To drive better outcomes at the health and care interface, changing behaviour is key

We were delighted to be asked by the North-West Learning Collaborative* to host a masterclass on Inspiring Behavioural Change: how systems can better co-ordinate and co-operate with a focus on relationships, trust and behaviour. The session drew on IMPOWER research and client experience to highlight the importance of looking beyond structure and process in pursuit of improved outcomes in health and social care.

The highlight of the session was a presentation from Anna Littlewood (Somerset County Council) and Kate Smith (Somerset NHS Foundation Trust) who along with IMPOWER’s George Boyd shared their experiences of implementing a new Intermediate Care pathway in Somerset. The team had to make changes to processes and structures across acute and community hospitals, adult social care and the voluntary and community sector – working at pace with the impact of the Covid pandemic beginning to be felt. However, they found that getting the structure right was only part of the solution.

As Kate described it, their biggest challenges came more from shifting the mindset from “why you can’t go home” to “what would it take to get you home?” To do this, Somerset worked hard with IMPOWER to create the required ‘headspace’ for change – allowing people to acknowledge and identify issues with the status quo, and then embedding change by systematically targeting behaviours.

The experience struck a chord with attendees. For example Gul Sanai Memon, Advanced Clinical Practitioner from Manchester noted that “clear communication between community and acute services holds great importance, and we must connect with each other positively”.

This illustrated the key findings of IMPOWER research we shared which asked professionals across health and social care about the factors that were driving poorer outcomes. We found that culture and behavioural factors were driving sub-optimal outcomes at least as frequently as system and process issues – but that 90% of the solutions being implemented are focused on structure, process and system.

My colleague Deborah Crossan then provided a brief overview of IMPOWER’s Applied Behavioural Science approach – giving examples of how we have used behavioural science to change behaviour and solve complex problems. The key takeaway was that behavioural science is best applied not as a one-off intervention but as a whole approach that focuses on changing behaviour, reinforcing that behaviour and then widely sharing the impact to build confidence and embed the change within the culture of a particular system.

Lively discussions in breakout and subsequent plenary highlighted a range of issues. For example, one group discussed the importance of courageous leadership in giving staff permission to experiment and fail. Huw Twamley, Critical Care Consultant at Preston and Chorley, noted that often “…we aren’t allowed to fail even if we are trying to change things with best intentions … creative people have lots of ideas, some bad, some good. If you aren’t having bad ideas then you are not being creative enough to be having the good ideas.”

Groups also recognised the importance of responding to local context and not simply applying things that have worked well elsewhere – and in particular of involving a broader range of local stakeholders if we want to see real change. Grenville Page, Non-Executive Director at Manchester Health & Care Commissioning, noted that the discussion highlighted “the importance of a place-based focus and the need to supercharge the role of [Primary Care Networks] to work collaboratively with our housing and VCSE sector to focus on prevention and early support to reduce flows into hospitals. It’s more than just health and social care.”

There was a clear desire for action at the end of the session, with participants energised and thinking about how to apply the learning in their own systems. We are looking forward to continuing the conversation with partners in the North West, and to contributing to improving outcomes in the region.

*The North-West Learning Collaborative is a partnership of five organisations: Association of Directors of Adult Social Services (ADASS) North-West Region; NHS North-West Leadership Academy; MIAA; NHS Employers North-West; and Advancing Quality Alliance. They curate a series of masterclasses together each year – more information on future sessions can be found on the website.