NHS

Case study one: Helping a key project team get back on track (Beds & Herts SHA)

Wingivers were invited in to assist this client with their implementation of the Connecting for Health Programme (previously known as the National Programme for Information Technology) - a nationwide programme for revolutionising patient care and service delivery through the introduction of joined-up information technology across the NHS. It was evident that the programme team had, for a variety of reasons, become dysfunctional, so Wingivers worked with all those involved - including the chief information officer - to analyse the situation and set up an appropriate action plan.

The first step was a meeting with the CIO who, although fully accountable for project implementation, had no direct authority over the team members, who all reported elsewhere. In-depth interviews with the rest of the programme team and other interested parties followed, to gain a broader perspective. Following Wingivers' characteristically collaborative diagnosis, participants began to co-create possible solutions, thus adopting 'ownership' of potential ways forward at an early stage of the process.

During the in-depth interviews, observations by various team members helped to identify a number of themes, patterns and hypotheses. These were subsequently displayed around the room at the next team meeting, enabling the team to see the whole picture for the first time and build on their early ownership of potential solutions. Individual members were encouraged to say which of views, themes and hypotheses resonated with them, and why. This novel approach provided a fresh opportunity for team members to engage meaningfully not only with the real issues, but also with each other, for the first time.

Concerns included the new CIO's lack of long-term NHS experience (in contrast to that of other long-served team members), a widespread level of dissatisfaction about how project meetings had been conducted, and a fundamental lack of clarity about the team's function, aims, structure, individual roles and responsibilities, capabilities and processes. In this context, team members had hardly been in the right frame of mind to contribute effectively and take the project forward.

Wingivers' interventions, which took place over a six-month period, helped everyone involved to establish clarity of purpose, understand their own and others' roles more clearly, and - most importantly - gain a level of mutual trust that had previously been lacking. As greater awareness of others' positions dawned, it transpired that behaviour originally interpreted as negative had in fact been positive in intention. The 'us and them' mentality duly evaporated. A further strand of support involved one-to-one executive coaching for the CIO leading the project team. This helped him come to terms with the process of challenging the status quo and driving change in the context of an unfamiliar organisational culture.

Following Wingivers' involvement the impasse within the team was resolved, and by embedding a more effective way of team working this key project has now regained its momentum.

Case study two: Studying best practice to improve service delivery (Trent and Norfolk , Suffolk & Cambridgeshire SHAs)

This assignment arose from the clients' participation in the Connecting for Health Programme (previously known as the National Programme for Information Technology) – a nationwide programme for revolutionising patient care and service delivery through the introduction of joined-up information technology across the NHS.

To help develop the leadership capability of a number of key players responsible for implementing this change strategy within the Eastern Cluster of strategic health authorities, Wingivers were asked to run a UK/US study tour programme. This was developed by Wingivers' founder Antonia Maclean in conjunction with Accenture's US clinical director, Dr Marshall Ruffin. (Accenture is the Eastern Cluster's local service provider, responsible for supporting the integration and development of systems to ensure that national applications can be delivered locally).

The programme involved around a dozen participants, including CEOs of primary, secondary and mental health trusts as well as directors of strategy, modernisation and nursing, CIOs and other senior functionaries. Its aim was to provide the element of focused leadership development that would significantly enhance the prospects for successful programme implementation.

An initial orientation day before departing for the US was designed to answer any questions and establish the key learning objectives. The five-day stateside tour included visits to a variety of hospitals and health centres. These visits provided the opportunity to observe comparable electronic systems in use, consider the technologies critical to their successful implementation, and discuss effective strategies for engaging clinicians and managers alike.

The study programme also explored various strategies for introducing technical change successfully, optimising collaboration with partner organisations (such as local service providers), and evaluating the merits of different leadership styles. It concluded with a half-day follow-up session back in the UK , covering both debriefing and discussion about the value of the learning experiences.

Following the programme, all participants felt much better equipped to specify and establish effective change management and support processes, drive the change strategy in conjunction with their local service providers, make informed choices about their own leadership approach, and transfer their learning effectively. Perhaps most importantly, the CEOs had gained a much fuller understanding of what was required of them personally to ensure successful project implementation, and thus maximise the keenly anticipated benefits to service delivery.

Case study three: Securing positive commitment from a key stakeholder group (Trent and LNR SHAs)

This assignment came about in the context of the Department of Health's National Programme for IT, which aims to revolutionise patient care and service delivery through the introduction of joined-up information technology.

Within this framework, Trent and Leicestershire, Northamptonshire and Rutland Strategic Health Authorities (part of the Eastern Cluster of SHAs) were in the process of bringing their own IT capabilities into line.

However there was a reluctance from clinicians to engage enthusiastically in this programme. Among the reasons for this was a lack of awareness about the impact of the changes that the new programme could deliver, coupled with an element of frustration about their own lack of involvement or consultation regarding the new initiative. Moreover, as many GPs were technically literate and comfortable with their own IT systems (which, incidentally, did not support hospitals' requirements), they remained unpersuaded of the need for change.

As a result, Wingivers were appointed to design and support a new kind of Clinician Engagement Workshop – a critical initiative for the SHAs concerned, since it represented their first real large-scale attempt to engage this key community effectively.

The Wingivers' approach involved a fundamental shift in the nature of this engagement from one-way communication to genuine dialogue. A key element of the strategy involved placing ‘ownership' of the workshop and its success with the clinical reference group (a voluntary group of clinicians who provide input to the SHAs' Chief Information Officer). As such, the workshop's credibility (and effectiveness) was based on its clinician-to-clinician, rather than SHA-to-clinician, communication.

Its strongly practical focus not only succeeded in gaining an unprecedented level of positive clinician engagement (with a number of individuals becoming real converts and espousing the cause enthusiastically), but also introduced a new way of communicating information far removed from the ‘passive conference' format, thus establishing a more effective methodology for dealing with large groups within the SHAs.

Wingivers led the project, which also included representatives of the SHAs' local service provider (Accenture), in a truly collaborative style. Its success has given the SHAs the confidence to extend the new workshop approach to other key communication issues.