Culture change: health and social care integration Alison Petch

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Organisational culture - drivers ✔ ‘can do’ culture ✔ perceived interdependence ✔ values difference ✔ collective responsibility publicly demonstrated ✔ everybody’s agenda ✔ willing to share/adopt good practice ✔ organic, flexible, delegated responsibility 6

Organisational culture - barriers ✗ sees institutional and legal barriers ✗ isolationist ✗ senior figures disown common purpose ✗ competitive ✗ rigid bureaucratic controls, ‘everything has to be checked’ ✗ values uniformity 7

Change management - drivers ✔ driven by champions ✔ task focused ✔ sustains and rolls out good practice ✔ commitment and flexibility to solve ongoing problems ✔ rewards success ✔ managed as a whole system ✔ dedicated resources for development 8

Change management - barriers ✗ presses on regardless ✗ not willing to devolve responsibility ✗ bogged down in organisational problems ✗ blames, only sticks ✗ focuses on projects, mainstream unaffected ✗ when champions leave, innovation dies 9

Cross profession engagement - drivers ✔ sharing information and skills for the bigger picture ✔ open, honest, transparent communication ✔ shared records – creative use of IT ✔ centred on user need ✔ ‘we all own this’ ✔ accepts challenges to mindset and learns ✔ ‘we will find a way’ 10

Cross profession engagement - barriers ✗ lack of trust ✗ tribal, protectionist ✗ ‘WE own this’ ✗ ‘not invented here’ ✗ ‘this is my turf’ ✗ threatened and restrictive 11

Place ie local context  Local needs assessment  Agreed, comprehensive vision, owned at all levels  Use of budgets to reflect local priorities  Build on existing good working relationships  Community engagement and co- production  Outcomes-based commissioning  Timescale appropriate to locality 12

Integrated health + social care teams  Shared commitment to goals and objectives  Interdependence of outcomes  Clarity on role and accountability, including leadership  Cultural congruity  Focus on quality + innovation  True co-operation  Interprofessional trust and respect 13

Leadership  Long-term commitment, enthusiasm, involvement  Trust and respect of peers  Shared vision and goals across partners, communicated to all  Proactive promotion  Building commitment, understanding, shared culture  Achieving outcomes 14

Time  ‘change did not occur overnight; time was needed for formal partnership agreements to be translated into changes in attitudes, culture and ways of working amongst front- line staff’ Hultberg et al,

Key questions  What is the vision for integration and how can it be shared?  How can effective leadership for integration be developed?  How can a culture that promotes integration be developed and nurtured?  How can traditional professional rivalries be overcome?  How can integration be effectively implemented for the local context?  What can make integrated budgets work? 16