what does an effective multi-professional team approach

Our values: clinical engagement, patient involvement, local ownership, national support

www.england.nhs.uk/vanguards #futureNHS

Whatdoesaneffectivemulti-professionalteamapproachlook

liketodeliverpopulationhealthoutcomes?

NewCareModelsProgrammeandtheAcademyofMedicalRoyalColleges

Friday27October2017



Introductiontotheday

DrSueGoss



Welcomeandpurposeofthisjointevent

CarrieMacEwenChairoftheAcademyofRoyal

MedicalColleges

Carrie MacEwanChair, Academy of Medical Royal Colleges

What does an effective multi-professional team approach look like to deliver population health outcomes?

AoMRC and New Care Models

• The Academy of Medical Royal Colleges and the NHS England New Care Model Workforce Team started working together in 2016

• Joint statement in Jan 2017• Recognising the importance of clinical engagement and

leadership of workforce change• Commitment to work together to promote change which

improves care and supports clinicians • Agreement to specific joint work and initiatives

• Subsequent focus on multi-professional team working

AoMRC and multi-professional working

Royal Colleges and professional organisations have come together to:• Affirm our joint commitment to multi-professional teams in

delivering better outcomes for patients• Identify issues we can address to enable clinicians to work

to their full potential• Jointly commit to work together, and with employers,

educators, and government to improve services for patients

• Joint professions statement October 2017

Joint Professional Commitment• Academy for Healthcare Science• Academy of Medical Royal Colleges• British Association of Art Therapists• British Dental Association• Chartered Society of Physiotherapy• College of Operating Department Practitioners• College of Optometrists • Queen’s Nursing Institute• Royal College of Midwives• Royal College of Nursing• Royal College of Speech & Language• Royal Pharmaceutical Society• Society of Radiographers

Cross cutting issues

• Recruitment and retention• New solutions for delivering healthcare• Professional development/career pathways• Valuing staff

Also commitment to work together on specific initiatives on professional regulation, workforce development and patient quality of life

Two events

Today• Where have we got to on delivering population health care?• Why team working delivers better health outcomes• Showcases• Tools to improve services and evaluate impact

January 2018 – Team based care in action• Reflections and learning from first event• Showcases and emerging evidence base• Common understanding of team based working• New care models



OverviewoftheNewCareModelsProgramme

Louise Watson, Director, New Care Models Programme



‘I was delighted when Karen called to check how I was managing at home. It gave me real peace of mind to know that someone was thinking about me and was interested

in my recovery’

Ronnie, 81 – Patient

Receiving care from a Care Coordinator in Dudley MCP



‘It is great to hear first-hand from patients the impact we are having on not only improving people’s health

and wellbeing but just as importantly their overall experience of accessing the service’.

Dr Andrew Weatherburn, Extensive CareFylde Coast Local Health Economy MCP



We are delivering the NHS Five Year Forward Viewthrough the new care models programme

Health and wellbeing gap1

Care and quality gap

2

Funding gap 3

Clinical engagement

Patient involvement

Local ownership

National support



50 vanguards are developing new care models, and acting as blueprints and inspiration for the rest of the health and care system.

Integrated primary and acute care systems

Multispecialty community providers

Enhanced health in care homes

Urgent and emergency care

Acute care collaboration

9

14

6

8

13



With the vanguards, we have developed the full MCP and PACS care models.



With the vanguards, we have developed the full enhanced health in care homes care model.

Highqualityendoflifecareanddementiacare

Joinedupcommissioning

andcollaborationbetweenhealthandsocialcare

Workforcedevelopment

Data,ITandtechnology

Reablementandrehabilitation

Multi-disciplinaryteamsupportincluding

coordinatedhealthandsocial

care

Enhancedprimarycaresupport



Per capita emergency admissions growth rate since baseline – MCPs, PACS and rest of England

Data on the impact on emergency admissions is available:

Nb. This chart compares the most recent twelve months for which data are available (the year to Q1 17/18) with the evaluation baseline year (2014/15)



NorthumbriaFoundationGroupACC

TheopeningoftheNorthumbriaSpecialistEmergencyCareHospitalandtheredesigningofurgentcareservicesatgeneralhospitalsites,

markedthefirstimportantphaseofworkoftheNorthumberland

Vanguard.

BetterLocalCare(Hampshire)MCP

FourpracticeshavecreatedaSameDayAccessServicewhichpoolsthesamedayprimarycareworkloadandworkforceforfourpracticesintoa

singleservice.

