A key challenge for all NHS organisations will be to meet their legal duty to deliver services that meet the Triple Aim for their local populations.
Within West Yorkshire Integrated Care System (ICS), local health and care partners are working together to improve the health and wellbeing of local people living in Bradford and Craven, Calderdale, Kirklees, Leeds and Wakefield.
To support clinical and finance leaders in applying the Triple Aim duty in their decision-making processes, the ICS commissioned Arden & GEM’s Healthcare Solutions team to deliver a development programme around value and stewardship.
The challenge
The Health and Care Act will enshrine in statute a legal duty for decision-makers across the NHS (within Trusts, Integrated Care Boards, and NHS England and NHS Improvement) to deliver services which meet the Triple Aim. Leaders must collectively consider the impact of their decisions on:
- Improving the health and wellbeing of everyone within the population they serve (including reducing inequalities in health and wellbeing)
- Increasing the quality of healthcare services for all individuals within the population they serve (including inequalities in benefits from those services)
- Making sustainable and efficient use of NHS resources.
Developing the mindset and culture needed to deliver the Triple Aim duty requires leaders to understand the fundamentals of value-based population health and care and the concept of stewardship.
Our solution
Arden and GEM’s leadership and OD experts developed a programme to support clinical leads and finance leads at West Yorkshire ICS through three workshops. The aim of the programme was to develop their understanding of how the Triple Aim could be met through a stewardship approach.
Our team worked with representatives from the clinical and finance forums at the ICS to finalise the exact outline of the workshops, ensuring it met both the overall aim and system-specific needs. More than 60 people – representing primary, community and acute care – were invited to the sessions.
"The workshops provided us with an insight into a different approach to resource management through stewardship and value which we will be discussing at our leadership groups and seeing how we can use this in our partnership work across the West Yorkshire ICS."
Richard Mellor, Director of Finance at Locala Health and Wellbeing, West Yorkshire ICS
Workshop 1
In preparation for the first workshop, participants completed an online training module in stewardship. Within the session participants explored concepts including value, the tragedy of the commons, stewardship and what these mean for healthcare.
Attendees were also asked to consider what thinking in population terms means, from a financial, clinical and analytical perspective. Finally, we explored the need for ‘systems’ as interconnected activities with a common aim.
Workshop 2
Before the second workshop, participants completed a further online module which described the key concepts for the new paradigm of value-based healthcare. In the session attendees explored:
- their connection with the Triple Aim
- what value means in their ICS for a chosen population segment or clinical priority area
- agreeing how West Yorkshire ICS would track delivery against the Triple Aim
- understanding the cultural and technical approaches needed to deliver value and the Triple Aim
- describing what will be different as a result of this and the level of impact.
Workshop 3
In the third and final workshop, participants agreed what delivering the Triple Aim means for West Yorkshire ICS and what actions need to be taken as a consequence. This included the role of the ICS versus place versus neighbourhood and preparation of a presentation, recommendations and elevator pitch for the Integrated Care Board (ICB).
Outcomes
The development programme has enabled 30 finance and clinical leads within West Yorkshire ICS to start internal discussions, within their forums, about how to adopt a stewardship model in their places.
Arden & GEM will continue to support these groups in developing a presentation to the ICB by September 2022. This will outline the cultural, financial and operating model changes required to deliver on the Triple Aim, create a culture of stewardship and develop a common language and approach across West Yorkshire.
"We all know that we need to move to an information-based, personalised service and that this requires resources to be moved where they can offer the best value for people, while being underpinned by an ambition to tackle health inequalities.
The language of ‘stewardship’ and ‘value management’ forms a firm foundation for health and care leaders to enable clinicians to make best use of resources in achieving the outcomes we all want with our populations."
Dr Jason I Broch, Clinical Chair at NHS Leeds CCG, Health & Social Care Lead at Yorkshire & Humber Health & Care Record, and Partner at Oakwood Lane Medical Practice