How to improve staff collaboration and delivered integrated care

In the London borough of Greenwich we recognised the commitment of our staff but also knew that our intermediate care and social care services were reactive and piecemeal. There were significant opportunities for better outcomes through integrated working.

Our vision was for one service, working across disciplines and sharing skills to improve outcomes for vulnerable older people and provide a collaborative and proactive approach for those with urgent health and social care needs. This required a change in culture, behaviour and attitudes.

We took time to map processes and discuss potential opportunities to do things differently on a wide scale. Staff also engaged in problem solving workshops, such as working out where and why there were delays in the existing system.

Despite initial natural anxieties and fears, there was a desire from the front line to take control of the destiny of its services and respond to the challenge to redesign the model. A vision was collectively created and a collaborative approach adopted. A strong, committed group of team leaders came forward to engage staff from the top to the front line. A new design emerged with:

• a single point of contact – incorporating referral pathways and immediately addressing user need;
• a joint emergency team – fast, immediate responses to prevent hospital admissions and urgent social care referrals;
• a hospital intervention discharge team – fast discharge to intermediate or social care;
• community assessment and rehabilitation teams – up to six weeks of rehabilitation and ongoing social care linked with a home care reablement service;
• proactive flow management through intermediate care beds with a collective key performance indicator so access and discharge is faster;
• shared management and co-located teams of nurses, physiotherapists, occupational therapists, social workers and care managers.

Critical success factors that really supported engagement included a belief that good and meaningful engagement with staff leads to good design and great outcomes. This meant developing the vision with staff, accepting their natural resistance and fears about change, and building commitment to a shared vision.

Enabling change

We fostered a willingness to change collectively the culture of the organisations involved through clinical engagement and development of a common language, leading to shared values, beliefs and altered attitudes. Facilitation needed:

• exceptional leadership to develop and empower managers to be leaders and champions, and act as great role models;
• joint governance and change management engaging staff at each step;
• work based on the premise that anything is possible, with a constant focus on user experience;
• the engagement of stakeholders including commissioners, patients, service users and staff unions;
• workshops and external facilitation;
• cross working with IT and teambuilding workshops to prepare for implementation and beyond.

Our staff must be valued, nurtured and respected. They are highly compassionate and intelligent with innate skills in problem solving and are driven by strong values. Ensuring we never lost sight of our fundamental values and purpose was vital when releasing potential. Connecting people built their confidence to shape their own destinies. Our leaders had to be self aware and authentic. When working across systems they are transparent and openly demonstrate trust and commitment to a common goal. Empowering staff in a different way was very liberating as they led people through the change process with empathy and emotional intelligence.

We aspired to create a culture in which morale, engagement and productivity are high. Feedback has shown that staff recognised the benefits and share a sense of satisfaction, recognition and value that further motivates them.

Oxleas Foundation Trust, in partnership with the London Borough of Greenwich, won the Staff Engagement award at the 2011 HSJ Awards.