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SoWhoCaresAnyway E4 No Transformation without workforce transformation · SoWhoCaresAnyway

Hello and welcome to So Who Cares Anyway, the podcast that shares learning, innovation and ideas from the world of health and social care and beyond.
My name is Ruth Germain and I'm inviting you to join me each week with my inspirational guests to hear about who cares.
What they do, their passions, their knowledge and ideas, and importantly, the difference they are making to improve the health and wellbeing of people in our communities.
I consider each of my guests to be incredible individuals working with people in new ways or with key messages to share.
People from health care, social care, the voluntary sector, community groups and more.
So join me each week to find out.
So who cares anyway, to find out more about me, who I am and what I do, please head over to my website, www.
reflectiveruthconsultancy.
com.
com where you can also catch up with previous episodes and read my blogs.
Today, I'm absolutely delighted, to introduce you to my guest speaker, Kim Manley.
I've known Kim since 2017, when Kim came along to support an education event I was doing for general practice at the time, it was mainly nurses, but we had a few GPs in the room and it was around leadership, which is something that.
Kim will probably be talking about today.
And at that time, Kim asked me if I wanted to be a critical friend, which I jumped at the opportunity.
I was absolutely delighted and quite honored at the time that Kim Steven asked me, and since then Kim supported me through a number of different projects and writing and different things that I've done.
So.
I'm going to pass over now because I think I probably can't give Kim justice, so that she can start to introduce herself and, give some of the background and how Kim's got to where she's today and her passions that's got her there.
Thank you and welcome Kim.
Thank you so much, Ruth.
It's a real privilege to be able to have this conversation with you and to talk about things that we jointly are passionate about.
I'm sort of semi retired at the moment.
I'm doing a little bit of work two days a week with the NHS England on the multi professional consultant practice work stream, which is part of their national strategy, and I'm also emeritus professor at two universities, which means I'm still doing a little bit of writing and publications.
I'm a passionate nurse by background, previously critical care nurse, but over the past 20 years have worked very much with all the professions in health and care, and I'm passionate.
Also about using the qualities that each health profession brings and helping everybody to work together so that we care for people with people in our community, in a way that feels equitable and focuses on what matters to them and also the workforce.
Thank you, Kim.
And I wonder if you want to give a little bit more about your background, so your journey, so when you started your nursing career, to give a little bit of idea to people as to where you came from and how you got to where you are today.
Well, I've always been passionate about practice, healthcare practice, and the context in which we work.
So that had a major impact on the direction I took.
I went on, I was a sister in critical care, surgical intensive care for cardiac people, patients, and became a clinical teacher.
For three years I was a clinical teacher at St.
George's, London, and then I was given the opportunity to do the, postgraduate certificate in education and I said, no, no, I'm not going to go away from practice.
I'm going to stay in practice.
So I agreed to do the clinical teaching course at the Royal College of Nursing, which I did, and then went to work as a qualified clinical teacher on the intensive care course at St.
Thomas's.
And that's where I had the chance to, undertake, my master's degree.
I hadn't got a first degree at that time, but I had been working with my first group with the Open University.
And so before I finished that, I was asked if I wanted the opportunity to do the Master's degree, which I did in Nursing, Arts and Science of Nursing in Wales.
And part of that led me to do my thesis on Primary Nursing in Intensive Care, which was really interesting because I was very keen to look at the.
therapeutic relationship.
I thought it was really important to have continuity of care between those providing care and those receiving care.
And so I was able to undertake that thesis.
And thereafter, just having a master's degree enabled me to go to the Royal College of Nursing Institute, where I was the first lecturer of nursing.
There, and that opened my eyes to a lot of the theoretical understandings of how you construct theory, how you work with practice, and all of the modules that I ran and was program leader for, right up to the master's degree, were all practice focused on what you do in practice.
Also I insisted, of course, that if I was going to be a lecturer in nursing, I needed one day a week in practice.
And so I developed a relationship with the then Westminster Hospital Intensive Care Unit and they moved to Chelsea and Westminster where I was able to, establish a King's Fund Nursing Development Unit in the Critical Care Unit.
Quite unusual, that was.
A lot of my peers in London thought it was quite strange to have a nursing critical care unit.
But we were, very, very lucky because we got the first tranche of funding from the King's Fund and all the other three areas were, in older people's care.
