PATIENT CARE
they seek to sustain and develop the business. However, although strategy needs to take place at an individual level, it also needs to take place in the context of the care ecosystem.
So while all these organisations have a local population to provide for, they need to engage in a strategy that is collaborative and that takes account of the other. There is some progress on this measure via STPs. Nevertheless, the hospital is always a disproportionally powerful player. Similarly, within and across organisations, managerial and professional conflict must be mediated in order to encourage those in managerial and professional roles to work collaboratively towards shared objectives. For example, there is a need to bring policy and delivery together. Otherwise, policy is developed without any reference to pre-existing process and practice. Thus, we need to ensure that policymakers, and not just executives but also middle level managers with clinical experience, engage with those who are delivering the care.
4 Workforce development
Delivering integrated care requires a multi- disciplinary delivery system. It needs a local level multi-disciplinary team that pulls in people from different organisations and professions to address patients with long- term needs. In addition, there should be a focus on
hybrid roles - professionals who move into managerial roles. This ensures that there is both the knowledge about what is required in clinical and social care, for example, but also that there is a good understanding about the resources needed for implementation in the particular local context.
The answer is not simply providing more doctors or nurses, either, something that is likely to take many years to filter through to improvements. Instead, we need to find ways to enable doctors, nurses, social workers and other key professionals who deal with long-term conditions, to become competent managers. Here it is worth acknowledging that workforce development is perhaps one element of process reform that the Government has paid attention to. This can be seen in initiatives such as the NHS Leadership Academy initiative. It is clear then, that while structural reform of the NHS is inevitable, it is unlikely to be effective unless it is accompanied by the necessary process reform. Furthermore, while reform of the NHS is a huge endeavour, there is much to be said for focusing on long-term conditions given its prevalence among the population and associated costs. Here, substantial improvements could be made by concentrating on four critical areas of process reform that support structural reform. In addition, besides reducing the cost burden of mismanaging the treatment of
long-term conditions, addressing these areas will undoubtedly encourage practices that are useful in NHS reform elsewhere. The introduction of market competition into national healthcare systems is a global trend. The question being not whether healthcare systems will be marketised but rather the extent to which they will be marketised.
A major challenge, therefore, will be how to optimise both competition and integration across and within domains, as intuitively the two seem to counter each other.
But by focusing on long-term conditions it will be possible to develop practices that promote better integration of all parts of the NHS family, regardless of whether they are private sector firms, social enterprises, public sector organisations or from the voluntary sector.
References
1 Currie, G. & Spyridonidis, D. (2018 forthcoming). Sharing leadership for diffusion of innovation in professionalized settings. Human Relations.
2 Wiedner, R., Barrett, M., Oborn, E. (2017). The emergence of change in unexpected places: Resourcing across organizational practices in strategic change. Academy of Management Journal, 60, pp. 823-854.
3 Currie, G., Burgess, N., Hayton, J. (2015). HR practices and knowledge brokering by hybrid middle managers in hospital settings: the influence of professional hierarchy. Human Resource Management, Vol 54, No 5, pp. 793-812.
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