FabTeams Week - Connecting people for innovation and

collaboration -

Claire Haigh, Cath Doman, Boena Zeneli, and Andrew Messina

3rd November,2017

The Team Today

Session ChairJanet Wildman

@jwildman1

Chat Room and Technical Support

Paul Woodley@PaulWoodley4

Twitter Monitor Leigh Kendall

@leighakendall

Twitter Monitor Rosie Redstone

@RosieRedstone

Joining in today and beyond

• Please use the chat box to contribute

continuously during the web seminar

• Please tweet using hashtag #EdgeTalks and

the handle @HorizonsNHS

Creating Surprising, simple and social spaces for public service

innovation and flourishing Claire Haigh

Co-Founder Collaborate Out Loud

@HaighClaire

#CollabOutLOud @CollabOutLoud #EdgeTalks

Three FabTeam Stories

Boena Zeneli

High Intensity User (HIU) Project

Teams beyond Boundaries

Andrew Messina Cath Doman

Transfer to Assess -Connecting People for Innovation and

Collaboration

The Harrogate vanguard

#Quality2017

Where do you currently do most of your team working?

A. In a traditional team reporting to one line managerB. In project teamsC. In collaborative teams across organisations and systems D. In teams that span formal structures and social

networks

#CollabOutLOud @CollabOutLoud #EdgeTalks

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

2/18 3/18 8/18 5/18

In a traditional team reportingto one line manager

In project teams In collaborative teams acrossorganisations and systems

In teams that span formalstructures and social

networks

Where do you currently do most of your team working?

Percentages

Collaborate Out Loud’s Community Manifesto Collaborate Out Loud communities are a democratic community of

innovative and generous public service collaborators who work out

loud to hack challenges, hatch new thinking, experiment with

implementation and prototype and spread impactful new ideas that

will enable the changing public services landscape to get further faster

and embracing the power of new ideas, collaboration and democracy

How we work• In an open and free way where anyone

could follow the story• Everything that we develop is open

source and free to be used by anyone • We are a group of true collaborators• In a way that successes and failures are

equally welcome opportunities to learn

• Where the process of collaborating in this new and free way is observed, tested and understood

What we do • Serve public services at all levels and places• Work on the challenges that public services are

facing in a shared space without the constraints of being within the formal systems and structures

• Crowdsource challenges to work on that serve public services in a different and freer space

• Actively encourages challenge, new thinking and learning from when things don’t work out as expected

• Brings together the unusual suspects, thinking and approaches and allows the magic to unfold

• Work with kindness, generosity and inclusivity

#CollabOutLOud @CollabOutLoud #EdgeTalks

#CollabOutLOud @CollabOutLoud #EdgeTalks

What have we learnt about Fab Teams from

the edgesCollaborate Out Loud’s Learning So Far…..

Shot-term and project based – come together for a limited time to get something done

Borderless– span across organisational, system, and professional

Complex - Working on increasingly complex challenges

Collaborative - a move towards collaboration rather than partnerships

Virtual – geographically spread often over long distances

Multi-layered - Individuals are often working across multiple teams at the same time

Agile - Need to change shape and direction easily to respond to changing landscape

Democratised - they are able to access people, ideas and skills in ways we never could before

Technology enabled – they have a loads of tools at their finger tips that help them to connect and be productive

Socially powered – need to build social rather than have positional power

Self organising - often built around the idea of a community that learns and shares together. Based on shared intent and trust

Whole – they encourage people to bring their whole self to the team

How are teams changing?

#CollabOutLOud @CollabOutLoud #EdgeTalks

We are all about creating surprising, simple and social shared spaces between the formal and informal and this is what we have learnt about teams in these spaces so far……..