And I was able to then operationalize the consultant practitioner role over three years.
in an actual research study.
That was very powerful.
I learned a lot about how to take people, with you,, how to create a culture where everybody's valued, where everybody achieves their potential, flourishes, and a lot of other insights as well.
Then going back to the RCN, after that three years I was then head of practice development and that too gave fantastic opportunities because the research institute part of the RCN institute was successful in getting some monies from the research assessment exercise and that was used for the practice development team to do two projects.
One was on this sort of expertise in practice, what makes expert practitioners.
in the context of everyday work, very much focused on using different types of knowledges and blending those and valuing the person and the relationship.
And then the other project was to do a concept analysis on practice development.
My colleague, Brendan McCormack and Rob Garbutt, they led on that and I led on the expertise in practice project, which was a UK project.
That was interesting because practice development at that time was very much seen as any little project that's undertaken in a practice team.
So by undertaking the concept analysis, we were able to really get the term recognized in the British National Index Journal.
So previously, if you searched on practice development, you came up with, practice of anything and or child development.
So the concept practice development was set and that paved the way then for international work and setting up the international practice development collaborative with colleagues around the world, including Australia, New Zealand, the Netherlands, and then more likely Scandinavia and Switzerland.
And also then, Each of us took a different lead on clarifying the concepts of practice development.
And I took the lead on culture and with colleagues from around the UK.
And we were able to clarify the concept of an effective workplace culture at the front line.
That's called microsystems culture.
I don't like to use frontline too much because it's a bit militaristic in terms of its word, but those teams that where care is provided and experienced is the culture that I was talking about.
Then more latterly, I was off sick for a year and when I returned the RCN Institute was restructured and so I had to go into a position which was a learning and development manager.
I didn't like the title of that at all, but anyways, worked with it and had six teams that were all around the quality agenda, evidence based, the NICE guidelines, all these sorts of things.
And during that time, really had the opportunity to work with the, Academy of Medical Colleges and National Voices to set up HQIC, that's the Healthcare Quality Improvement Partnership, and to facilitate the development of the principles of nursing practice with charities and service users across the UK, using practice development principles.
Then after that, I went on to, into a joint appointment at the England Centre of Practice Development in Canterbury with the local NHS Trust.
And that really kept me in practice working and supporting people in practice to, first of all, develop shared purposes and shared values and to ensure that we're all working in the same direction.
And secondly, to be a real embedded researcher, again, helping people to evaluate what matters.
And they're making them, enabling them to happen, and then more laterally again with the Anglia doing quite a bit of work on impact continuums.
What are the impacts of these roles? What are the impacts of practice development? How can we build the building blocks to ensure that healthcare transformation happens at every level by using those principles, using the concepts of systems leadership and so on.
So that, in a nutshell, probably touches on quite a few, important things, but I think the foundation has always been to work in practice with practice and to recognize that practice is complex and you cannot, take a linear approach to developing practice.
You have to recognize all of the facets and that sort of led me to really focus on things like realist synthesis and evaluation, which also does that as practice development does.
Thank you, Kim.
And so I'm just going to ask from there, because it's a fascinating, every time I hear it's fascinating hearing how you've got there.
And this drive really, and your understanding from quite earlier on, that actually, we need to really think about how we develop cultures within the teams and practice development.
So I'm aware, we've probably got people listing who might not completely understand practice development and what that actually means.
And you've also touched on the concepts of it, and you've touched on the culture, but I think there's more,.
So I wonder if you might give a bit of an explanation of practice development and then explain some of those concepts a little bit further for us, please.
Yes, so, now it's easier to define it.
So I would define practice development as having clarity of purpose about delivering person centered, safe and effective care, which is evidence informed care, with continuity.
And that's the aim.
for populations, communities, individuals, families, and so on.
The second thing is that it achieves this by attending to the context of care, and the context of care includes the culture, and the culture is dependent on the leadership.
The leadership is a little bit more of an implicit concept.
But culture and context is very, very strong.
And culture would be the way you experience care, with how providers experience care as well as service users experience care, the things linked to the behavior and whether one lives one's values and everyday practice.
And the third, The other thing to back up is that it's dependent on skilled facilitation.
And what I mean by skilled facilitation is not a project management approach, it's about holistic facilitation that enables people to have a safe psychological space to be creative.