MyLifeAFullLife(IsleofWight)PACS

Anewcrisisteamwasintroducedin2014asapilotandisnowgrowing.Theserviceisdesignedtosupport

patientsaged65+toavoidadmissiontohospital.

SuttonHomesofCareEHCHThe‘HospitalTransferPathway’(theRedBag)was rolledoutinOctober2015.Thebagcontainsstandardisedinformationaboutaresident'sgeneralhealth,anescalationformaboutthechangestotheirconditionandinformationabouttheirmedication. Thisinterventionhashelpedtoreducehospitallengthofstaysanddelayedtransfersofcareforpatients.



Multi-disciplinary teams

What do health and care professionals say?

“Having that access to professionals and not having some of those boundaries, that helps

us to deal with things much more efficiently.” Manager of Lye Community Project



Multi-disciplinary teams

What do patients/carers say?

“Thanks so much for thinking of doing it. I already think the carers feel like it has helped them, and that can only be good for Mum.”



What have been the vanguards greatest achievements?

Anumberofvanguards

havewonHSJawards

MidNottinghamshireBetterTogethervanguardhashalved

thenumberofpeoplestayinginhospitalformorethan14days

87%ofusersofConnectingCareinWakefieldsaid

theyfeelinvolved intheircareandsupport

FyldeCoastMCPhas seena23%

reductioninnon-electiveadmissions

UltrasoundAngiologyDiagnosticshave

increasedthenumberofscansitprovidesatDarent

ValleyHospital(DVH)byathird



With the vanguards, we have learnt about the key requirements for developing, delivering, and spreading new care models

• Build collaborative system leadership and relationships around a shared vision for the population.

• Develop a system-wide governance and programme structure to drive the change.

• Undertake the detailed work to design the care model, the financial model and the business model. This includes clinical and business processes and protocols, team design and job roles.

• Develop and implement the care model in a way that allows it to adapt and scale.

• Implement the appropriate commissioning and contractingchanges that will support the delivery of the new care model.



Our challenge for the year ahead will be to cement the improvements, and spread successful new care models, demonstrating the benefits for patients and the system,

extracting wider learning on care models and supporting vanguards to embed their improvements in local systems so

they become ‘mainstreamed’ beyond April 2018.

10 shadow Accountable Care Systems (ACSs) were announced in June, including two ‘devo’ areas.

We will support ACSs to go further than other systems, demonstrating service improvements, delivered within their available share of the NHS budget, whilst at the same time

building rigorous population health management capabilities.



ACS and STPs: the vehicle for spreading new care models

TheSTPswillactasthedeliveryvehiclesforthecommitmentssetoutintheFYFVand

theNextStepsdocumentby2020.The

ACSsarethefrontrunnerswithinthese

STPs

ArangeofsupportwillbedeliveredtotheACSson:

• Populationhealthmodels-Tailoringthedesignandimplementationofpopulationbasedcaremodel(s)toeachACS

• Enhancedhealthincarehomes- FocusingontherapidimplementationoftheEHCHcaremodelinACSs

• Networkinghospitals-SupportingthedesignofnetworkinghospitalsinACSsandfacilitatingdialoguebetweensites



What other tools are available to support spread?

FutureNHScollaboration platform

Hands on support to STPs

Leadership and account management

Communications & engagement

Publications



More details can be found on the NHS England website:

www.england.nhs.uk/vanguards

You can email the programme at: [email protected]

Or join the conversation on Twitter using the hashtag:

#futureNHS

For further information…



Howtobuildeffectivemulti-disciplinaryteams:learningfromthe evidencebase,pilotsandexperimentsonthegroundVanguards,pioneers,localvisionand

system-wideapproaches

MarthaRobertsHeadofODandStaffEngagement.NHSEngland

DrSueGossPrincipal,IntegrationandSystemsLeadership,

OfficeforPublicManagement

MarthaRoberts

BuildingMulti-disciplinaryteams

27thOctober2017

JointProfessions’StatementAcademyofMedicalRoyalColleges11th October2017

‘‘Building a ‘joyful team’ leads to good work and better care’’• Recruitment and Retention• New Solutions for Delivering Healthcare• Professional Development/Career Pathways• Valuing Staff

AstonOrganisationDevelopmentLtd2017

BenefitsofTBWNHSresearch

• Reducedhospitalisationandcosts• Increasedeffectivenessandinnovation• Increasedwell-beingofteammembers• Inter-disciplinaryteamsdeliverhigherqualitypatientcareandimplementmoreinnovations

• Lowerpatientmortality• Reducederrorrates• Reducedturnoverandsicknessabsence• Increasedstaffengagement


