Creating the conditions to facilitate complex change

As health and social care integration develops across Scotland, we’re focused on creating the conditions in which integration joint boards (IJBs) and their associated health and social care partnerships (HSPCs) can reach their full potential in the planning and delivery of health and social care services. Here, we look at two examples of how the ihub has helped facilitate such improvements.

Clackmannanshire and Stirling IJB is in the unique position in that three statutory organisations are working together under the auspices of one IJB, including two local authorities and one NHS territorial board.

Working in partnership with the Chief Officer for the HSCP, a programme of board development support started, with the aim of maximising the effectiveness of the IJB.

The programme involved a phased approach. Starting with a diagnostic process, Board members and officers explored their perceptions of the functioning and effectiveness of the HSCP. This was followed by a learning session using a systematic mapping approach to consider their challenges and opportunities.

This process enabled members to view the complexity of their situation, including any competing loyalties and priorities of the three constituent organisations, and work out together how they could best meet the shared objectives of the HSCP.

Feedback from the Chief Officer has described a number of positive outcomes with:

  • Greater clarity of purpose.
  • Deeper understanding of each other’s roles and responsibilities.
  • Stronger commitment to the shared agenda.

The Board has subsequently agreed a series of actions to improve how the HSCP functions, with a follow up session facilitated by an ihub Improvement Associate later in 2018.

Meanwhile, in Wigtownshire, the focus was on creating a whole system leadership team from within existing structures in order to create conditions that would lead to transformational change.

The leadership team was formed from four different directorates and facilitated by an ihub Improvement Associate and the HSCP’s own Community, Health and Social Care Manager.

Every locality has experienced a similar situation, with a key question being, “How can we develop a sustainable model of health and social care that best meets local needs, now and in the future?”

The work undertaken at Wigtownshire on ‘creating the conditions’ - or putting in the foundations and relationships that facilitate complex change - has been highly successful.

The success was achieved by a number of factors, including influencing culture change within the leadership team. They started to:

  • Initiate new conversations – with social workers, with nurses, with service users, and with people at all levels of the health and social care system, regardless of perceived hierarchy.
  • Physically experience working environments within the HSCP that they wouldn’t normally interact with, and to reflect on that experience.
  • Understand different parts of the system and how they interact – not just through data but by direct experience.
  • Develop the discipline to maintain momentum and attend regular meetings, even when progress seemed to The meetings focused on reflection and learning, conversation and decision-making.
  • Live and demonstrate shared behaviours and values.

Ultimately, the leadership group evolved from individuals managing their discrete service areas to a cohesive leadership team that is leading the transformation of health and social care, as well as new ways of working. They’re now proactively implementing systemic improvements.

“Across the whole of Wigtownshire”, said June Watters, Community, Health and Social Care Manager, “we’re now set up to co-produce a sustainable health and social care system that meets local needs.

“Through the ihub’s support, we’re better equipped to be more responsive to system needs and changes as they emerge, and to engage proactively in the right conversations at the right time – not least with the service users.”

See the NHS Dumfries and Galloway website for more information about Wigtownshire’s health and social care integration.

Visit for contact details to enquire about how we might be able to support your local integration plans.