The PSC news-insights: entry

11/01/2023
Transformation, Insights

How can we harness the full potential of Integrated Care Boards? - Part 2

Our transformation team shares practical steps that NHS leaders can use to cultivate intrinsic motivation and unleash the full benefits of Integrated Care Boards.

In Part One of this article, we looked at two key challenges in the transition from Clinical Commissioning Groups (CCGs) to ICBs:

1. Cultural:
- How can we enable leaders and staff to view this change differently…and to avoid falling back into previous ways of working?
- How can ICBs enable a dual focus on both the needs of local communities, and system wide equity and population health?

2. Relational:
- How can and should the ICBs delegate functions in practice?
- How can ICBs strike a balance between a focus on collaboration and shared priorities, whilst also holding individual organisations accountable for improving outcomes in their patch?

How can we harness the full potential of Integrated Care Boards? - Part 2

Click here to read part one. 

We considered three principles of intrinsic motivation: Purpose, Mastery, and Autonomy, describing how these concepts can inform approaches to change management, helping to overcome these cultural and relational challenges.

In this article (Part Two), we apply these principles and develop practical steps to implement change using an ‘Integrated Interventions Framework’.

 

Applying an ‘Integrated Interventions Framework’

We can develop practical steps to support senior leadership teams and managers to cultivate purpose, mastery and autonomy within ICBs; contributing to the culture and behaviours that enable genuine collaboration across the system. 

The following is a high-level outline of how this approach would work in practice:

Integrated Interventions Framework - big picture:

 

This support can take the form of ‘learning partnerships’ lasting for up to two years or more, in line with a ‘progress pathway’, and gradually empowering ICBs in taking ownership of the approach, and running and sustaining it in the long run. 

 

 

Designing Integration Improvement Cycles (IICs)

 

To achieve the expected shift in mindset and behaviours associated with improved purpose, mastery and autonomy amongst ICB stakeholders, we can co-design ‘Integration Improvement Cycles’ (IICs). Each of these may last four months, consisting of targeted support and initiatives. Following the completion of IICs, these may continue in the form of four-month-long ‘Performance Improvement Cycles’ building upon a strong foundation, and ensuring continuous performance improvement.  

The support provided as part of IICs would include the development and adaptation of practical tools, contextualised templates and processes. We can also provide mentoring and coaching for senior leadership, service leaders, and workshops for employees. As part of this learning partnership, it is vital to develop a sustainable approach, empowering organisations and emphasising ‘talent nurturing.’

 

 Here are some examples of what this could look like, under each IIC:

*These can be adapted to suit the nature of the ICB, and priority areas to target.

 

Monitoring progress and identifying opportunities for improvement

In addition, organisations can collect data relating to key indicators of progress. Using a data-driven approach to monitoring, evaluation & learning, we can conduct ‘monthly progress checks’, helping to maximise key improvement opportunities.

Presenting a high-level roadmap for Year 1

The following is an illustrative example of a high-level roadmap for the first year of the ‘learning partnership’ with an ICB.

 

*Timelines can be adapted to suit the nature of the ICB, and priority areas to target.

 

Key takeaways and next steps for ICBs

In Part I of ‘Harnessing the full potential of ICBs’, we spoke of the value in instilling a sense of purpose, mastery and autonomy within individuals, organisations and services; all of whom are key to fulfilling the potential of a transformation initiative. Next, we spoke about the importance of role modelling, with the ICB playing a pivotal role in fostering new system ways of working, and engaging partner organisations. Finally, in Part II, we explained how applying an Integrated Interventions Framework, and using underlying principles of intrinsic motivation, can offer ICB leaders, and health and care colleagues, a helpful lens through which to view change management.

As integrated care systems continue to mature, ICB leaders face a number of unanswered questions: 

  • With ICBs moving to delegate functions, what will success look like across varying local populations?
  • How can ICBs better engage with citizens, to spread awareness of the vision for integrated care, and the impact on patient choice and quality of care? 
  • Against a backdrop of significant operational pressures, how can ICB leaders continue to drive system-wide transformation forward?

As health and care colleagues work to address these complexities, understanding and acknowledging the power of intrinsic motivation becomes ever more important. The transition to ICBs is taking place against the backdrop of a deeply felt cost-of-living crisis, and hitting a workforce fatigued from Covid who have already experienced years of seemingly interminable change. ICBs need to be able to convene the system around them if they are to succeed in delivering real benefits for their populations.  Engaging partners in a sense of shared purpose, and providing individuals with the opportunity and freedom to pursue their own professional development goals, is at the heart of creating intrinsic motivation and workplace satisfaction. By striving to support individuals at all levels across the system, the ICB can enable them to reconnect with the significance of their work, and the role they each play in improving people’s lives.

 In short, applying this intrinsic motivation framework offers a roadmap to support organisations to unlock colleagues’ individual sense of purpose, mastery and autonomy, creating both the cultural and relational foundations for success. This is no easy feat. But it is crucial for developing ICBs into high performing, learning organisations that can deliver equitable, high-quality care for their residents.

 

Authors: David Schneider, Elanor Bond and Nivedita Prasad

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