And to begin to experiment with their practice, to feel supported and challenged in their work, to be reflective, and to focus on the consequences of their actions for themselves and for others, and to use them to enable empowerment, which is the motivation to want to change.
And then enlightenment.
and emancipation which big words but just means challenging the way we think the things we take granted and freeing ourselves up from that from those assumptions and the things we take granted in everyday practice to help us to move forward.
It also recognizes that context adapt and change and that we need to be attuned to them too and responsive to them.
And I suppose the last point is, the principles underpinning practice development are all the SIP principles, which stands for Collaboration, Inclusion and Participation.
So you always would expect to work with stakeholders, to work with service users, to work with charities, to work with the people who the services Intended to support, as well as the staff, staff expertise and other stakeholders to co create and co produce direction and then the implementation and evaluation of that together.
So, I think I've probably covered everything.
When we did take forward the concepts, for example, Brendan McCormack, who is now in Australia, he led on the, person centered aspects of it.,
and other colleagues led on the facilitation aspects and then, those were the three main concepts that we took forward for further in depth understanding and then applied those not just to the microsystems of FONT19 but also to other levels In the integrated care system, so micro, organizational and macro, which is population based focus very much like you focused on place based learning, focusing on place where care is provided to all of those levels.
We've applied the principles to.
And latterly, I've just completed a meta analysis of 20 years of practice development projects that myself and my other colleagues and Sally.
Hardy and Kerry Jensen, we've undertaken to draw on how you would judge the impact of, transformation and what we identified where they are key, building blocks, the building blocks have to be in place if we want to sustain any transformation, and if we want to achieve the social determinants, improvements in social determinants of health and public health, And the social context, and we have to attend to the building blocks.
And the other thing that we found from analyzing 46 projects over the 12 years is that, you cannot separate workforce transformation from systems transformation.
The two are interdependent and it's key to think of both and to invest in both.
Leadership has become very much stronger in our own work, particularly collective leadership, where everyone can be a leader on something, and also systems leadership, where systems leadership It's really important if we want to enable our resources to be used effectively, if we want to enable the journey to be wrapped around the citizen rather than around the profession, and for the relevant capabilities to be developed that can be grown, especially when we have such a challenge with our workforce at the moment, not just attracting them, but retaining them and growing their potential.
Thank you, Kim.
And I think that gives quite a nice sort of context around that practice development.
And what I always find interesting when I look at that is the fact that it's, when we think of practice development, people often think about skills or capabilities.
And I know that, You're really particular about how you use those words and rightly so.
But people will think about that and think, Oh, we need to be able to do X or Y.
But this really thinks about the culture and about not accepting that status quo, thinking differently, freeing up the mind to do new and different things.
So rather than just being.
People that do is thinking about health and care practitioners as being people that do things, but actually think about how that makes a difference in an impact to the people that they're caring for.
And that's one of the things that's really always fascinated me and draw me into to this because I think that quite often, I know my own clinical experience was about doing things and getting things done.
When I worked in general practice, it was about just getting patient.
Patience as people were called.
And to me, there were people that were coming in to see me, getting them in and getting them out and thinking, actually, that's not the way I want to work.
I want to do things for people that will actually make a difference and impact them.
And when I met you realizing that actually there's this whole body of work and literature and things that have happened to start to do this was why I became quite fascinated in what you were doing.
So, I think there's two sort of examples that build on that, really.
One is, a piece of work, we did at the England Centre for Practice and Development for Health Education in England around, CPD, Continuous Professional Development.
And, we did a massive, realist synthesis of what was available.
And it's really clear that we're not using CPD in the most effective way to help us to achieve transformation.
And we explored the purpose of CPD.
We looked at all the knowledge bases, Human resources, personnel management, as well as all of the professions in health care.
But we were able to identify clarity of what the purpose of CPD is, which is very much tuned in with the practice development focus on person centered and effective Care, safe care with continuity and the sub purposes were all about transforming so there were four areas about what we need to do with that CPD, which is, it's about transforming the career pathways for our profession so that we maintain and grow them and develop their potential.
It's about transforming the culture of care so that we can ensure that we provide quality care and also value our staff.
It's about transforming knowledge translation.
So we're using the best evidence based and best informed evidence for every part of the patient's journey.
So that's at every level of the system, as well as in day to day practice.
And, that we're also adaptable.