2.7

2.8

2.9

3

3.1

3.2

3.3

Low Moderate High

Teamfunctioning

Patie

ntexperiences

Clarityofobjectives

Reflexivity

Supportforinnovation

Team functioning and patient satisfaction


Healthcareteaminnovation

0.5

1.5

2.5

3.5

4.5

5.5

5 7 8 9 10 11 12

Innovation in quality of care

Professional diversity


0

5

10

15

20

25

30

35

Not in a team Pseudo team Real team

%

Teamworkingandmentalhealth

Patientmortalityandrealteams


5%morestaffworkinginrealteamsassociatedwith3.3%dropinmortalityrate(p =.006)

Foran“average”acutehospital,thisrepresentsaround40deathsperyear

MortalityIndex

Extent of Real Team Working


Workinginteamsandjobsatisfaction

www.nhsstaffsurveys.com

3.24 (0.68)

3.34 (0.72)

2.76 (0.73)

2.93 (0.74)

3.63 (0.64)

2.50

2.70

2.90

3.10

3.30

3.50

3.70

3.90

Not Working inTeam

Pseudo III Pseudo II Pseudo I Real team

Types of Team Working Patterns

Job

Satis

fact

ion


Workinginteamsandintentiontoquit

www.nhsstaffsurveys.com

2.47 (1.01)

2.80 (1.07)

3.13 (1.12)

2.64 (1.05)

3.29 (1.12)

2.20

2.40

2.60

2.80

3.00

3.20

3.40

3.60

Not Working inTeam



Inte

ntio

n to

Lea

ve

AstonOrganisationDevelopmentLtd2017 www.nhsstaffsurveys.com

Workinginteamanderrors,stressandinjury

1.00

1.57

1.26

1.00

1.91 1.88

1.00

1.70 1.69

1.501.61

0.91

1.31

0.870.90

0.70

0.90

1.10

1.30

1.50

1.70

1.90

Not Workingin Team



Odd

s R

atio

ErrorsStressInjury


Teams,harassmentandviolence

1.00

2.32

2.15

1.28

1.00

2.07

2.28

1.45

1.00

1.511.46

1.35

1.00

1.691.60 1.63

1.10

0.80

0.891.00

0.70

0.90

1.10

1.30

1.50

1.70

1.90

2.10

2.30

2.50

Not Working inTeam



Odd

s R

atio

HarassmentfromcolleaguesViolencefromcolleaguesHarassmentfrompatientsViolencefrompatients


The nature of teams


TeamBasedWorking

• Teambasedworkingisaphilosophyorattitudeaboutthewayinwhichorganisationswork– wheredecisionsaremadebyteamsofpeopleratherthanbyindividualsandattheclosestpossiblepointtotheclient,patientorcustomer


WhatisaTeam?

• Typicallynomorethan12memberswho:

– Havesharedobjectivesincommon– Needtoworktogethertoachievetheseobjectives– Havedifferentanddefinedrolesintheteam– Haveateamidentity

©Aston Organisation Development Ltd 2017

Types of teams

Uni-disciplinary Multi-disciplinary Inter-disciplinary

Committees

• Personalparticipation:– Basedonindividualinterest,narrowly

prescribedbyspecialistknowledge

• Poordecisionmaking:– Slow,highlyformalised,moreconventional

decisions

• Passiveandreactive• Disciplineexternallyimposed• Goalssetexternally• Lowlevelsofinter-dependence• Lowlevelsoftrustandsupport• Focusondata-gatheringanddetail• Commitmentlevelsdeclineovertime

Teams

• Teamparticipation:– Individualsfocussedonwiderinterestsofthe

team

• Effectivedecisionmaking:– Speedier,moreinnovativedecisionsandincreased

ownership

• Taskandfutureorientated• Self-disciplineandresponsibility• Clearobjectivessetbytheteam• Rolesdifferentiated&inter-dependent• Highlevelsofoverttrustandsupport• Outcomeandachievementorientated• Commitmentlevelsincreaseovertime


44

WardManagementTeam

TrustboardPortering

Radiology

HR

IT

OT

Physio

EstatesTheatres

CareHomes

LocalAuthority

G.Ps

Government

RegulatoryBoard

BereavementCounselling

CarerNetwork

PatientForum


Barrierstoeffectiveinter-professionalworking

45

StructureProcess

Inter-personaldifference/behaviour


Somebarrierstoeffectiveinter-professionalworking

46

Scaleandcomplexity:inourbusyliveswe

likesimplicity

Time:welookforquickfixes

Ourbrainsareequilibriumseekingdevices:weliketogetbacktoourcomfortzone

Unconsciousbias– wetakeshort-cutsto

formopinionsaboutpeoplebasedonpast

experience

Wedevelopcareerpreferencesearly:cosmo v

local

Leadershippreferences:traditionalorcollective

Wedon’tlikechangingourminds.

