Published: 28/02/2002, Volume II2, No. 5794 Page 14 15
As Britain grows older, so health and social care professionals are running faster to keep up.
Last week, in response to a poll by the BBC which found an overwhelming majority of the public were in favour of free care for elderly people, prime minister Tony Blair made it plain that the costs of such a policy U-turn - estimated to be about£1bn - were prohibitive.
Instead, the NHS is focusing on new models of working to provide care to an ever-ageing population. In the next 25 years, the number of people over 90 will double, each one with a different set of needs.
Trent region hopes the collaborative approach will provide solutions - and has a high-profile fan in Paul Plsek, senior fellow with the US's Institute for Healthcare Improvement.
Mr Plsek, who is something of a regular on the international health policy circuit, and has worked with the NHS for the last seven years, spoke to HSJ before heading off to a one-day 'clinic' for the region's health and social care collaborative for older people. Trent is the only region outside London to adopt the collaborative model for older people.
The collaborative approach is becoming an increasingly popular way of making large organisational change in the NHS.
Three prominent examples are the cancer collaborative, established in October 1999 with nine pilot sites studying five key cancers, and those for primary care and coronary heart disease.
But Mr Plsek believes the approach can only succeed if it puts patients ahead of processes.
'It is easy to become somewhat analytical and detached, ' he says.
But collaboratives must find ways of getting more viscerally in touch with the patients' experience.
'I have seen collaboratives go through several meetings, I've read the minutes, looked at the work they are doing - and it lacks that touch with the patient. It has become numbers and systems and processes and we must not forget there are one-by-one stories of patients' experience that must be incorporated.'
He says front-line staff share the need to know how they can maintain the motivation and enthusiasm necessary for change amid a raft of other priorities - and how to ensure that gains achieved in a limited project are sustained.
'There is a notion that a lot of improvement work tackled as a project in the NHS has a start and an end and is then bolted on to everything else, ' says Mr Plsek, who has facilitated dozens of collaboratives in his native America and helped to establish many in Sweden, Norway, the Netherlands and Australia.
'And I wonder if we set ourselves up with the terminology? Instead of referring to project managers, we might start thinking of a name relating to organisational development. Because this improvement thinking needs to become a habit, not just a project.'
Linda Tully, regional project manager for the older people's taskforce, sponsors of the collaborative, agrees: 'We are already learning that the collaborative methodology should not be regarded as an off-the-shelf management model. It should be an integrated style and habit.'
She says the clinic allowed facilitators and representatives from each of the collaborative's 12 teams to take time out to further explore the collaborative methodology for rapid change improvement.
'This includes the ability to step back and accurately define exactly which real problems threaten our provision of care, ' says Ms Tully.
'Often we think we know what the problem is - It is usually identified anecdotally and talked about in corridors. But is it the root problem or the perceived one?'
Learning to work together, sharing best practice and celebrating achievements are all vital ingredients of collaborative working, Ms Tully says.
Mr Plsek sees that because most NHS staff have entered the healthcare professions through the 'education silo' - nurses learning with other nurses, doctors with doctors - they are unused to sharing and testing ideas.
But he believes that the NHS has been diligent in doing its homework. 'There is a huge potential for learning, but the NHS is pretty good and has been going out and getting this information, ' says Mr Plsek.
He believes the US, Canada, Scandinavia, Australia and New Zealand lead the way in collaborative working. 'I constantly see those people who run the collaboratives on a national level at conferences in the US and in Europe. I would applaud the NHS for going out and looking around.' l Dream team: doing it the Trent way The Trent collaborative for older people is divided into 12 multi-agency, multidisciplinary teams, including service users, across the region. It is one of the cornerstones of the region's older people's taskforce, which is developing intermediate care services and whole systems for effective and appropriate discharges and transfers of care.
Though working to a tight timescale - teams receive formal development support for eight months - Linda Tully knows that already some measures have influenced improvements and others had a 'dramatic impact'.
In Lincolnshire, patients are now discharged early in the morning, with a packed lunch or microwave meal, to free a bed on that day.
At Bassetlaw District General Hospital, the collaborative team is using hospital radio to capture the patients'experience and to raise awareness of the project.
And across Rotherham and Barnsley, changes have greatly improved transport efficiency, after a survey in a 10-day period revealed that 80 per cent of delayed discharges were due to misinformation.
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