We're responsive, looking at the changing context and can respond to that.
So that, that, that endorsed.
The importance of attending to all of those things and again facilitation came out very strongly because it's no point If you develop yourself transform yourself and actually working with some of our my medical colleagues So our leadership, they wrote a paper when they wanted to call it transforming the NHS by transforming themselves.
It's very much about that journey for us as an individual.
But as leaders, it's about enabling everybody to participate in that journey as a team at every level, all the partners across the ICS.
And the, the second piece of work, which was really important was, again, it was for health education in Kent, Surrey and Sussex.
And we were asked in about 2012, 13, to look at how you transform the urgent and emergency care workforce across place, across the whole.
Context, and, the work we did on that again showed that we need to attend to really important things.
And if we really want to take the pressures of A& E, departments, we've got to look at the resources across the whole community, the whole of primary care.
not just focus on acute care.
And to do that, we found there were certain things lacking that prevented that.
And so there were three things that you needed to action to enable that care to be transformed.
And that was, first of all, you needed to look at systems leadership.
So that's Really driven the multi professional consultant practice work stream because, and I'll say a bit more about that in a moment, but it's the systems leadership that breaks down the barriers, breaks down the silos, that expertise in terms of how to do that, as well as the credibility that professional expertise in healthcare brings, regardless of the profession.
The second thing was the importance of facilitating and integrating.
So the facilitation skill set comes out again, but it's about integrating a joined up approach to learning, knowledge translation, improvement, inquiry, innovation, all of those things together.
And again, many of our Organizations have separate silos for those things.
We need to join them up.
That's what you'd expect a systems leader to do.
That's what you'd expect a multi professional consultant practitioner to do.
So that was required.
And the third thing that was required to transform healthcare was to around the capabilities around the patient's journey rather than around the profession and to draw on all the professional experts that we have from different healthcare professions to complement each other.
We're recognizing that there's some overlapping capabilities that is needed but also recognizing the unregistered workforce as well and how They contribute a tremendous amount to the patient's journey and how they also have the potential for ongoing development through apprenticeships and so on.
So those, two projects really accentuate the importance of creating and attending to culture, the same skill set that practice development addresses.
And again, another piece of work we did, did with my colleague, Carrie Jackson was, we looked at developing the Venus model, which is a model that identifies the five skill sets that are required to sustain workforce transformation.
So again, that's things like practice development, culture.
leadership, improvement and a knowledge translation.
Those skill sets are absolutely vital.
We've got to get those right if we want to build and sustain any change that's going to be effective and in the long term.
Thank you, Kim.
That's really helpful, giving some context there.
And I think what I've, was thinking about while you were talking there was around I know that you've been very involved in that advanced practice and the consultant level practice.
But when I was working again to Medway, and I was working leading that advancing practice piece of work across the system was about how people still tend to work in the silos or within their areas.
But what you're talking about and what's really important is about people coming together and to bring those people together, to start to share that understanding across the system, because if you're going to impact on.
urgent emergency care as you were speaking about, then actually everybody else, all those other partners and stakeholders need to be involved.
So how do you involve them and how do you, encourage them to realize that actually they need to talk to other people or to be part of those conversations rather than being where they are.
So I think that these is quite nicely, I don't know what your thoughts are about that, but I think that also leads us quite nicely into the reason why we need that consultant level practice as well that you, touched on there.
Yes.
I would, define a multi-professional consultant practice as being an expert, fresh, a professional practitioner in the profession of the consultant, which could be any healthcare profession.
So they're gonna be an expert.
in their professional practice.
But in addition, they are, have expertise in the other domains which are all integrated and it's integration.
They're not separate pillars.
They are integrated domains.
So the first domain is about enabling and strategic leadership.
So the enabling is key to the facilitation of collective leadership, shared purpose and direction and shared values.
And also thinking about the influence because all the work I did with trying to do this with stakeholders.
It always came up against the most senior executive decision makers.
So it's really important to have the influence at the systems level, but you have the credibility and the professional expertise to break down the silos.
So the first domain was, and enabling strategic leadership.
The second domain, not surprisingly from what I've been talking about, is about integrating learning, development, improvement, knowledge translation, innovation and inquiry using the workplace itself as a main resource for all of those activities.
That skill set is about being a holistic facilitator and using the workplace and that's a community, that's if you're talking about the system, every and every context across the system.