“Toenablelearningwemusttakedelight inchangingourminds”Prof

BrianCox

Weneedtobelong:wefocus

onstructureratherthanoutcomes

WakefieldConnectingCare• IntegratedSingleteamtoaddress;- Fragmentedhealth,socialcare,independentresidential

caresector,GPsservices- Healthcareprofessionalshortagelocally- Admissionscausedbythegaps/connectednessofthe

service- Reducedindependentlivingforcitizens

‘patientsfeelmoreincontroloftheirhealth’

‘stafffeelempoweredandtheyaremakingapositivecontributiontohealthandwellbeing’

47

Enablersofeffectiveinter-professionalworking

48

Structure

-Commonpurpose- Placementwithinthewider‘teamcommunity’- Clearobjectives- Roleclarity

Process

- Involvementindecisionmaking

- FocussedCommunication- Reflexivity

Inter-personaldifference/behaviour

- BuildTRUST- Understanddifferences- Valuedifference- Challengebias- Promoteconstructivedebate

- Resolveconflict

FocusonQualityandInnovation

StockportTogether• 8coreneighbourhoodsaligninghealth,socialcareandvoluntaryservices- AccesstoconsultantsbyGPs- ITsystemsnotsupportingcrosssystemworking- Patientshavingunnecessaryvisitstooutpatients

‘blockcontractallowedbothpartiestotakepart’‘collaborativeITprojectprocuredConsultantConnects

‘‘asuperbwayfortheGPtohearfromtheconsultantwithoutmegoingtohospital….We’vehadalovelytriptoArnside onthetrainwhichwouldnothavebeenpossible(withoutfastmedicationchanges)andIwouldprobably

stillbewaitingforahospitalappoinment now’’

‘’Wecanuseourtimeonseeingthemostappropriatepeople’’

‘’Thisisparticularlyusefulforpatientswithcomplicatedneeds..’’49


Realteamsversuspseudoteams

• Thestartingpoint:– Clear,sharedteamobjectives

– Roleinterdependenceandroleclarity

– Meetingregularlytoreviewandimproveperformance

AllTogetherBetterSunderland• LocalityMDTstoclarify,coordinateandspeedupresponsesto

patients’needsdescribedchallengestheyovercame:- co-locating- Equipmentownership- Supplies- Repairs

‘..Thewholethingissetuparoundme– tosupportmeandsupportmyhusband.Ican’texplainhowmuchofadifferenceithasmadeto

mylife..’

‘IjusthavetoturnaroundfrommydeskandIcantalktoasocialworkerandorganiseapatient’scareinminutesinsteadofdays’

51


TheAstonTeamPerformanceInventory

•Teamtaskdesign•Effortandskills•Organisationalsupport•Resources

TeamProcesses•Objectives•Reflexivity•Participation•Taskfocus•Teamconflict•Creativityandinnovation

•Individualsatisfaction•Attachment•Teameffectiveness•Inter-teamrelationships•Teaminnovation

Inputs Processes Outputs

Leadership•Leading•Managing•Coaching

Fully effective teams

[email protected]

Thankyou

27thOctober2017

PRESENTATIONBY:PRESENTATIONBY:

Someprovocations..

SueGoss,OPM

CLASSIFICATION: RESTRICTEDEXTERNAL

Learning,leadershipandmulti-disciplinaryteams

PeterSENGE..5th discipline

Welearnfromexperience…butthingsmovetoofasttoexperiencetheconsequencesofouractions..

Causeandeffectarenotcloseintimeorspace..Needtounderstandunderlyingcausesandfeedbackloops..Smallactionscanleveragebigchange..

“Systemsfoolusbypresentingasasingleevent,buttheyaremomentsinaflowofevents..”

Thereisno‘outside’– “youandthecauseofyourproblemsarepartofthesamesystem”

Wecarryverystrongmentalmodels..Educationandlanguagereinforcelinearthinking…

wethinkoforganisationsasmachines,buttheyarecomposedoflivingbeings….

Whatseemstomattermostisstartingwithvalues…itisthecareforthepatientthatbindspeopletogether…

Whatdowemeanbyateam?Whereishome?

Cliniciansandprofessionalsstillexperiencetensionsaboutidentityandbelonging…

Oftenwehavefoundwork-arounds,buthavenotbeenabletochangethewaythesystemworks..

