Easier INC

Personalised Care In Dorset - The Move To Action

 

This blog is the third in a series co-authored with Saskie Dorman (a consultant in palliative medicine from Dorset) and Karen Stratford (a system lead for personalised care in Dorset).

The Move To Action

Emerging from our first 1.5 days of work together, collaborators in our 4 day kick-start had: 

• (BLOG 1) brought into focus the opportunities and challenges of personalised, strengths-based care and support.
• (BLOG 2) developed a clearer sense of the difference their intended projects could make (i.e. their purpose and value);
• (BLOG 2) identified points of leverage that would help them make this difference in practice without biting off more than they could chew.

Their job now was to translate all of this into action.

To do this our 3 PCN (Primary Care Network) teams split into smaller groups, each generating as many ideas as they could for how they would approach the practical work of delivery. Teams then pitched their approaches to each other and to the core group from each PCN area who would be coordinating this work. The brief was to arrive at an approach which put learning, rapid adaptation and engagement at the heart of this work so that:

• as taking action revealed new insights, efforts wouldn’t be limited to the ideas and plans we started with;
• projects wouldn’t become islands of learning and practice with no obvious route to scaling and spreading those things.

This was a process of iteration; taking good ideas and clarifying them, seeing how they fitted together, checking how realistic they were, whether there was the capacity to see them through and whether those that would need to be involved are up for it. The goal was to design an approach to each project that would start ‘clean’ and build momentum rather than start ‘dirty’ and see energy dissipate into all of the problems that would prevent it getting moving.

To help guide this iteration each team had a checklist. This provided prompts for things to think about and a mechanism for PCN teams to self-evaluate their plans. The checklist invited team members to speak up when they felt that any of the statements on it were not true:

• Our plan is realistic.
• It is focused on the right things.
• It makes the most of our strengths.
• It gives everyone that matters a clear role.
• It makes clear what will be expected of them.
• It makes clear what they can expect of you / others.
• It enables action, learning and progress to be shared with everyone that matters in ways that will work for them.
• It keeps learning sighted of the difference between doing things right and doing the right things.
• It makes it easy for anyone to surface and share learning in real time (or very rapidly).
• It makes it easy for anyone to adapt in real time (or very rapidly).
• It compels people’s efforts not just their blessing - including your own.

Here's a short video of the teams presenting their plans back to each other.

Some Emerging Patterns

As the teams discussed and then shared their plans back with each other it was hard to miss the commonalities that had emerged…

Anything after the first 30 to 60 days tended to look more like an outcome or intent than an action

While the near-term actions each group needed to take were clear, the further into the future they looked the less certain things became. The value of the longer range elements of their plans was therefore mostly in seeing how their actions in the near-term contributed to their overall goals and purpose, much less about organising their longer-term efforts.

With Co-Created Clarity Of Purpose, Action Requires Action More Than It Requires Meetings About Action

We had taken 4 days together to run this kick-start but having done so, what seemed to be emerging was a sense that:

• we could now get on and do.
• many of the issues we may hit en route could be resolved through action and iteration, supported by brief ad hoc comms but not requiring overbearing governance or regular project meetings.
• everybody didn’t need to be involved in everything; they trusted each other to do what was required, to ask when help was needed and to share when it was relevant to do so.

Transparency By Default

Supporting this emerging bias to action, each team also discussed how they could make what they were working on and learning visible to each other by default, without turning doing so into a bureaucracy. Various different technologies were mentioned that could support this (Trello, Microsoft Teams, Basecamp, etc) with a combination of Teams and TeamNet being decided upon for local, pragmatic reasons. Using these tools, individuals and teams may be able to “work out loud” without filling each other’s inboxes and without having to invest significant extra time in creating bespoke comms.

Learning, Comms, Engagement and Governance Can Usefully Be The Same Thing

Somewhat in the same spirit, it was notable that teams had developed mechanisms that were about learning out loud NOT JUST within the core project team BUT ALSO in public through systematic engagement with colleagues and communities. For example, Team 1 planned to engage clinical colleagues who refer into their social prescribing service in a process of iterative learning. This would focus on discovering together:

• who the ‘hidden individuals’ are that may benefit most from social support.
• what indicators may be most diagnostic in identifying these people.
• how they can improve their collective capability to find and support those people.

NB See blog 2 for more background.

This approach to treating action and learning as public, interactive and emergent suggested that - although there may still be some residual elements of programatic learning, comms, engagement and governance - for the most part, these would be baked-in to how the work was done rather than being something additional and separate.

Scaling Up Happens From Day 1 - More An Emergent Outcome Than A Phase

A further extension of this adaptive, emergent and transparent approach seemed to be that each project was essentially creating the platform for scale and spread from the start of their project rather than waiting to discover what works then treating implementation as a phase. This makes all sorts of sense in complex systems, not least because it means that, alongside securing the insight and ownership of those who will ultimately determine whether this work becomes ‘how we work’, each project will also be creating the habits, norms and routines that enable learning and improvement to become something continuous. Not just a binary shift from state A to state B and so perhaps not really a project at all!

Back To Reality

Of course, exciting as all of this work may sound - and the energy in the room across the 4 days suggested that it was exciting - there are and will be no panaceas. Each team, and this programme of work in general, will face its fair share of hurdles, bumps in the road, set backs and frustrations. We know this. In fact, within the 4 days of the kick-start many of these were visible. Arriving at clear shared purpose statements, agreement about where the points of leverage were, personal commitment to shared plans, etc were all hard work and all required give-and-take, pragmatism and, in various ways, a willingness to trust each other.

We know that as we leave the room, these 4 days together disappearing into the rear view mirror, reality will bite and the real hard work will start.

We expect that in some ways and to some extent we will fail so the aim is to fail forward and to fail together. Put another way, the aim is to learn and to support each other. Not to be disheartened or beaten when we fall short of our grand ambitions. Just to use the learning and fellowship that we are creating as a platform on which to dust outselves down and go again; each iteration hopefully making achieving our grand ambitions a little easier.

Staying Connected

To do this we’re going to stay connected - within Dorset but with you too if you want to.

• In early May then again in September we will be holding shared learn days for the Dorset teams; a formal chance to reconnect which will punctuate their day-to-day processes of working transparently.
• We will be publishing updates from those events on this blog and through our sister site and community of practice at www.nextstageradicals.net.
• Some of the Dorset team also plan to share occasional, more ad hoc updates on that site too. Check it out if you are interested and consider subscribing for updates.
• Consider also sharing YOUR stories and learning there too. You can start exploring aloud with us - no cost attached, just an expectation that you will keep it civil and learning led. Find out more here.
• Those are the same ground rules for the Next Stage Radicals facebook group, which you can join in with too and which is ideal for those who prefer to connect in conversation rather than to publish blogs and podcasts, etc. Join up here.

In the meantime and until our next update…

Thanks for reading!

---

Format: Blog

Tags: Client Story

---