Western Isles Strategic Plan Raghnall Culley Priomh Oifigear

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Place-based Systems of Care Emerging evidence that place-based systems of care improve outcomes (King’s Fund, 2015) Southcentral Foundation Alaska Established in the mid-1990s - quality of care and outcomes among the worst in the US Now regarded as one of the most successful examples of health system redesign in the world Transformation began when it was given control of a single budget and responsibility for a broad range of services for its population Started with careful consultation with the community, defining mission and values Established in the mid-1990s - quality of care and outcomes were among the worst in the United States. Now regarded as one of the most successful examples of health system redesign in the world. Costs are down and quality is up, with health outcomes among the best in the United States. Transformation began when it was given control of a single budget and responsibility for a broad range of services for its population. It delivered transformation entirely ‘from within’ rather than as a response to top-down performance management

Engaging with communities Five locality areas across the Western Isles Provides a framework for locality planning Supports the strategic planning process Connects directly to communities

Developing the Strategic Plan

How effectively did we engage? Supported self-assessment against the National Community Development Standards Weaknesses: More work to do to involve communities in planning Supporting engagement, especially for service users Strengths: Working effectively across partner organisations Methods of engagement Impact of engagement Established in the mid-1990s - quality of care and outcomes were among the worst in the United States. Now regarded as one of the most successful examples of health system redesign in the world. Costs are down and quality is up, with health outcomes among the best in the United States. Transformation began when it was given control of a single budget and responsibility for a broad range of services for its population. It delivered transformation entirely ‘from within’ rather than as a response to top-down performance management

Our Vision and Values… We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. - Atul Gawande, ‘Being Mortal’

A human rights based approach Respect for the inherent dignity and worth of all individuals Promotion of individual autonomy including the freedom and support to make one’s own choices Support to ensure full and effective participation and inclusion in society Respect for difference and a desire to respond to individual needs Equal access to resources, services, information and opportunity  

Applying our Values…End of Life Care Some individual services work well but lack of joined-up approach Intense capacity challenges High levels of variation between localities Dying is a human rights issue  

Developing our Strategic Plan Developed in partnership Population Needs Assessment Draw on communities’ priorities Articulation of vision and values Assess existing service provision Identify resources Focus on high tariff reforms Describe the drivers of change Measure improvement

Sharpening our Focus Situated 25 ‘Key Deliverables’ within Triple Aim framework: Quality Population Health Value and sustainability Linked to National Health and Well-being Outcomes Detailed proposal for each of the deliverables: what, why, how, etc. Programmed change overseen by Integrated CMT IJB signed-off March 2016

Four Objectives Developing our locality arrangements, to ensure that our services are responsive and connected to local communities Working with staff, stakeholders and service users to develop integrated delivery arrangements which are capable of improving the experience and outcomes of the people we serve Deploying our resources transparently, making sound investment decisions and managing a very fragile budget Implementing our strategic plan, to ensure that our services change and adapt in response to population need

Impact on Care Experience

Conclusion Potential of place-based care Anchor work in community engagement Spend time on values (human rights) and mission Let the data guide you Use strategic planning process to sharpen focus on high tariff change Link high level objectives to operational integration