Sometimestherearerealbarriers…boundaries,protocols,riskandtrust….

Arethebarriersasrealastheyareimaginedtobe?

Isthepatientspartoftheteam?Thecarer?Thefamily?

Thecommunity?

Specialistversusgenericteams..howdowekeepourexpertisewhilecreatingholisticcare..

Reducinghandovers…Enablingadvancedpractitioners…

Cherishingdifference…usingthecreativetensioninamulti-disciplinaryteamtolearnnewsolutionsbyseeinginnewways…

Changingourideaofleadership…..howindividualsystemsleaderswork..

1. Waysoffeeling(personalcorevalues)– value&commitment

2. Waysofperceiving(observationsandhearing)

- observing‘fromthebalcony’aswellas‘fromthedancefloor’- allowingfortheunseenandunpredicted- seekingandhearingdiverseviews- sensitivitytoothernarratives

3.Waysofthinking(intellectualandcognitiveabilities)- curiosity- synthesisingcomplexity- sense-making

4.Waysofdoing(enablingandempowering)- narrativeandcommunication- enablingandsupportingothers- repurposingandreframingexistingstructureandresources

5.Waysofrelating(relationshipsandparticipation)- mutualityandempathy- honestyandauthenticity- reflection,self-awarenessandempathy

6.Waysofbeing(personalqualities)- braveryandcouragetotakerisks- resilienceandpatience- drive,energyandoptimism- humilityandmagnanimity

…Buildrelationships..

Whatdocollaborativeleadersdo?

Changethedynamicsfrom“Committee”to“ExpeditionaryForce”..Createtheconditionsforadifferentkindofconversation– forameetingtobeuseful,ithastochangesomething!CreatespaceforpeopletobuildrealunderstandingofeachotherListencarefullytothe‘songbeneaththewords’– exploredifferencesanddifficultiesFindallies..empathise..offer compassionandsupporttocolleagues

(FromHeifetzandLinksky ‘A

survivalguideforleaders’)

seethewholejourney……

Whatdocollaborativeleadersdo?

“Danceontheedgeoftheirauthority…”

Itcan’tonlybedoablebythe“heroicandthefabulous”!

Howdoallofusworktogethertogetthistoworkatscale?



Tea&CoffeeBreak



WorldCafé:showcasinglearningfromvanguardsandRoyalColleges:ExploringtheissuesParticipants will choose the presentations they wish to learn from, and then participate in discussions to identify the key issues going forward



TABLE

1 ErewashVanguard Creatingwellbeing– lessonsfromcarecoordination

2 FacultyofIntensiveCareMedicine TheAdvancedCriticalCarePractitioner

3 NHSWales Thebenefitsandchallengesofcollaborativemulti-professionalworkingingeneralpracticeinWales

4 YourHealthcare,Kingston Adifferentway,learningfromasocialenterprise

5 RoyalCollegeofOphthalmologists TheWayForwardproject6 RoyalCollegeofNursing TheCapitalNurseprogramme7 FacultyofSexualandReproductive

HealthcareCommunity-basedSexualandReproductiveHealthleadershipinGreenwich



TABLE1 Dartford&GraveshamandGuy’s&St

Thomas’vanguardAcuteCarecollaborativelearning

2 RoyalCollegeofAnaesthetists Preparingpatientsforsurgery:CommunityPrehabilitation andCrosssectorworking

3 RoyalCollegeofPsychiatrists Mentalhealthandnewmodelsofcare:learningfromtheVanguards

4 FyldeCoastVanguard EmpoweringFamiliesmulti-disciplinaryteamapproachforchildrenandfamilieswhoarehighusersofHealthcareservices

5 RoyalCollegeofGeneralPractitioners Integratedcareforolderpeoplewithfrailty:innovativeapproachesinpractice

6 RoyalCollegeofPhysicians FutureHospitalProgramme:localityhubsproject



Lunchandnetworking



Developing the forward agendaIdeas which have surfaced in conversations:

• Future Clinical education• Collaborative training in the field• Professional identity, organisational loyalty and team – handling the

tensions • Specialism v generic workers – skills levels, handovers and referrals • Boundaries, protocols and risk – removing obstacles • Is there an agreed new care model? How would we reach one?• System leadership – building relationships and trust • ‘Work arounds’ versus radical change – how to move obstacles



Facilitated discussion –what is the work that would

take these discussions forward a stage?



Planning next steps: Summary position of the day

Dr Nav Chana, Clinical Associate, New Care

Models Programme



Agreement on next steps, thank you and close

CarrieMacEwenand Louise Watson

what does an effective multi-professional team approach

Documents