The third domain is about innovation and research but that's very much as an embedded researcher.
So what I mean by an embedded researcher is that you're working in context with people, with stakeholders, trying to understand the complexity of it.
That's where most of the challenges exist, according to Sean.
who talks about the swampy lowlands.
That's what it feels like for most people.
It's frontline practice regardless of your profession.
And it's being an embedded researcher.
So by co creating together direction, shared values, then, looking at what meters and evaluating what it is, not what the tick boxes are, but evaluating what matters and demonstrating and getting improvement and action over time, continuing that relationship with the stakeholders.
So, that last one embedded research is really, really key, is a different type of research doing randomized controlled trials.
I'm not saying that randomized controlled trials aren't important.
Of course, they are the specific interventions, that are used, but for the approach that we're addressing in terms of quality of care, addressing the context in which we're all working is much more multifaceted, the focus on, complex adaptive systems being much more realistic approach to research in a practice setting, understanding all of the factors impact on practice.
What are the strategies that work? What are the strategies that don't work? And then lastly, of course, consultancy, but consultancy is about as four levels.
I was influenced by Kaplan.
Kaplan was a psychiatrist who identified four levels of consultancy.
The first two are very much about practice.
The first one is the consultancy discipline.
provided to clients, to patients.
The second one is about consultancy provided to our other disciplines to help them get a more joined up approach about how everybody can support each other.
And then the last two levels of consultancy are very much across the system and across the system to implement the systems that are required to Assure that we get continuity, that we wrap capabilities around patients and citizens, and we provide care as near to home as possible.
Now, expertise in all of those areas that complements your professional expertise is what makes a multi professional consultant practice.
Of course, you can't achieve that immediately.
You have to build on your professional expertise, your advanced practice expertise to develop expertise in those other domains.
Now, Rob Crouch and I did a Delphi study that looked at, which capabilities are required at which level.
So, we were able to identify the transition capabilities that are required for advanced practitioners in the profession to move into consultant practice and the capabilities you'd expect at year three and capabilities by year five.
So, it's a continuum, a lifelong learning continuum.
development expertise, but using that expertise to influence and transform healthcare is absolutely key for different client groups.
And it's not something that can be achieved by administrators and managers who are non clinicians, or I don't mean to say non clinicians, clinicians implies very acute focus.
I mean, non experts in their healthcare profession.
So it's really important that you understand.
what it's like to work in practice and the things that come left field that challenge your values, that challenge your care, all of the time.
It's really important to appreciate that and professional experts in their healthcare professions understand what that's like and therefore what the challenges are, what needs to be done to get the best evidence implemented and to enable everyone to work together.
Thank you, Kim.
And One of the things that I've noticed as well is that we talk about having those sort of that professional expertise, but what you've really developed with the advanced practice, because you've been involved in all of this all the way through the advanced practice and the consultancy practice, is that framework of a career and how that should be shaped for those people that are working to start to have that.
systems leadership.
And I think in the past that hasn't particularly been there, but actually now we've got this thing to say, actually, if we're going to those people that are systems leaders, we've got a real framework about what's.
pathway have they followed? And then what expertise do they have? So it isn't only about the fact of having, clinical leaders or professional leader is at that systems level.
It's about having the ones that have developed the right skills, or capabilities, to be able to work at that level and to have that influence.
So I wonder if you've any thoughts about how do we make sure that the people that are at that level that consultancy practice.
How do we make sure that those people have a voice at that level and it's recognized that all of these things, that you speak about are needed for people, when they start to work at that systems level? I hope I'm making sense.
Yes,.
I think there's three things.
So based on the two years, of the first pilot with learning disabilities and autism practitioners, which include occupational therapists, nurses, art therapists, speech and language therapists, clinical scientists, which is privileged to work with them across England.
They are, pioneering The role, some of them are in a consultant role, some of them are aspiring to be one.
And I think we go back to the capability framework that has been developed over 30 years.
And so I developed the framework originally in my PhD and it was really key what we found in that framework that you have to have authority.
So if you don't have authority at systems level, it makes it really difficult to change anything.
And secondly, you need to co create and use the facilitation processes.
With the stakeholders.
and the first thing is you have to be able to get support from the executive or ICB, the integrated care board.
You have to get them.
