Zoe Nicholson, Here co-founder and Chief Executive reflects on our community services being rated ‘Outstanding’ by the Care Quality Commission
Growing outstanding healthcare
Here has been delivering NHS clinical services in partnership with patients, staff, NHS and third sector partners for 9 years, since 2010. Our ambition has always been to create joined-up care, across the boundaries of organisational walls or place and put patients in control of their healthcare journeys. So, it is with great humility and honour that we are thrilled to receive the badge of “Outstanding” from the Care Quality Commission. They describe us as outstanding for many reasons and their headline message is we deliver a “truly holistic approach to assessing, planning and delivering care and treatment to all people who use the service”.
Creating joined-up care with patients in control
When we first started out as a social enterprise in Brighton and Hove with the Community Eye Clinic, we were struck by how citizens were expected to go to different institutions for their care. They might go to a hospital, a GP surgery or a community clinic and it seemed that what the patient was offered was largely dictated by what was on offer from that different building or that specific set of professionals. We had a vision of more joined-up care, where the needs of person dictated the pathway, what the professionals offered along that pathway and from where. So our services have always sought to organise care around specific groups of patient needs. To achieve this in a healthcare system that is largely driven by where to house safely the greatest number of clinicians, or the most expensive piece of kit and how to make it cost effective to utilise that resource has always been challenging.
Working continuously to understand the need
To achieve a “truly holistic approach” in this fragmented system takes creativity, ingenuity and sometime pure stubbornness, more politely referred to as determination. It has involved some key building blocks that sometimes get overlooked in our busily stretched professional lives. Some of the building blocks are the idea that we design services around groups of patients’ “presenting” condition, rather than professional offer, that we use data to guide what is needed rather than what we would like to do, that we determine who would be the best clinician or in some cases professional to meet that need, the competencies required; and then build capability to those competencies rather than what we have always done or always offered. We work to understand the needs of groups of patients and then we test and involve, retest and learn if a solution works. These principles whilst sounding very sensible are often simply lacking from the design of NHS services, and some even think are too hard to achieve. They are a key part of the DNA of our organisation and now a key part of other organisations’ DNA – those we have worked with in the NHS.
Working and learning in partnership
Our services are delivered in partnership, and while our clinicians and staff are often employed by different organisations, we create single teams, and a single sense of team and purpose. We create single governance structures across organisations to ensure we monitor care across the pathway. We create single learning and feedback structures. These are not run by managers – these are clinically-led, citizen-led and colleague-led according to the purpose. It was not a surprise to read in our CQC report that we have strong collaboration, team working, and consistently high levels of constructive engagement with staff and people who use the service. This might sound arrogant, but it’s because it was designed that way, and when it fell off the rails or wasn’t quite doing what it was supposed to do, we adjusted, tweaked and got it back on track.
Growing leadership from the ground up
One of the interesting features of our approach has been longevity of our leadership teams and the way we have grown key clinicians and leaders over time. Many of our clinical leaders and our service directors have been in post for on average over five years. Our staff have grown from their roles within the organisation. In an NHS that often seems to value fast-paced changing faces, through our continuity of leadership we have broken the mould, continuing to learn, innovate and achieve our purpose of supporting people to be in control of their own healthcare journeys.
You may also like
26.07.2019 | by Una Nicholson
Here in Brighton and Hove
08.04.2016 | by Peter Devlin
Disruptive innovation in health care
10.06.2019 | by Zoe Nicholson
Creating a clear purpose to do social good - why our jobs matter