• They embrace and harness the energy of difference and the crowd

• They create surprising, simple, and social spaces between the formal structures and informal networks

• They spend time building a community, trust, and a shared intent where people bring their whole selves

• They embrace the principles of transparency, democracy, and openness

• They are social, share with generosity and kindness

• They work on real and often complex challenges collaboratively

• They borrow learning and thinking from anywhere and everywhere to learn collectively

• They co-create novel solutions and ideas to tackle their collective challenge

• They are able to rapidly test their ides and iterate them together

• They work out loud as you go — attributing their ideas and inspirations

• They spread the best ideas (as well as the learning from what didn’t work)

What are we learning about teams

from the edges?

#CollabOutLOud @CollabOutLoud #EdgeTalks

Cath DomanProgramme Director – Harrogate

Vanguard@cathdoman

cath.doman@nhs.netWorking on behalf of:

Harrogate and Rural District Clinical Commissioning Group, Tees Esk and Wear Valleys NHS FT,

Harrogate Borough Council, Yorkshire Health Networak,

North Yorkshire County Council, Harrogate and District NHS FT

“Being brave enough to say we haven’t got something right, …is often quite easy to say but hard to do in

practice.”

Sam Jones

March 2015…

Creating effective teams: the beginningThe good: Integrated care teams Out of hospital care Working with GPs Involving mental health and

social care Skill sharing and role blurring Dissolving the boundaries Everyone working happily

together

The bad: “Do something different!” “Integrate!” Wifi Inadequate attention to OD Pressure to deliver too fast: “just

do it!”

The just plain ugly: Incontinence corner General grumpiness ‘Behaviour’

The journeyMarch ‘15: •‘hey- we’re a Vanguard!’

Feb ‘16 •Pilot starts

March ‘16 •Funding reduced

Stop and regroup

July ’16: new plan

Nov ‘16: roll-out across the District

Mar ‘17: STOP!

Unaffordable

March 2017…

Stop and regroup

March ‘17: the Transformation Board’s challenge

• Test something radically different

• Create a ‘pop-up’ organisation that feels really different

• Focus on preventing avoidable admissions

• Practice population focused (3 practices)

• True integration

• Support and permission

Magic ingredients

Permission Ground-up design Protected time Co-location and sharing the

milk Daily problem-solving Access to leadership Daily huddles Access to systems Parking Anxiety management tools

Quality Improvement System:Purposeful and Productive Community Services (PPCS):

Daily huddles

Leadership team

Visual controls

Caseload management

Cell working

Diary manage-

ment

GP

Living Well

Social care

Pharmacist

Practice manager

PMO

Team leader

Questions for Cath

High Intensity User (HIU) ProjectTeams beyond Boundaries

Boena Zeneli NEE CCG

03.11.2017

The High Intensity Users (HIU)- Working across boundaries

• We identify frequent users of urgent and emergency services, mainly A&E and the ambulance service but also 111, OOH and GPs and use multi-disciplinary team (MDT) approach to agree care/intervention plans

• We work with a variety of clinicians including: ambulance service, acute trust, mental health, community services, 111, Out of Hours and GPs as well as non clinical partners including: social care services, voluntary and fire services, police and Borough Councils

• We haven't been perfect but through this work we’ve learned a few things that we feel are worth sharing

So how do we work with teams across boundaries and build the team spirit?

The Goal: Working with different professionals beyond organisational boundaries to achieve better integration of services, reduce urgent and emergency activities and ultimately provide effective and efficient healthcare for patients as well as enhancing working experience for our team members

The How: Understanding the culture, be that organisational or personal is crucial to building the team spirit

• Being proactive and tenacious as a leader/PM and – Establishing common aims– Building trust/commitment – Doing, in the timely fashion, what you say you would do– Putting processes in place and showing determination

• A lot of: – Communicating– Sharing and learning– Reiterating– Empowering and treating each individual fairly and equally– Informal ambiance for MDT meetings– Flexibility- see, analyse and readjust…

• And biscuits and cakes definitely do the trick!

Challenges to how we developed as a Team and achieved our objectives?

