System learning from the management of COVID-19

Following the initial response to the COVID-19 pandemic, systems were keen and encouraged to review and reflect upon their behaviours and learning to inform both immediate recovery plans and future system development.

Three Sustainability and Transformation Partnerships (STPs) in the Midlands: Birmingham and Solihull, Black Country and West Birmingham, and Lincolnshire commissioned Arden & GEM’s Effective Leadership Solutions team to undertake a system learning review focused on a series of key themes.

Utilising a rapid approach comprising research, interviews and workshops, each system was presented with a final report detailing findings and recommendations to support their learning journey.

The challenge

The response to the COVID-19 pandemic required systems, and their leaders, to work together in the most productive way possible, with a greater sense of purpose, to meet shared goals.

After the initial response to the first wave, systems were encouraged to undertake a review to capture their main learning and reflections, which would inform restoration and recovery work as well as future system development.

Birmingham and Solihull STP, Black Country and West Birmingham STP, and Lincolnshire STP all separately commissioned Arden & GEM’s Effective Leadership Solutions team to undertake a system learning review.

The reviews complemented a regional review led by NHS England and NHS Improvement Midlands by providing a richer picture of system behaviours.

Our approach
Undertaken by experienced senior consultants with strong NHS backgrounds, each review included a desktop review, interviews and final report, with a focus on six key themes:

1. Leadership and culture
2. Governance
3. Clinical and quality processes
4. Administrative support processes
5. People
6. Inequalities.

The review process, for each system, took place in just four weeks to ensure that learnings could be acted upon quickly and findings could inform the wider regional review process.

Desktop review
Our approach for each system began with a desktop exercise during which we reviewed key strategic documents including STP long term plans, governance arrangements, recovery and restoration plans, and lessons learnt returns.

Interviews
We then undertook a series of semi-structured interviews with senior leaders across each system. Contributors included strategic commissioners, provider boards, primary care, public health, local authorities and the third sector. A focus was kept on the key six areas detailed above and covered what had and hadn’t worked well, the reasons for this and the impact this had. Interviews also provided an opportunity to explore further any gaps in learning identified during the desktop review and from our work with other systems.

Throughout the projects, weekly updates were arranged with the Senior Responsible Officer and Programme Lead to provide updates on progress and ensure timescales were met.

For each system, ongoing findings were discussed and contextualised in the most appropriate and meaningful way to meet their needs. Within Lincolnshire STP, this included the facilitation of a confirm and challenge workshop with system Chief Executive Officers and Chairs to explore how the key themes and learning opportunities could inform future system strategy.

The outcomes

Each system was presented with a final report, as part of a dedicated session or workshop, which detailed findings and recommendations in each of the six focus areas. Findings were substantiated by the inclusion of specific examples and also included a thematic collation of the insights shared in interviews and workshops. Outside of the six key themes, the reviews also recognised system specific themes including service innovation, GP delivery models and the development of Nightingale Hospitals.

Learning points
A number of generic themes and indicative learning areas emerged across the three systems. When considering ‘what worked well’, the reviews found that:

• A ‘system first’ approach was facilitated by system leaders working more closely, supportive governance arrangements and the removal of existing financial arrangements
• A clear and common purpose created a sense of empowerment and freedom to act
• An unprecedented pace of digital transformation took place, particularly in primary care.

When thinking about ‘what didn’t work well’, common findings included:

• Frequently changing guidance within short timeframes
• Variable access to national data to enable fast and accurate local decision making.

Ongoing development
The system learning review and final report has left each STP in a strong position to take forward their recovery plans and wider system development. The reports have also fed directly into the NHS England and NHS Improvement Midlands regional team review with common areas for future consideration identified:

• Giving greater attention to population health and health inequalities
• Maintaining a ‘system first’ approach as financial and regulatory pressures resume
• Managing the workforce across a system and building a health and wellbeing offer for exhausted staff.