Herding Cats The Bristol ‘Connecting Care’ Programme

1. Herding CatsThe Bristol ‘Connecting Care’ Programme The Bristol story of Interoperability between organisations who don’t naturally interoperate Andy Kinnear

2. Introduction • Connecting Care – why was it needed and what is it? • Who is involved – our partnership • Update on where we are • What are we buying? • Our plans & next steps • Managing the ‘behaviours’

3. Connecting Care – why is it needed? Clinical leaders told us that NOT having access to accurate, timely, shared information is a ‘blocker’ to providing high-quality, effective, efficient care… “There needs to be better communication between ‘in-hours’ and out of hours services.” “Adequate and timely information must be shared between services whenever there is a transfer of care between individuals or services.” “The information I have is limited and frequently is missing important elements…” “Services in all settings including health and social care need to improve their communication and handover ” “I don’t have access to some important information electronically…” “I can’t call people in the middle of the night for information…” “There are delays in getting hold of information that I need…and I spend a lot of time chasing it up…” “Sometimes I just have a piece of paper and I’m not sure who wrote it or when” *Summarised from feedback from clinicians during workshop events

4. Connecting Care – what is it? Clinical leaders told us that NOT having access to accurate, timely, shared information is a ‘blocker’ to providing high-quality, effective, efficient care… Connecting Care is our response to the call from our clinical leaders across Bristol and beyond for better, more joined-up information Connecting Care is our name for the BNSSG Interoperability Programme. We aim to deliver a detailed, local shared patient record that pulls together health and social care information - providing a unified / holistic view that can be used to facilitate improved care provision and clinical decision-making

5. Connecting Care – what is it? • Pan-community project involving 13 local health & social care organisations • Pulling together & integrating information from primary, community, mental health, acute care and social care in order to support point of care • Taking a staged approach – • Stage one will focus on urgent and unplanned care (12 months) • This will involve iterative development methods, a lot of learning, very close working with clinicians who are part of the pilot, close working with the technical supplier and a firm focus on exploring benefits– to support the delivery of a Business Case for the full strategic solution

6. Connecting Care – what? Scope • General • Taking a staged approach – first stage is for 12 months. • Key deliverables • A working system • A Business Case for the second stage • Second stage contract will be for 5 years (plus extension) • Clinical / care ‘theme’ • Stage one intends to focus on urgent & unplanned care • Stage two will be for wider use (long term conditions, other pathways, ‘patient portals’…and whatever else we choose to do) • Numbers of users • Stage one c.300+ • Stage two – 10,000+

7. Connecting Care – our partnership • South West Commissioning Support (SWCS) - leading the programme • 3 Acute trusts - North Bristol Trust, University Hospitals Bristol Trust, Weston Area Health Trust • 3 Local Authorities - Bristol City Council, North Somerset Council, South Gloucestershire Council • 3 Community Providers - Bristol Community Health, North Somerset Community Partnership, South Gloucestershire Community Health Services • 3 CCGs - 110 GP Practices • Ambulance - Ambulance Service • Mental Health - Avon & Wiltshire Partnership Trust

8. Connecting Care – What are we buying?

9. Connecting Care – whatinformation?

10. Connecting Care – What are we buying?

11. Connecting Care – where are we? • Completed a complex procurement process (competitive dialogue) • Signed contracts in February 2013 • Started work on the project last month • Governance in place • Scoping the work with our local clinicians and social workers • Project planning, solution design and information governance deliverables all underway

12. Connecting Care – timeline

13. Connecting Care – Behaviours The ‘herding cats’ challenge – Connecting Care characterised by: • Multiple organisations with multiple agenda • Multiple clinician professions with multiple priorities • Multiple system suppliers with multiple commercial interests But there is only ONE patient

14. Connecting Care – Behaviours The ‘herding cats’ challenge – Characteristics of successfully meeting that challenge: • Leadership • Vision yeah yeahyeah • Direction • Individuals But managing ‘behaviours’ is key to cat herding

15. Connecting Care – Behaviours The ‘herding cats’ challenge – Recognise and work on the different elements – • Political dimension • Personal dimension • Human behaviours • Organisational behaviours • Interests, motivations and blockers • Time and timing

16. Connecting Care – Behaviours • Work at it - it doesn’t happen by accident • Accept it is going to take time • Create ‘independent brokerage’ • Recognise different interests and work to accommodate • Recognise vested interests and pander to them where necessary • Give everyone reasons to be at the table • Encourage collegiate behaviour, liking each other being happy about the programme • Appeal to the greater good • Bring dissenters inside the tent • Deal with key stakeholders individually and in groups, formally and informally – be flexible in your approach • Be trustworthy, honest and open….but a little clandestine now and then ;-)

17. Connecting Care – behaviours It takes time to build a partnership

18. Connecting Care – Behaviours The ‘herding cats’ challenge – “When my cats aren't happy, I'm not happy. Not because I care about their mood but because I know they're just sitting there thinking up ways to get even” Percy Shelley

19. Connecting Care – Thank you Thank you for your time Andy.Kinnear@swcsu.nhs.uk