While the greater integration of health and care is intended to improve the planning and delivery of services for local populations, the challenges of integrating pathways, structures and organisations can lead to difficult relationships between system leaders.
Arden & GEM’s Health and Care Transformation team was engaged by one Integrated Care System (ICS), for a 12-month period, to deliver coaching interventions for the Chairs and CEOs of local NHS organisations.
By creating safe spaces for discussion and employing observational inquiry, within team and pairs coaching sessions, positive changes in the connections between participants have been accelerated to support the development of integrated clinical pathways and operating models.
The ambition behind ICSs is to improve population health, advance quality of care and ensure the sustainable use of resources through joined-up planning and delivery of health and care services. But greater integration often calls for significant service, organisational and structural change which can impact upon relationships, progress and outcomes.
For one health and care system, integration challenges had led to strained relationships between clinical and administrative leaders at place level which was impacting progress. To move forward, relationships and trust needed to be re-established and greater engagement was needed on developing integrated clinical pathways.
With experience of delivering organisational development (OD) interventions at a board and executive level, Arden & GEM’s Health and Care Transformation (HCT) team proposed a series of coaching sessions. These would take place for Chairs and Chief Executive Officers, over a 12-month period, against the context of a wider programme of work led by external consultants to design a new clinical operating model.
The coaching intervention would seek to accelerate positive changes in the connection between participants so that they could:
- Model partnership working and collaboration for the benefit of the population, patients and staff
- Build environments where they could be honest with each other from a basis of trust
- Agree how collectively to hold each other accountable for behaviours
- Establish practical, realistic and shared commitments
- Find ways to promote, encourage and facilitate effective collaborative working across the system.
An initial diagnosis phase comprised 1-2-1 coaching conversations with the identified individuals to better understand the history, mindsets and dynamics embedded within the local system.
This was followed by a series of team and live coaching sessions which were delivered as part of the existing meeting and governance structure. An experienced coach joined these forums to support leaders in different roles and different organisations to work better together.
Live coaching, or ‘coaching in the moment’, is a form of team coaching that brings independent observation and challenge from multiple stakeholder viewpoints. Skill and experience is needed to know when to let conversations run and when to interject to bring items such as the language being used, the messages being conveyed, and other un-heard voices to attention.
"Our role was not to find a solution but to help participants have conversations, at the end of which they each felt heard by their colleagues and knew something as a result that they did not know at the beginning, in order to move forwards as collaboratively and collectively as possible."
Arden & GEM’s Coach
As the live coaching sessions moved from a weekly to monthly frequency, these were complemented by the introduction of pairs coaching.
These initially took place as peer to peer conversations (e.g. Chair to Chair) but then progressed to include different roles within the same organisation and finally different roles within different organisations. The coach’s role was to facilitate conversations and create a safe container for transparent and honest discussions to take place. Often this would include open challenge which helped to align understanding and re-establish trust between the individuals involved.
The programme of coaching facilitation has helped to create an environment of collective leadership where individuals are able to challenge and support each other more appropriately. This has been achieved by creating psychological safe spaces and employing an observational inquiry approach within meetings. This in turn has influenced participants to apply different lenses to situations and challenges, in particular that of the patient and other key stakeholders.
"For some time, our system was engaged in a project designed to integrate health and care that involved significant service transfer and change. This had resulted in a breakdown in relationships between organisations, clinicians and managers, and a consequent absence of trust and effective progress towards desired local system outcomes.
The Chairs and CEOs of the local NHS organisations and council agreed to an organisational development intervention designed to rebuild relationships to enable the system to operate more successfully and for agreed service change to be enabled. This involved engaging an experienced coach from Arden & GEM’s HCT team in a series of ‘team coaching’ interventions. A ‘live coaching’ process was introduced to regular Chairs and CEOs meetings, as well as facilitating coaching sessions in ‘pairs’ for all permutations of Chairs and CEOs.
While the issues in the local system are deeply embedded, and will require further work on the part of the participants to achieve a resolution to the satisfaction of all, the ‘team coaching’ intervention and support has greatly assisted the system in terms of being able to move forward to a point where integrated pathways are being developed and clinicians are successfully engaged."
Managing Director at the ICB