35 Suffolk and North East Essex ICS | ‘Our Journey Together’ 5.3 Put purpose before structure Start with Why? A number of stakeholders talked about the importance of one particular principle which became established in the ICS at an early stage. From the outset of the ICS people talked about the rationale for creating local health and care systems being in part to shift from a centralised top-down approach to a more local approach to commissioning and public health, together with local accountability and a greater voice for patientsxxxix. That means that the starting point for all conversations should be ‘why’ good health and wellbeing is important to people, and what ‘good’ looks like to them. To truly understand people’s needs and the challenges they face in living healthy lives, it is vital to listen and to learn. This concept became part of the system narrative with people talking about the need to ‘Start with Why?’. The broader principles of taking an outcome-based approach were then further embedded through an extensive training programme in outcome-based approaches across the ICS. This was based on the original Outcome- Based Accountability (OBA) methodology developed by Mark Friedmanxxxi, but adapted and tailored to specifically support ICS programmes. Over time these methods were integrated into everything from investment decisions (by a crosssector ‘System Investment Group’), to the use of measures and strategic planning by both local Alliances and the ICS. Some stakeholders said that they thought that this principle influenced the leadership culture in Suffolk and North East Essex and that this was crucial in enabling a shift in approach to one based on listening and understanding. Leaders cared, were open to hearing criticism and willing and able to influence change. They identified the challenges they were trying to tackle, and how to do that safely, effectively and well. Using an Outcome-Based Approach to structure ICS events was also important in enabling people and communities to lead the narrative and for a broader range of voices to be heard. The power of ‘a coalition of the willing’ Stakeholders highlighted that what developed in Suffolk and North East Essex was a real appetite for collaboration in the system, and a strength of feeling that we would be ‘stronger together’. However, having agreed ‘why’ we needed to work together the next challenge was to agree ‘how’ to work together and to agree system governance to support that shared ambition. Many stakeholders told us that they thought that the introduction of ‘start with why’ so early on in the ICS was crucial because it meant that conversations about how to work together as a system then started from an understanding of our shared purpose as a health and care system which then in turn informed the creation of structures that could enable us to meet those shared aims. Working out how to balance the collective accountability arrangements needed for integration with the sovereign responsibilities of so many individual significant public sector organisations was a real conundrum that local leaders struggled with for some time. System governance arrangements were however eventually agreed in 2019 based on some deeply reflective collaborative work by local leaders determined to solve the problem and create an effective way to work together as a genuine system. Applying outcome-based thinking helped enormously with this task as it meant starting with the genuine health outcomes for people (rather than outputs for organisations) and then exploring how each part of the system can work Picture – ICS Outcome-Based Approaches Training in Ipswich, February 2020
RkJQdWJsaXNoZXIy MTA4ODM=