'Let’s get together and feel all right' - How can we support people to maximise their potential by working across traditional boundaries?
Laura Porro, Consultant
The news often mentions the ‘workforce issues’ in the NHS. Most recently, we heard of skills shortages, at least partly due to the risks of Brexit, and calls to lift visa caps for doctors.
But what is ‘workforce’? ‘Workforce’ is people: therapists, porters, paramedics, health care assistants, nurses, midwives, doctors, discharge coordinators and many more. There are over 300 different NHS jobs performed by over 1m people, according to Health Education England. They are the ‘workforce’.
The main challenges of managing such a large and diverse group of professionals are well known:
- We need the right number of people in each profession
- We need each profession to operate according to best practice, minimising bureaucratic tasks, and using their highest level of capability
There is, however, an additional challenge that is often overlooked, and not just in health and social care: things change. At one level, this is obvious. There are more elderly people now compared to sixty years ago so we need more professionals who can take care of them. Research constantly improves health and care techniques so professionals’ learning must evolve.
Things also change quickly, however, and many times during professionals’ working lives. PPL’s experience shows that a key problem facing organisations is bringing people along the journey of change. Organisations and people usually know what needs to be done to improve care - the challenge is how to do it. How do you do things differently with the same people?
In recent years, evidence has shown that effective integration between existing services leads to better outcomes for people, professionals and organisations. Organisations are therefore currently changing some of their models of care (e.g. discharge to assess or case management) to bring together professionals from different backgrounds. Often these professionals do not even belong to the same organisation. For instance, an elderly person living alone with diabetes may need to see a district nurse to see to their feet, a social worker to help with their housing situation and the Red Cross team to join a local support group. Professionals face obstacles to working in this new way. Some are practical barriers (e.g. different IT systems and different offices) and some are cultural barriers (e.g. professionals not fully understanding or trusting each other).
So if we know that professionals will face all sorts of change during their working lives, are we teaching them how to change? If we know that professionals will have to keep learning new models of care and unlearning old ones, are we teaching them how to learn?
There is an urgent need to ensure that learning and training activities for all professionals working in health and social care, from the very start, focus on these two elements. This means enabling our most valued professionals to be ready for anything the future holds: new medicines; new models of care; more complex interactions across organisational and professional boundaries; new policies; new financial arrangements.
In practice, this means:
- Understanding how different people (including one self) react to change and why.
- How to provide/obtain support during change.
- Dealing with difficult reactions to change (including one’s own).
- Building resilience during ongoing change.
- Understanding one’s own learning style and preferences.
- Familiarising people on how to use all learning techniques, including on the job learning, shadowing and peer-to-peer collaboration.
PPL has seen the success of this approach. For example, when we supported a group of organisations to change their approach to discharge we trained over 100 of their professionals including social workers, discharge coordinators, nurses, doctors, therapists and more. We did not teach them the pathways of the new model or show them the new discharge policy. Instead, we told them about change. We allowed them to express their excitement, discomfort and fears. We told them about working with new people. We understood why talking to other professionals is difficult and we faced the inevitable conflicts arising from these situations. They are now ready to read the discharge policy and the pathway. And they will be ready, in a few years’ time, for an improved version of this model, and for the next one too.