• The main challenge was to securing meaningful engagement from all providers so that we could work as a team without boundaries and provide integrated healthcare for our patients

• The bigger challenge, however, was not implementing the change, it was (and still is) finding and engaging with the right players/champions in order to maintain the team’s effort to continually engage with the process and not accept slippage…

• The process of team engagement across boundaries needs to persevere and continuously improve, typically requiring endless pushing/support from a leader/PM

• Keeping myself inspired whilst being faced with endless obstacles

How establishing meaningful connections resulted in achieving great success?

• By introducing novel methods to communication and engagement we created a culture that has high performance standards and accountability, along with positive relational glue keeping everyone supported and engaged (team members willingly coming to MDTs on their days off)

• Success: we have had great engagement across the economy but also we are starting to see engagement from new services. Furthermore, due to the Information Governance limitations, we have established separate non clinical HIU MDT and have anexcellent partnership with Borough Councils, Fire/Voluntary services

• Success: we have and continue to explore different avenues to empowering patients to take ownership of their health and well-being whilst decreasing their dependency upon unscheduled care services, i.e. home MDTs, fire services home visits

• Success: Started to helping others to set up similar way of working collaboratively and across boundaries

What do our team players say about the project…

‘’Without collaborative multi-disciplinary working we cannot expect to deliver patient focused, cost effective services that allow us to maximise resources where they are needed most…’, East of England Regional Clinical Coordinator – Paramedic

‘’…If it stopped I would not have access to provide better quality care for my patients. There would be no integration at all between primary and secondary care and it would be very difficult to support these patients without the MDT approach…’’, GP Practice matron.

‘’We have made a difference to patients who are now not high intensity users due to our regular communication… I do feel that it would negatively impact our patients if the group were to disband’’, Deputy Clinical Director, East of England Out of Hours

Where do we go next?

The HIU project enhanced our understanding about managing teams beyond boundaries in achievingcommon aims and shared purposes. It also showed us that in order to implement and sustainimprovement in an integrated and multidisciplinary team environment, team members mustunderstand the objectives and logic of the change and collaborate without boundaries.

A lot has been done but we still need to:

• Continue with partnership working which is crucial to enabling team members to engage andwithstand engagement in implementing changes across boundaries

• Continue creating and sustaining a patient focus and cost effective services as well as encouraging apositive working experience for our team members

• Encourage and engage with more services to share our experiences, successes and lessons learnedand understand and seek to learn from the successes of other teams and organisations

Last thought…

Questions for Beona

Transfer to Assess Connecting People for Innovation and Collaboration

Andrew Messina (Programme Lead)

Through the Stockport Together programme, we’ve

introduced Discharge to assess pathways, which we’re

calling Transfer to Assess (T2A).

Within the T2A pathways, identified patients are discharged

as soon as they are medically well enough to leave hospital.

What is Discharge to Assess? Nationally recognised as best practice for supporting patients who no

longer have care needs that can only be met in an acute hospital.

Proven to enable a shorter discharge process of up to 2 weeks,

with care packages being put in place directly with the person

at home.

T2A pathway cuts

across multiple

organisational/

service boundaries

Lack of trust

across

teams

Period of

significant

change Ou

r

ch

alle

ng

es

Empower staff

to make change

happen

No blame

All views equal

Patient journey

Problem solving

Plan, Do, Study,

Act

Learning

environment

Imp

rove

d s

yste

m flo

w

Around 50 people

discharged through

T2A each month.

Care packages

reduced by

half.

Breaking down

silos & better

relationships.

Greater

level of

trust

Champions

of

changeSta

ff

be

ne

fits

Solution

focus

Any

questions?

Questions for Andrew

How energised are you to try some of the approaches and tools you have

heard about today in your work?

A. Very motivatedB. A little bit motivatedC. Not sure yet D. I still need some convincing

#CollabOutLOud @CollabOutLoud #EdgeTalks

0%

10%

20%

30%

40%

50%

60%

70%

11/17 5/17 0/17 0/17

Very motivated A little bit motivated Not sure yet I still need some convincing

How energised are you to try some of the approaches and tools you have heard about today in your work?

Percentages