A case study on driving collaborative partnership working between key stakeholders in the South West to facilitate a shared understanding of the local health and care challenges and ultimately establish an innovative learning system that responds to these.
Themes: Culture, Health Inequalities, Partnership Working
Case study summary
This case study describes collaborative work between South West Academic Health Science Network and the ICSs within the Peninsula, to develop a sustainable approach to the adoption and spread of proven innovations and innovative practices that align to local population health and care needs. Specifically, their approach to developing a learning system that facilitates identification of priorities for innovation, builds innovation capability within the system and supports partners to test and evaluate innovation.
What was the problem or opportunity?
The South West is geographically diverse, with people living in coastal communities, isolated rural areas and urban centres. This creates distinctive inequalities and defines the populations experience of health. For example, poor transport and communication links exacerbate the problems associated with living rurally, and people experiencing significant levels of deprivation. At a regional level, the population appears relatively healthy. However, regional statistics mask the significant variation that lies within each ICS.
In the last three years, South West AHSN has been working collaboratively with the ICS’s in the region (Somerset, Devon, Cornwall and the Isles of Scilly) to explore how they might achieve even greater insight and impact and develop capability within the workforce.
How did this support innovation adoption and spread?
In 2020 the South West AHSN began to work with the three ICSs within the geography to uncover where health challenges are particularly acute in the region.
A number of areas of work sought to maximise local insights to improve and accelerate delivery of innovation within integrated or complex care pathways. These included:
- Gathering insight and analysis from within the ICSs using qualitative and quantitative studies around change, improvement and innovation: initially working with Cornwall ICS, then subsequently across all three emerging ICSs to understand and codify how change occurs. This enabled the development of ‘8 conditions for change‘ to support the rapid adoption of innovation locally.
- Learning from other ICSs and other systems using desk based and qualitative studies: for example – building on the 8 conditions above, researching and identifying the 10 factors that suggest how to effectively integrate innovation and improvement into emerging ICSs.
- Engaging with the workforce (including ICS leaders from all three ICSs) via focussed workshops to:
- Understand where innovation could help address health inequalities: developing a deeper understanding of the specific health and care needs of coastal and rural communities, and where there is evidence of health inequality within the region.
- Maximise the potential of collaborative work across the region: utilising the cumulative experience of ICSs across the region, and research from the South West AHSN on the role of research, innovation and improvement in the onward evolution of integrated care.
- Undertaking change programmes, developing improvement communities and leadership training: supporting regional teams to identify where they need communities of practice and peer-led learning to develop workforce capability within ICSs.
- Applying innovative practice and learning through doing: concentrating on vulnerable parts of the system during COVID-19, South West AHSN and Devon ICS (previously STP) drove increased attention in whole pathway approaches to improvement eg reducing attendances at emergency departments via the Think NHS 111 campaign.
Leaders within the ICS teams share that these approaches have enabled them to focus on pressing challenges whilst capturing the learning for system change. Additionally, their team members talked of new possibilities, a positive working culture in working to rapidly understand and solve problems. In this way integrated and complex health pathways could be improved through the collaboration of colleagues in a wider team.
“Within the Devon system we recognise the vital role that innovation plays in our health and care system. Learning from our work with the South West AHSN to date has created a mutual appetite to work further partnership as a system and across the region – creating the optimal conditions for joint working.”
– Nigel Acheson, Chief Medical Officer, Devon ICS.
What was the role for or contribution from the Accelerated Access Collaborative (AAC) and/or NHSE’s Innovation, Research and Life Sciences Team?
AAC programmes such as the Rapid Uptake Products have provided opportunities for AHSNs to work with emerging ICSs. A key element of ‘learning by doing’ has been enabled through such work, which has in turn created a lasting legacy of approaches to adoption and spread of innovation.
What were the results?
Partnership working between South West AHSN and the ICSs in the region has facilitated a shared understanding of the health and care challenges in the South West, and the development of a learning system based on the collective experience of all partners. All involved have been able to take the learning from these programmes of work and apply them to specific points in the system to help build capability and the conditions for innovation to flourish.
Overall, this work has facilitated early development of processes that support ICSs to:
- target innovation based on system prioritises
- enable onward use by spreading what works across ICSs in the region
- adapt for context, ensuring innovation can work in new environments eg ensuring it is optimised for use in a rural context when spreading from an urban incubator
- collect evidence on what works and what doesn’t, to inform more effective development and deployment.
Two regional health equity programmes have also recently been launched across Somerset, Devon and Cornwall, and the Isles of Scilly – on perinatal health, and children and young people’s mental health. This builds on our work gathered through our national commission including through PERIPrem.
PERIPrem is a bundle of 11 perinatal interventions to reduce brain injury and neonatal mortality. There has been a 26% increase in the proportion of mothers/babies who received all of the interventions that they were eligible for in this impactful bundle. Success being attributed to evidenced-based innovation, and capability building to foster a culture receptive to innovation and learning.
What were the learning points?
South West AHSN continues to work with ICS leadership teams to embed a sustainable approach to the adoption and spread of innovations/innovative practices that meet population health needs in the South West.
A number of streams have been identified from these sessions as opportunities for increasing and accelerating the impact from research, improvement and innovation in integrated care systems:
- Creating a single point of entry for innovators from a range of sectors (including NHS, academia, industry, VCSE sector organisations).
- Developing an aligned approach to managing the innovation pipeline, building on the AHSN Network pipeline model to support innovation at all stages of development.
- Establishing collective decision-making processes, to define local system priorities and help align these to innovations within the pipeline.
- Using a learning system approach to create standardised approaches for evidence synthesis, project evaluation, benefits realisation and capturing/sharing learning across ICSs.
- Integrating innovation pipeline management with ICS transformation programmes to ensure the pipeline is demand led based on local population health priorities and integrated within ICS transformation work.
- Building system capability by capitalising on existing expertise, establishing methods and approaches to adoption and spread, and providing support to the workforce.
Next steps and sustainability
Building on several years of work and insight, South West AHSN are continuing to work with all three ICS teams to develop a learning system to deliver impact and insight across the South West. This approach (currently in development) will inform the design of ICSs and builds on shared ambitions and priorities for health and care across the South West Peninsula.
The expectation is this will accelerate the practical adoption and spread of innovation and learning across the Peninsula. In addition, insights from this work will be shared with other regions where there are similar challenges (due to their own coastal and rural geographies) to increase the reach and impact of this work nationally.