It’s not hyperbole to say integrated care is one of the most complex and challenging behavioural changes the public sector has ever faced – but together we can make it work, writes Alex Khaldi

Presenting at the HSJ/LGC Integration Summit earlier this month confirmed something for me that I had long known. Practitioners recognise the power of a behavioural agenda, they just don’t know what a first step into it looks like.

The health and care system is complex, with a multitude of relationships, interactions and competing interests that all make for fertile ground when considering how to unearth powerful behavioural insight.

Alex Khaldi

‘Integration is arguably the most complex and challenging behavioural ecology the public sector has ever had to face’

For many, a barrier is scale. How can I cover off as many of the dynamics at play to really make this worthwhile without a) disrupting our current work, and b) investing too much before I know where the efforts are truly best placed?

The answer in my mind is, not alone. Instead of a single organisation trying to do it all too early, you need a cooperative of participants all sharing the risk and the learning. By bringing together a group of locator organisations that are each charged with working on a single behavioural dynamic we will be able to build the UK’s first health and care integration behavioural network analysis.

Integration is here to stay

Despite some resistance from clandestine forces in Whitehall, the health and care integration project is ploughing ahead. One of the major messages I took away from the summit was the sense that irrespective of the party in power from 2015, this project will run and run.

Arguably, even without the big central pot of funding (so often the trigger for cross-agency collaboration and yet rarely a mechanism to sustain it) there is enough medium term activity to suggest it’s beginning to assume a life beyond the relatively short term funding available.

‘The correct approach in the face of such complexity is to come together and learn as a group’

In iMPOWER’s report last year, A Question of Behaviours, I wrote that one of the first things that was needed was the agreement that it was not only OK to have a behavioural agenda but actively advantageous to have one.

This, at its heart, is a leadership challenge. On the basis of the reactions of people at the summit, I’m confident that we’ve moved passed this. The next hurdle is where to begin? As experienced practitioners in the behavioural change field we’ve seen a multitude of projects, trials and redesigns all driven by core behavioural insight. It is not hyperbole when I suggest that health and care integration is arguably the most complex and challenging behavioural ecology the public sector has ever had to face.

Don’t go it alone

Jumping in alone is an unnecessary risk. From our experience the correct approach in the face of such complexity is to come together and learn as a group. With that in mind we are creating a time limited learning programme called Pinpoint.

This programme invites 10-15 organisations in health and care integration to detect and measure a series of behaviours and relationships across the integration landscape. Each participant will take responsibility for a single behaviour and relationship, with the results of each participant being collated and released as a report at the conclusion of the programme.

This is the first programme of its kind in health and care integration and it will help to inform behavioural agendas across all integration efforts.

We’re encouraging all those, who like us, believe sustainable positive change is behavioural change to consider being a locator organisation and join the Pinpoint programme.

Alex Khaldi is managing director at iMPOWER. To find out more about Pinpoint contact him at