So how we did that with the pilot is that they were one of the sponsors.
They had to sign the application that the people would be going on a developmental pathway, and that there would be a job for them at the end in some respect to the systems wide working.
So being a sponsor as well as the employer.
So some of the employers were NHS trusts that they supported, the participant on the development pathway and they were involved in all of the, reviews that the participants, undertaken.
So the participant is focusing on the priorities for the, integrated care system, in their everybody identifies what those priorities are and what the key issues are and that they, that the consultant would then be working to achieve, a strategic approach with stakeholders to address those priorities.
So that's the first thing.
That's the hardest thing.
Trying to influence the executive if they don't know what is available that can help them and they try to work for transformation managers.
The transformation manager is not going to achieve anything.
They don't have the credibility and professional expertise to break the barriers.
They're still not practicing their profession, whereas consultant practitioners are practicing their profession for, periods of time in their week.
And so the second thing is then we try to anticipate that.
By making sure that the capability framework, the NHS, a capability framework, but actually it was developed through working with 1000 participants or see you can is also linked to an impact framework.
So, you can't just be indulgent in terms of our development.
We have to be able to.
Demonstrate that we're having an impact and that impact starts off with the changes in behaviors and attitudes of other individuals and other teams through co creation.
Through those three E's that I alluded to at the beginning, how you engage them to help them be aware of the consequences of their actions, how you enable them to implement change and be liberated from the things they take for granted.
So the impact framework.
Raises awareness of that.
And again, within education, we often think about the learning outcomes, just focusing on the participant.
We need to focus on the outcomes for the people that we ultimately are working with and serving and so impact.
is key.
And the third thing is really emphasizing that there has to be building blocks.
You've got to attend to the building blocks if you want to transform the system.
And so that work is not quite published yet, but it ties in with the analysis I mentioned of the 46 projects over 12 years to illustrate what the impacts need to be for system transformation, what the impacts are for workforce transformation, and how the two link together, of which having systems leaders is key, having effective workplace cultures at every level is key, having the facilitators in the workplace who can enable an integrated approach is key.
So if you haven't got any of those.
it's really difficult to achieve sustainable change.
So this, this focus on impact is, really important and also links in, of course, to valuing and celebrating the achievements of our teams and our professionals and focusing on the brilliant things that they are doing, of which they still are today, even in these difficult times, and really cherishing that.
So I know I take from.
My experience of the Nursing Development Unit, when we established that as a Kingsland Nursing Development Unit, the recruitment and retention of staff was dreadful.
We couldn't recruit and retain staff.
So we started off with a long journey of doing values clarification with everyone to clarify our purpose.
And so it took 16 months to do that with all 75 staff because they were on night duty, day duty in different ships and so on.
Now of course I can do that in two hours in a workshop, but then it took 16 months.
But what we found once we co created that, we changed the way that we worked as nurses.
We organized our care differently so that we could provide the continuity.
We moved from total patient care whereby you turn up on duty and you're allocated a patient, could be any patient, you look after them for the whole of that shift.
to, primary nursing, whereby you have teams of people looking after the same patients to provide the continuity.
And then over a period of the three years, we just have people queuing up wanting to come and work with us and work with those families because we did market them.
We ran a conference every year to celebrate the achievements.
and, we did a lot of publications and we grew and nurtured our staff, because there was not only work.
staff members, a member of the primary nursing team, but they also were a member of the inter team projects, which looked at our research, our learning and development culture, looked at how we celebrated and shared these things.
So at the end of the three years, even though, the staff changed over the subsequent 10 years, the senior leaders used the same processes and they were able to show that even every year they got a quality mark.
Quality from the NHS because of that.
I didn't research that formally, but I knew that happened.
and again, I've had other examples of where the recruitment patterns change because you get the culture right, you get the quality right, you're open to feedback.
So, We knew of our colleagues at the Royal Brompton Hospital.
There was a patient there who every time he was discharged from the patient, from the hospital, he'd write a report to the chief executive saying what could be better.
And we thought, oh, that's brilliant.
That's just the sort of person we need.
So we got him on our steering group to give us feedback about the care that we're providing.
So starting off that dialogue, wishing to learn from other people's experiences.
So I know that's replicated in many situations where you get those building blocks right.
So that's why I'm so passionate about it, really.
Thank you, Kim.
