Relationships, resilience, and collaboration help deepen integration during Covid-19, and for the long-term

As one of the largest NHS providers in the North West London sector and the wider London region, the staff across the Trust hold a valuable and wide-ranging set of professional and personal relationships outside our own organisation. But how well do we harness these relationships to gain insight into how we work together and learn how we could improve? This question was explored as part of the Trust’s learning & insights programme this summer, following the first wave of the pandemic.

In four conversations held over two weeks, colleagues from primary care, the voluntary sector, local authorities, commissioners and community health providers generously gave their time to share reflections with us. The findings summarised here represent only the tip of the iceberg. But the insights we gathered underline that strong relationships built on mutual trust are fundamental to problem solving and delivering high quality care. Never more so that during a crisis. 

Imperial has made strides in working differently with colleagues in General Practice in recent months. Hotlines were set up in April for GPs to access specialist advice on the management of patients with respiratory conditions, especially those with a suspected or confirmed case of Covid-19, and also for care of children. GPs reported feeling well supported by Imperial’s specialist teams, with barriers removed to enable a shared focus on the best patient care. Education sessions offered to GPs were felt to be very useful and received positive feedback, as were the video-based group clinics that allowed shared primary and secondary care to be delivered to patients in their own homes. Looking to the future, we need to reflect on the way our administrative systems are experienced by primary care teams and plan ways to communicate more effectively on what services are or aren’t available and how to access them.

Collaboration across local systems between health and care providers has been positively accelerated by the pandemic, with most interactions becoming virtual overnight. Our collective ability to work together in an agile way has been enhanced and changes progressed more quickly. What has become clearer than ever, is that where good relationships were already in place between teams in different organisations, service development happened more rapidly. And a “fail fast” mentality meant that colleagues were able to react generously and weather short-lived storms with greater resilience. How we react in these moments sets the (positive) tone for the future of partnership working. Never was this more evident than during April and May when the new hospital discharge hubs were set up, led by community health providers.  The benefits  included: a flat hierarchy and co-location of key staff, social care, community teams and Continuing Healthcare commissioners on our hospital sites; volume of emails was reduced; colleagues came to better understand each other’s pressures; and the ground was laid for quicker planning of many complex discharges. Working together through rapidly changing government guidelines, and including local care home managers in daily calls, enabled our partnership to support care homes through implementing PPE, patient cohorting and a range of other necessities to keep staff and residents safe.

Lisa Redfern, strategic director social care, H&F Council, has this to say about the benefits of close working relationships, “I particularly valued our ‘can do’ partnership. It was innovative, proactive, agile, and worked at speed. This was so important for our discharge planning and infection control work with care homes. Our relationships have become closer and more meaningful as a result. We are determined to use this a foundation for future integration work and pandemic planning.”

Donna Barry, interim head of service at the Tri-borough Hospital Social Work Service, added, “There was a huge amount of really positive close collaboration between our services during the pandemic: NHS, ASC and Community Health Partners, working hand in glove to support the setting up of the hubs and facilitating safe and prompt discharges of our residents. We all learnt a tremendous amount from each other during the pandemic, met new people and implemented new guidance very quickly, adapting our process and ways of working. We have taken the positive parts of the changes and built this into our new process and our ‘business as usual’. Our services have demonstrated extraordinary resilience and between us we will use this to develop more integrated ways of working to respond to future challenges.”

There are obvious links from the insights gathered from this set of conversations to the Trust’s work on cultural change, values, and behaviours. To become a mature learning organisation, we must look for ways to reward generosity of spirit and genuine curiosity and continue to be active bystanders in calling out unhelpful cynicism. As we look to the future, we must adopt the language of the Institute of Health Innovation and ask our external colleagues “what matters to you?”. Only when we truly understand and appreciate what keeps our partners up at night can we hope to work effectively with them to address our common goals. A clear theme running through the insights we gathered from our partners and colleagues was how a single, shared goal can galvanise teams to work together. Once Covid-19 is safely behind us, we must reflect on how we retain the common driver of best patient care to keep us bound together.