will test the leadership and encourage us to look at new ways of working, calling on our creative strengths and the ability to adapt as a Service, as we’ve successfully proven in the last two years since the National Issues Committee team was introduced.

The National Issues Committee have recognised that the key collaborative areas identified will impact on all of us, and are examining all aspects of our work to ensure that the Welsh Fire & Rescue Services deliver on the Governments agenda for improved, more efficient and citizen focused public services.

With strong innovative leadership, the Fire and Rescue Service in Wales are overcoming the challenges being faced whilst continuing to provide a first class service. The innovative strengths and ability to adapt to changing circumstance are enabling and shaping the future services of the Welsh Fire & Rescue Service.

From the outset the National Issues Committee have been determined to keep everyone abreast of its work streams, with progress reports, regular updates and briefings, via a National Issues Committee web page and through sound communication channels, including the use of social media. The positive leadership of the National Issues Committee has resulted in motivated teams working harder than ever to deliver the aims of each collaborative area, and forging stronger working relationships between the three Fire and Rescue Services in Wales whilst meeting the current economical demands and challenges head on.

Celtic Scrutiny – lessons shared across the Irish Sea

Scrutiny

Firstly, thanks to the Wales Audit Office for the invitation to the ‘Scrutiny in the Spotlight’ seminar and the opportunity to view at first hand the shared learning that is taking place across the public sector in Wales.

I set out from Dublin with three goals in mind:

  1. To find out more about this Scrutiny thing that everybody in Wales seems to be so enthusiastic about!
  2. To see the approach taken by the Wales Audit Office to the administration and delivery of shared learning seminars.
  3. To explore the potential for collaboration and information sharing between the audit offices in Ireland and Wales.

Prior to the seminar, I have to admit that I was sceptical about the relevancy for me of discussions about the scrutiny function in local government (local authorities in Ireland do not fall under the mandate of our office and are audited by a separate Local Government Audit Service). However, it struck me during one of the workshops that scrutiny in a broader sense is part of any effective governance regime.

Irish Audit Office

Now I might be wrong (it wouldn’t be the first time), but I think that a critical aspect of well-functioning scrutiny is about putting the right questions to the right people at the right time (and continuing to ask them until you get satisfactory answers!). That principle is obviously just as relevant to those charged with governance in a school in Cork or a hospital in Galway, as it is to local government in Wales.

As for my second goal, I was particularly interested in seeing whether the five hosting partners could work together to deliver a seamless programme. With so many parties involved, there was the potential for mixed messages or an over-packed agenda. In that sense, I think the workshop format worked very well, allowing multiple themes to be explored and enabling participants to choose the ones most relevant to their own work.

As an aside, I have to say that my personal highlight of the day was the presentation from Peter Watkin Jones on the public inquiry into the Mid Staffordshire NHS Foundation Trust. While the subject matter had the potential to cast a cloud over proceedings, the speaker was able to throw light on the failings that occurred and offer hope of a brighter future. While we all know the imperative of learning from our own mistakes and experiences, it can be just as valuable (and a lot less painful) to learn from failings in other jurisdictions.

Just to prove that audit offices do practice what they preach, I met with members of the good practice exchange team the morning after the seminar to discuss opportunities for future collaboration and shared learning between our offices.

So with my three goals achieved (a triple crown, you might say), I turned for home.

On a final note, I have to say how impressed I was by the number of contributions made in the Welsh language during the seminar and how this was facilitated (without any fuss) by the organisers. I think it’s fair to say that the Irish language faces many similar challenges, so maybe this is another area where shared learning is in order.

Slán agus beannacht libh go léir.

Shane Carton

Office of the Comptroller and Auditor General (Irish National Audit Office)

Using Information Technology to enable better public services

Effective use of Information Technology

Our shared learning seminar on Effective use of Information Technology was the first one that I’ve organised since joining the Good Practice Exchange at the Wales Audit Office. I’ve learnt a lot in terms of ensuring future events are run effectively, but also on the subject itself.

When we spoke to the Auditor General for Wales about the seminars, he was very clear about the role Information Technology can play to enable new ways of delivering services.

In the seminar I was particularly struck by how Information Technology is having a direct influence on service delivery in some organisations. I was fortunate enough to facilitate Andrew Durant’s workshop in North Wales, which looked at Powys County Council and Powys Teaching Health Board’s collaborative Information Technology service. It was interesting to hear how frontline staff of both social services and health are now better able to co-ordinate their work as they have access to each other’s work calendars.

This wasn’t the only session that looked at enabling better public services. I also attended Wendy Xerri from University of Wales Trinity St David‘s workshop on Green Information Technology, which focussed on the needs of students. Students were often forming endless queues to print their essays, but by focussing on the student experience they moved the essay submission system online, thereby streamlining the system for students’ benefit and vastly reducing the amount of paper that was being used.

As there’s such an array of public service bodies in Wales, it was no surprise that Information Technology approaches and equipment varied between each organisation. It’s clear that there is no ‘one-size fits all’ approach for Information Technology, but it was really heartening to hear how public service staff at our seminar were all looking to improve the effectiveness of their work.

Dyfrig