And I think those things that you've mentioned, the fact that you've brought that succinctly down to three things that we need to have makes it much easier to have that clear messaging because I think that messaging is still needed.
As you know, I was working as an advanced practice lead across Kent and Medway, but slowly those roles aren't are continuing.
So in some areas they're continuing, but not as much as they need to be.
But actually to embed this into the system, this is a potential for the transformation.
And I wonder if there's still more to be done for people to actually understand that if we can embed this, this is my thoughts, if we can embed this and actually the transformation that we need to happen in health and social care will follow on and will happen.
So that's not to say that there aren't places where it's happening already, but at scale.
across the UK, if you like, for it to happen, we need to really embed these cultures and these core principles that you've, talked about and, been a massive part of developing really, Kim.
Yes, I quite agree.
Yeah, so I would distill them down into four areas, really.
And I think the first thing is about having clarity of purpose, you have to co create with.
Stakeholders with those providing care and experiencing care set of values that can guide our everyday work.
There needs to be both collective and systems leaders.
We can't do this as individuals.
We can only do that by working collectively.
The role of the system leader is the credibility is to dismantle those silos.
And those boundaries and enable people to work together for shared purpose enable the best evidence to be implemented into a look at the contextual barriers that may be working against them.
And then thirdly, to take a facilitation approach to using the workplace itself, we don't need to send people off to expensive courses and programs.
We can help them learn.
In the workplace, if they've got skilled facilitators who take an integrated approach to learning, development, improvement, knowledge translation, knowledge mobilization, inquiry as embedded research and innovation.
And then lastly, that we value professional expertise as complementing each other and the additional expertise that is required to become an effective clinical or systems leader, professional systems leader.
To ensure we're using our resources effectively, we're doing, providing the best care, we're providing the best environment and cultures for our staff,, and as embedded researchers, we are evaluating what matters to people and we're working to them, implementing it, reviewing it with them.
So, in a nutshell, I would say those four things.
Of course, there's a lot of other points that underpin each of those four, but if you wanted to focus on them, on key change principles, for me that would be what would guide my practice in helping others to achieve these things.
And I haven't said much about the values except from what I started at the beginning, so the values for me is about being person centered, person and people centered, always enabling a safe environment, holistic safety that is.
Always trying to use the best evidence to inform our care and blending that with what matters to people and what we know about context.
And,, Going on our complimentary professional expertise, recognizing again that there is, there are some common capabilities that we need to address.
For example, prescribing, why wouldn't we weigh up the potential of our whole workforce to prescribe in a safe effective way.
That's an example then whilst respecting that we also bring different expertise that complements our profession and we need to work together and wrap those capabilities around the patient's journey, which is what we try to do in the University of East Anglia around their eye care, the eye care developments across East Anglia using the Royal College of Ophthalmologists.
learning modules, which we'll call, but also focusing on the micro level requirements and the system level requirements in terms of care, what the capabilities needed to be and gain what the building blocks will require working with everybody.
Thank you.
So Kim, you've given quite a few key points here, but I'm just aware of time and, I could carry on asking you questions.
But what I'm going to come to you, you might have already touched on them, I think.
But what would be your key messages for people that might be listening today? What do you think needs to happen? Or is there anything that you particularly want people to take away from today? Well, as individuals, I think it's important that you have support and challenge.
So,, get a critical companion, get somebody who's going to be able to help you together and that you work together to co inquire, co innovate, co learn together.
It's, you can't do any of this on your own unless you've got somebody to work with.
And particularly at systems level, you're looking at peer learning, peer inquiry, so you're working with other stakeholders to achieve that.
secondly, look at where there are like minded support networks, of which there are ones that exist, that you can experience and support yourself.
I think those are the important things.
And then thirdly, begin to chip away at developing that skill set of expertise that's required.
It won't happen overnight, but look at opportunities that will allow you to do that.
Opportunities might be just working with somebody else, or working in a shadowing context to learn what is.
Potential and to share your own expertise with them.
So I think at that level, probably those would be the priorities.
Okay, thank you.
And at systems level, I would just hope that people recognize that there needs to be systems leaders for a care group, and that person has the credibility and respected.
Thank you..
So thank you so much, Kim.
It's been really insightful talking with you.
And thank you so much for joining me.
It's a pleasure.
Pleasure.
Thank you for asking me.
Thank you.
Bye.
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