This is the fourth blog in a series about timebanking. You can read the first blog here, second blog here and third blog here.
With Integrated Care Systems (ICSs) on the ‘delayed’ horizon, the way we define problems and develop an approach will slowly and surely evolve. An ICS presents an inter-dependent and more closely woven health and care landscape than ever before, and this means that all stakeholders will need to go through an awareness and learning process in order to navigate and flourish in the brave new world. The key difference in approach will be looking at challenges through a much wider lens, to ensure System-wide benefits rather than simply individual organisational success. The ICS is emblematic of the shift in thinking towards an adoption of Value Based Healthcare – an approach which focuses on overall population health vs cost to the System, as opposed to more transactional, point-in-time, provider specific metrics. This means both the problems and the solutions around patient care and delivery will change, with a welcome shift in focus from more immediate KPIs to longer term progress and success metrics; shifting our focus from the urgent to the important. Through the pandemic and winter pressures we are seeing staff burn out and the stream of NHSEI directives often present an unwelcome distraction. This has been recognised by the recent communication: ‘Reducing the burden of reporting and releasing capacity to manage the COVID-19 pandemic’, but does this go far enough and how do we understand what is important?
Resource management is a minefield we need to navigate. Besides the logistics of cost and staff time management, one of the big challenges remains – harnessing the NHS’s most valuable resource: in-house knowledge. Even if the System has the knowledge base necessary, deploying it to an area of need is trickier – because this knowledge is so dispersed, managing it is now more important than ever. Legacy pockets of knowledge across the System might not correlate with the area of need, and traditional methods of knowledge sharing such as webinars and briefings, or more long-term methods like secondments, will simply not be responsive enough to deal with the challenges associated with this transition.
Establishing and fostering links across providers and stakeholder such as local authorities and the voluntary sector will be crucial for the success of the ICS. The NHS is currently too siloed to optimally serve its true purpose and maximise patient outcomes, resulting in learning being lost and a mismatch of cultures and norms within different parts of the organisation, and different perspectives on pressure points. True collaboration – breaking down this siloed way of working – and shared understanding of problems, will be key to developing and deploying fully informed and joined-up solutions that place the patient at the heart of healthy populations. Perspectives and values must shift if our goals and behaviours are to become more aligned – which will be necessary in the new ICS world. Presently this is less of a priority as organisational success comes before System success in most cases. But with the ICS this approach must change. As the goalposts shift, so must our perspectives and behaviours.
“Sure, whatever you say,” I hear you scoff. This rhetoric around collaboration is tired. And yes, it is much easier said than done. But collaboration, like love, cannot be mandated. It comes from trust and a recognition of mutual dependence and benefit. If everyone could automatically work together better, more collaborative practice would have been established by now. And I do appreciate, it’s not always easy – this is a big unknown. However, we have a secret weapon in our battle to break down these silos; a force that is only becoming stronger and more powerful every day: technology. The pandemic has already forced us to drastically change our way of working and communicating, with the swift implementation of telemedicine in primary care, videocall meetings, the tighter control and rigour around calendars and mailboxes, and the changing ways with which we share and communicate. It can be done, but we often need a push in the right direction. Collaboration isn’t easy, but through digital transformation, the barriers are removed.
Take a digital platform such as Hexitime. Hexitime is a community building platform designed to enable connection and hence a form of digital collaboration; it’s a time-bank and healthcare-focused knowledge sharing platform. In an era where digital connections are the norm, and in which shared purpose is more important than provider, this is a concept whose time has come. Users either offer expertise and time or make a request. Success is based on giving and taking being balanced and is aligned to the concept of ‘paying it forward’. Rank-agnostically, it provides a new way of knowledge-sharing and learning within healthcare, all without the need for extra cost or compulsion. It helps connect, breaks silos, is open, accessible, low cost, fast, and can be used as and when needed: a highly agile solution to a multifaceted problem. This approach and its outcomes are integral to the integration and change processes that are upon us, and as a means of connection: forming the basis for future collaboration of your teams, organisations and Systems.
And frankly, this type of solution is only the start. Digital transformation and innovation are vehicles for leaders, teams and individuals, making it easier and easier to communicate, share and learn, and position Systems to be able to deal with the challenges of tomorrow using the knowledge we have today. By breaking down organisational boundaries and the hierarchy of position we can connect and build a truly collaborative System with trust as the foundation.
Dr Hesham Abdalla, Consultant Paediatrician and Head of Quality Improvement at Oxford University Hospitals, as well as cofounder of Hexitime.
Dr Masood Ahmed, Chief Medical Officer, Black Country & West Birmingham CCG
tl;dr:
- How to problem solve for a System vs a provider: balancing short-term KPIs with long-term success.
- Resource management in a Value Based Healthcare system.
- Collaboration and removing silos as a way of understanding and solving for a System.
- Digital transformation enablement as a tenet of future thinking.
- Hexitime – a digital solution to an age-old problem.
Hesham Abdalla
Hesham Abdalla is a consultant paediatrician and director of medical education and quality improvement lead at Oxford University Hospitals. He has over 10 years’ experience of leading service improvement seen through the twin lenses of patient and staff experience and has led teams to a number of Patient Experience, Patient Safety and Quality Improvement awards. Twitter: @hesham_abdalla @hexitime
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Co-founder and director of Hexitime Community Interest Company, Trustee at the Point of Care Foundation.
Masood Ahmed
Masood is the Chief Medical Officer for the NHS Black Country & West Birmingham CCG, serving and commissioning for a population of 1.5 million in the West Midlands, UK. As CMO, he holds executive responsibility for Primary Care, Medicines Management & Clinical Policy, Patient & Public Engagement, Clinical Leadership and is the CCIO supporting the digital agenda for transformation and innovation across the System.
Masood is also the Clinical Technology Officer for the West Midlands Academic Health Science Network. Other commitments include the NHS Confederation BME Leadership Network Steering Committee, Save A Child Advisory Board, and Brent Council Data Ethics Board.
Masood is a digitally focused NHS leader with commercial acumen, a clinical background and over 20 years of international healthcare experience. He is passionate about tackling health inequalities and developing diverse leaders for the future. Twitter: @Doctor_Masood
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.