Supporting the relationships that drive change: a Q&A with Samantha Jones

Samantha Jones was NHS England’s Director for New Models of Care until May 2017 and before that led a varied career in health care, including time as Chief Executive for both Epsom and St Helier Hospitals NHS Trust and West Hertfordshire Hospitals NHS Trust. She is a member of the Sciana network, an initiative bringing together outstanding leaders in health across Europe. We spoke to her about leading the redesign of care in the health service, and what she’s learnt about the ingredients for successful change.

Having worked both nationally within NHS England, and locally leading provider bodies, what do you think are the ingredients for success when it comes to service redesign?

I think the biggest lesson from everywhere I’ve worked is yes, you need to address the payment systems, organisational structures and governance in order to redesign pathways of care, but change just won’t happen unless you also consider the people. You have to change people’s behaviours and that means focusing on leadership, building relationships, and making sure everyone understands and shares a common purpose. Equally, just focusing on the softer behavioural aspects (arguably the harder work) without structural changes, won’t be sustainable. It is when you put organic behavioural change together with structural change that it really gets powerful.

Tell us about the different ways you’ve helped to support this kind of change across pathways and services?

To support the work of the vanguards (the sites participating in NHS England’s new care models programme), we asked people what was getting in the way of new models of care being delivered, and then we then turned that into a support package. This involved helping to develop communities of practice, bringing together people who were trying to drive similar kinds of change so they could talk in a safe space. We also set up an online collaboration platform, where people can share information and ask questions. It’s important to help people build their networks, as these are the things that really support change.

It was the same when I was working in hospitals – whether that was creating informal scenarios where people could share learning or talk about what they were working on, or more structured approaches such as coaching, paired learning, or deep dives on a specific issue – it’s always about facilitating the relationships that drive change.

When I was at West Herts we developed something called The Onion, which was about peeling back the layers and really understanding what gets in the way of delivering safe care to patients. That project also really demonstrated how important it was to bring the right people together, the ones actually delivering care, because they hold the detailed knowledge. The Onion was quite a simple approach but it really showed the power of those people to bring about change. We demonstrated hard outcomes as a result, including a significant decrease in mortality rates, and a drop in infection rates.

What projects are really breaking boundaries when it comes to redesigning care pathways?

I think the approach that the Dudley multi-specialty community provider vanguard took to improving out-of-hospital care was extraordinary. They recognised the need to both focus on the 'what' in terms of what they were trying to deliver in their work with GPs, but also the ‘how’, investing in the organisational development and support needed for primary care to build those relationships across the sector. The work is very inspirational, combining transactional, organic, and behavioural change. For example, they have a community centre that really supports and involves the local population in the work in a variety of different ways.

There are loads of other inspiring examples from the vanguards. The Wakefield care home work and the way they’ve worked with the voluntary sector and across the health sector, care homes and local government. The approach that Yeovil took in terms of building relationships with primary care from the acute perspective. And the approach to building engaged relationships with the local community that Northumberland took, that has led to local people leading change in their area.

As a member of the Sciana network, is there anything you’ve learnt from other countries about redesigning health services that might be useful learning for the UK?

The Sciana network is such an invaluable opportunity to learn and to spend time with people working in health care in different countries. We’ve been looking at some of the challenges facing global health over the next 20 years, and what you realise is that our issues are pretty similar. We may have different drivers and timescales – it’s clear that the UK has a very urgent agenda at the moment – but other countries are also struggling with challenges like workforce.

We’re all looking at how to make the most of digital opportunities in health care to accelerate change and improve care. We’ve also been talking about how to engage with politicians in our respective countries about what needs to be delivered, recognising that you have to work with the wider democratic infrastructure, as well as driving change by working with the people delivering the services.

Follow Samantha on Twitter: @SamanthaJNHS.