Leadership of the development of integrated services

By completing this theme you will be able to:

  1. Gain leadership principles: self-awareness, understanding the perspective of others, developing team working and using stakeholder engagement.
  2. Understand your ‘local landscape’ and the ‘whole population’ approach.
  3. Explore the drivers and barriers for local service change.
  4. Engage with other health professions to design and implement care across services.

What you need to do over the course of the programme:

  • Attend the relevant PICH seminars
  • Project Work: one of your projects is likely to have involved leadership of change. If it hasn’t so far, conduct a project that focuses on leading change.
  • Reflect on your experience of leadership.  Use the Form for trainee to complete for each theme (on the PICH website) – or a tool of your choosing  –  to record your reflections.

Ideas for you to consider within this theme:

  • Looking at your local services there is probably variability of integrated services. Identify gaps and problems with local service provision. Consider the barriers that prevent smooth integration of care. What could be improved?
  • Identify a problem, quantify it, design and implement a solution. Evaluate the impact
  • How does your local area perform against national standards, eg NICE asthma standards/local strategic clinical network standards? Can you use this information to help improve the services?
  • How can you use patients experience and expertise to re-design services?

Ideas that have already been developed – to stimulate your thinking:

Case Study 1

Identify a problem, quantify it, design and implement a solution. Evaluate the impact

A GP trainee working in Brent noticed that her referrals to community paediatrics were frequently rejected. She met the community paediatric team and learned that it very different from adult services (eg those that offer community care for uncomplicated diabetes). She teamed up with another GP trainee: together they found that 35% of GP referrals to community paediatrics had to be redirected. They created a directory of community paediatrics to guide local GPs to the correct referral decision. The directory was published on websites and on the GP electronic patient record. Evaluation of the number of referrals that need redirection since implementation is underway.

Case Study 2

Engage stakeholders to accelerate change and improve sustainability

A CCG commissioner wanted to understand why parents were choosing to come to A&E rather than visit their GP. She organised a workshop of stakeholders. This included patients, paediatricians, GPs, patients, health visitors, London Ambulance Service, voluntary organisations, and commissioning leads. The workshop was very fruitful and was augmented by a piece of work carried out by two paediatric trainees who spent time in a local baby clinic. The trainees talked to mothers about their experiences and were able to get first hand quotations from parents. The commissioner illustrated her report with these quotes, which brought the report ‘alive’ and made it more powerful.

Case Study 3

A paediatrician noticed that many babies aged 0-6 months were attending hospital with common feeding problems. She buddied up with a GP and set up a baby clinic in the GP practice. This required preparation, including going to a ‘Transition to Parenthood’ communication course. Evaluation has included a simple economic outline, showing the savings this service brings to the health economy. They also explored liaising with other health care professionals to aim for a truly integrated clinic. The pair are now exploring ways of spreading the model to other GP practices.

Case Study 4

A GP believed that many common baby problems were referred to hospital unnecessarily. She used the EMIS (GP practice data) and Public Health Profiles to understand her practice’s demographic and referral rates. It confirmed high referral rates. With her PICH paediatric ‘buddy’, she looked at the local hospital data and found that 35% of patients were being seen for baby feeding issues. The local JSNA identified ‘infant mortality, childhood obesity, immunisations, CYP mental health, young carers and poverty’ as priorities. She found a published commitment from the Local Authority and clinical commissioners to ‘deliver a range of Parenting Programmes’, drive integrated paediatric outpatient care and avoid unnecessary referrals. These data enabled them to develop an ‘early months clinic’ within the GP practice and they are waiting to see if it would have an impact on local referrals.

Further reading:

Key Leadership Papers:

  • Goodman, M. (1997) Systems thinking: what, why, when, where and how. The Systems Thinker. 8(2): pp 6 – 7.
  • Grint, K. (2008) Wicked problems and clumsy solutions: the role of leadership. Clinical Leader. 1(2)
  • Vogt, E. Brown, J. and Isaacs, D. (2003) The art of powerful questions: catalysing, insight, innovation, and action. Mill Valley: Pegasus Communications
  • Goss, S. (2015) Systems leadership: a view from the bridge. London: OPM. Available from: https://traverse.ltd/application/files/4915/3062/4273/Systems-Leadership-A-view-from-the-bridge.pdf 

Some key Integrated Care literature:

Also good, if you’re interested:

And more papers…

  • Gordon, P. Plamping, D. and Pratt, J. (2010) Working in systems: the landscapes framework. Centre for Innovation in Health Management. Available from: www.wholesystems.co.uk/landscapes.pdf  [Accessed on 01 May 2019]
  • King’s Fund (2011) The future of leadership and management in the NHS: no more heroes. Available from: www.kingsfund.org.uk/sites/default/files/future-of-leadership-and-management-nhs-may-2011-kings-fund.pdf [Accessed 15/07/2019]
  • Malby, B. and Fischer, M. (2006) Tools for Change: an invitation to dance. Chichester: Kingsham Press
  • Malby, R. and Edmonstone, J. (2014) Effective medical leadership for a complex NHS. British Journal of Hospital Medicine. 74(8): pp 461 – 463
  • Pratt, J. Gordon, P and Plamping, D. (1999) Working whole systems: putting theory into practice. London: King’s Fund Publishing
  • Rubbra, T (2016) On purpose. Available from: https://vanguard-method.net/2016/08/on-purpose/ [Accessed 02/07/2019]
  • Seddon, J. (2008) Systems thinking in the public sector: the failure of the reform regime and a manifesto for a better way. Axminster: Triarchy Press
  • Wheatley, M. (1999) Leadership and the new science: discovering order in a chaotic world. Oakland: Berrett-Koehler Publishers
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