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Leading improvements in population health
STRATEGY
Durka Dougall
Senior consultant, The King's Fund
The King’s Fund has recently launched an exciting new five-year strategy. This sets out a vision for improving health and care across places and communities. We will do this by supporting people, championing compassion, and nurturing great leadership. The strategy promises to build on our work around population health, so now feels like a good moment to look back at the lessons learnt to date.
Assets-based approaches
Leaders for improving population health often ask, ‘where is the best place to start?’. Our work with local areas suggests the answer to this is to understand where you currently are. This means understanding the local population, their needs and the assets that exist locally to help meet these needs.
It is easy to overlook existing good work or progress already made and, instead, start by trying to find new ways to deliver improved integration or population health. However, we have found that by starting with a focus on assets, areas can create a shared understanding that is key to furthering population health efforts for the longer term.
We have been using our Vision for population health framework to help areas prioritise actions on population health. This also helps support people to think through the leadership practices needed in their context. Using our framework, areas – such as the Coventry and Warwickshire, or Cheshire and Merseyside Health and Care Partnerships – have worked with a range of partners to map assets, and identify existing good practice, skills and passions that lay untapped.
This assets-based approach then allows areas to move forward by considering gaps and opportunities, identifying shared priorities and developing strategies for improving the lives of local people. The areas we worked with agreed strategies including a range of cross-system practical actions that could be undertaken by partner organisations in the short, medium and longer term.
In Coventry and Warwickshire, organisations found that talking about the Vision for Population Health helped them to identify untapped resources such as public health skills, work by local charities to mobilise communities, and senior-level support for more joined-up working. In Cheshire and Merseyside, 125 health and care partners used the Population Health Framework to identify the good work local organisations were already doing, decide which areas needed more system-wide action and agree practical steps for progressing these.
“By starting with a focus on assets, areas can create a shared understanding that is key to furthering population health efforts for the longer term”
Brave leadership
The reality for leaders at all levels as they try to work differently for population health is that they encounter messiness, complexity, uncertainty and may feel confused or under-prepared for the task ahead of them. They may question the adequacy of their training and struggle to apply a wider health and care system view, if they come from a specialist background.
Leaders may face the strain of trying to find the time and opportunity to contribute their insights while working in under-resourced parts of the health and care system, such as public health, charities or social care teams. They may face conflicting priorities, such as balancing internal organisational objectives, while trying to work as a part of an emerging ‘system’. Or they may find it challenging to work in a new way that requires system leadership skills, test-and-learn approaches and an acceptance that there is no blueprint or ready-made solution to use.
This leadership challenge is a natural part of making progress and is the most common issue we hear about in improving population health. We have found that success is possible when leaders are supported to work through these challenges by developing skills and confidence. A key part of this process is senior leaders supporting staff members to act for population health.
For example, leaders across Oldham, North East England and London are working to build their local population health workforce in this way. More than 140 people are working on more than 50 population health improvement initiatives that have begun to unlock significant potential.
Collaboration is key
Many of the factors affecting the health of individuals and populations lie outside the realm of healthcare services – effective population health is a collective responsibility. However, in some areas the focus remains on healthcare, or government-led population health efforts.
So, another common question we hear is “Who else do we need to involve?”, quickly followed by “How should we work together?”. We often find ourselves responding: “Where is the community and the voluntary care sector? Or the wider workforce? Where is public health? Where are the police, education, housing? Where is social care?”
Evidence from our Leadership for Population Health programme suggests that bringing an extensive range of individuals together early triggers considerable gains. The collaborative approach needed for population health can be likened to a football game: if the goal is to improve the lives of people in a place, then the various organisations, like players, each have a unique and important role to play. Understanding the role of oneself and others and formulating a co-ordinated approach becomes paramount.
Taking the time to build understanding, trust and dialogue across partners is fundamental to progress, although this is not always easy because of different priorities, language, viewpoints and focus. Using this approach, integrated care systems (ICSs), primary care networks, individuals and organisations – for example, Dorset ICS, Northern Ireland health and care partners, and Mid and North East Essex Primary Care Networks – are beginning to create change.
