Ten lessons for redesigning care pathways

Redesigning services across traditional care boundaries is not easy. Making change in the context of multiple complexities, differing professional viewpoints and varying organisational priorities whilst getting on with the day job of delivering safe, effective health care is a huge task.

And yet, in these challenging circumstances health and social care professionals are redesigning services, determined to improve care for people whose care may otherwise have fallen through the gaps created by service fragmentation. This is demonstrated by these case studies, improving care for patients at the end of their lives in Leeds, and for care home residents in Rushcliffe.

In our new report – Some assembly required: implementing new models of care – we set out ten lessons for local leaders seeking to systematically make changes across services in their area. These are based on first-hand accounts of clinicians and managers from NHS England’s new care models programme vanguard sites, who have developed and tested new ways of joining up health and social care services.

The approach to change emphasises the benefit of local co-creation and testing of new cross-organisational pathways and services before contractual solutions:  

‘The tenth [and final strand of work] was commission and contract but it’s interesting that it’s the tenth… you don’t do that until you’ve planned, you’ve designed, you’ve developed, you’ve mobilised, because it should be the tying of the ribbon.’

Deputy chief officer, CCG

The lessons are underpinned by a strong focus on evaluation to understand what works and why. Not only to support the efforts of those implementing the changes but also so that this learning can be shared across the health and social care system.

Ten lessons to support the development and implementation of new care models

1. Start by focusing on a specific population
Focusing first on a specific cohort of the population gives teams experience of co-designing services with patients and using data to understand need.

2. Involve primary care from the start
Primary care plays an essential role in delivering coordinated care for patients, families and communities. General practitioners can offer significant insight into the needs of populations and where services can be developed.

3. Go where the energy is
Identifying individuals and teams who already have ideas for and commitment to change can help gain momentum locally.

4. Spend time developing a shared understanding of problems
Ensuring there is a shared understanding of the problems to be solved is a crucial factor in cross-team improvement work and requires that people are bought together at the beginning of any change initiative.

5. Work through and thoroughly test assumptions about how activities will achieve intended results
Developing logic models can help teams think through and articulate links between planned activities and outputs without rushing to implementation. 

6. Find opportunities to learn from others and assess suitability of interventions
When looking at learning from elsewhere bring staff together to work through how to adapt the interventions for the local area. 

7. Set up an ‘engine room’ for change
In the absence of formal organisational structures, it is important to put in place a central project team that includes project management, data analysis, communication and administrative expertise. This should include staff who have already worked in the local area to create confidence among stakeholders.

8. Distribute decision making roles
Ensure decision making roles are allocated across organisations and professional groups – not just at the most senior level.

9. Invest in workforce development at all levels
With the creation of new cross-organisational services, investment in developing people is crucial. This is necessary at all levels of the local system and requires a focus on individual skills, team development and training for those in leadership roles.   

10. Test, evaluate and adapt for continuous improvement
Giving teams licence to experiment is crucial in order to understand the impact of changes and to help shape plans as they progress. It’s important to make sure the people and teams involved are given feedback and supported to alter plans when changes do not go as intended. 

Although the new care models programme is drawing to a close in 2018, wider application of this approach to change could have substantial impact on the health and care of the population.

Anna Starling is a Policy Fellow at the Health Foundation. Follow Anna on Twitter: @annastarling.