To transform services, ICSs should move away from the traditional siloed approach to care pathway redesign and instead adopt a bottom-up approach, writes Beccy Fenton

The challenge of redesigning care pathways presents our fledgling integrated care systems with the ideal opportunity to develop the eight capabilities they require to be successful.

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However, that’s going to require a different approach to delivering change; focused on the systematic redesign of care, driven by collaborative, ambitious leaders, incentivised with the right reimbursement mechanisms.

Research undertaken with Forrester in 2019 helped us identify the eight capabilities that the world’s most successful ICSs have invested in. These included having insight-driven strategies; experience-centricity by design; an agile and empowered workforce; and digitally-enabled technology architecture.

There were no real surprises in that list. However, when it comes to thinking about how to practically improve these capabilities (if ICS leaders even have this on their radar), the default option is typically to think of them in silos and in a top-down fashion. I don’t think that’s the best way to go about it.

I recently attended a presentation where a colleague of mine, Anna van Poucke, our global head of health, talked about the success of the Finnish healthcare system in digitally redesigning care across the care continuum. The Finns moved away from the traditional siloed approach. Instead, they systematically redesigned and implemented new digital care pathways through a bottom-up approach. This started in 2013 when they delivered five new digital pathways for healthy weight management and mental health.

Progress after that was steady, if unremarkable. By 2016, another eight pathways had been redesigned. However, what was a trickle of change soon became a torrent. A running total of 25 by 2017 became 57 by 2018, 157 by 2019 and over 300 just a year later.

The explanation for the scaling up of pace and volume in those later years is simple. Repeat the redesign process often enough and you’ll spot a lot of commonalities about major structural problems, such as a lack of an electronic patient record, and capability gaps, such as having an inflexible workforce.

In looking at these individual pathways, consciously or not, Finland was addressing the eight capabilities required of a successful ICS.

Repeat the redesign process often enough and you’ll spot a lot of commonalities about major structural problems… and capability gaps

At KPMG, we refer to this as “reverse strategic planning” – where the capability gaps identified at a care pathway level (and the tactics adopted to overcome them) can be used to inform an overarching ICS strategy in each of the core capability areas, which in turn accelerates future pathway design work.

With their remit cutting across the entire care continuum, there’s nothing to stop our new ICSs taking the exact same approach. Will they however have the vision and ambition to use care pathway redesign as the vehicle for determining and developing the capabilities they require to be successful at a system level? Or will their leaders revert to looking at these capabilities from a siloed, stand-alone perspective?

I’m not sure that many are preparing to adopt the former approach – or are even giving capability building the attention I believe it deserves. However, to be fair, such an approach does require a medium-term time horizon, as the work in Finland shows. Currently, short-term thinking is the order of the day across the NHS. Somehow, that needs to change.

I also wonder whether, for such an approach to work, it requires a catalyst to give it extra urgency. If the pandemic taught us anything, it was that urgency born out of crisis delivers increased levels of collaboration and innovation.

Therefore, there may be something here about being provocative to help create the sense of urgency and scale of transformation needed.

Start bandying around predictions such as how 25 per cent of current tasks could soon be automated through AI or suggest that in five years’ time, more money will be spent on out-of-hospital care than in acute care and we may quickly focus a few more minds.

What is for certain is that the creation of the ICSs and the desire to rethink care pathways has presented us with the ideal opportunity to develop vital capabilities across the NHS. We should seize that opportunity now.