NHS ICS/ICB & Providers - Improvement Readiness

The Health Foundation - Five principles for implementing the NHS Impact approach to improvement in England - 21 April 2023

“What is lacking, however, is an infrastructure, strategy and management approach to connect and maximise the impact of these disparate strands, as well as sufficiently mature systems thinking.”

This, for me, was the stand-out sentence from the latest publication from the Health Foundation, hot on the heels of the Hewitt report, and very much in line with the article I published in 2019 and re-issued in April - Achieving Your System Goals - An assurance guide for Integrated Care Systems and Integrated Care Boards Chairs, Chief Executives & Leaders. ?

Key highlights from the Health Foundations report include:

• The NHS Impact approach to improvement - It articulates – rightly, in our view – the importance of taking an aligned and integrated approach to improvement delivery and capability building across organisations and systems.
• A strategic balance will need to be struck between action to address urgent operational pressures on the one hand and, on the other, ensuring that providers and ICSs have the time and space to build the skills, culture, infrastructure and, crucially, the momentum required to embed the improvement approach in full.
• There appears to be a growing consensus among regulators and policymakers about the value of improvement approaches as a driver for change
• Creating opportunities for honest conversations about providers’ and ICSs’ ‘improvement readiness’ between providers, ICSs, NHS England, and their national partners is vital.
• Ideally, these conversations should focus on providers’ and ICSs’ capacity to deliver organisation and system-wide improvement, and to carry out the detailed planning work it requires. It may not be feasible for them to do either in the short term, but they may be in the position to implement some preparatory work – such as an audit of existing improvement skills – that will allow work to start in the medium term.
• ICSs are expecting to play a more prominent role in convening and coordinating improvement or are considering the case for developing the in-house capacity to support improvement initiatives or train provider staff.
• Another challenge for many providers and ICS leaders is how to reconcile the myriad locally driven priorities for improvement that exist.

It is this preparatory work; to discover the capability and capacity to deliver organisation and system-wide improvement and review the existing myriad of local change initiatives and the interdependencies with the portfolio of national initatives that ICB/ICS Leaders can start now.

To understand what improvement readiness means and to start those conversations, I would advise using an assessment framework. ??

The article I referenced - Achieving Your System Goals - An assurance guide for Integrated Care Systems and Integrated Care Boards Chairs, Chief Executives & Leaders includes extracts of such an assessment framework.

Objectivity is critical when completing this type of assessment. System leaders must put themselves in the shoes of an organisation system engineer or improvement practitioner and see what exists through the perspectives of systems thinking (structure, processes, and behaviours), organisation development and improvement science.

The Health Foundation report is another voice adding to the growing movement - advocating a focus on the HOW. As it’s, the HOW enables the effective execution of the WHAT.

Michael Shaw

If you are an ICS/ICB leader and you would like a copy of the assessment framework, please get in touch.