A real-life example is a powerful way to explain a way of working. Anand Iyer (Programme Manager, Northern Care Alliance) and Barney Schofield, (Director – Planning and Delivery, Northern Care Alliance) with colleagues explain how they successfully worked with complexity by combining programme management with system convening. 

They share their learning and reflections in this blog and in their video here and in the short version here. These feature in session 5 of The School for Change Agents (which is an online learning community on Futurelearn that's free to join!). A key message I take from watching the video is the fundamental importance of having shared values and a clear and agreed goal within the team.

I’ll pass over to Anand and Barney to explain the journey…..

"Rapid Diagnostic Centre (RDC) is a transformative programme based around a set of principles developed by NHS England to facilitate earlier and faster diagnosis of cancer. At the heart of this transformation is improving patient experience as they progress through their diagnostic journey from referral to treatment or discharge.

"Northern Care Alliance (NCA), in partnership with Greater Manchester Cancer Alliance, was the first to go live with establishing RDC in the Greater Manchester (GM) region in June 2020. When we reflect back on this achievement as a team, the journey from initial inception to opening our doors to the first RDC patient in the midst of the initial COVID-19 pandemic wave took an enormous amount of perseverance, persuasion, planning and a tinge of calculated brinkmanship. We didn't know the approach we took at the time can be recognised as ‘System Convening’, until we attended an NHS Beneficial Changes Network workshop presented by Diane. It was a moment of realisation!

"Although we had access to the national RDC specification and guidelines, establishing a RDC locally in the NCA was far from a ‘recipe-book’ approach considering the complexity associated with layers of decision-making (national, regional and local), group model of working with four hospital sites, the scale of GM geography, multiple digital systems, multi-stakeholder engagement and to say the least – the COVID19 pandemic grappling the local system at the time.

So what made it all possible…?

"Given the scale and complexity associated with this transformative change programme, an early decision was to form a core programme team to oversee the development and implementation. The team worked with a clear vision and applied programme management principles to establish appropriate governance, planning and risk management. 

"However, the crucial key to success was blending this programme management approach with that of ‘system convening’. This included active and extensive stakeholder engagement to ensure –

  • a shared sense of RDC vision and goal is developed to reinforce ‘future perfect thinking’.
  • the value-proposition of the RDC model is clearly articulated to stakeholders including demonstrating direct value-gain and benefits to patients
  • good buy-in from primary and secondary care colleagues to facilitate adoption and spread of the RDC vision
  • building connections beyond organisational boundaries to ensure NCA plans were aligned regionally (GM Cancer Alliance) and nationally (NHS England)
  • conflicting stakeholder priorities are identified early and managed

"We believe another key ingredient to the success of this programme could be attributed to the collaborative, distributive and system leadership approach taken. This leadership approach was particularly important given the emergent nature of the programme and uncertainty associated with some aspects of its delivery. A more hierarchical and micro-managed approach to leadership would have seen the programme fail the first day. The approach also instilled a great sense of trust which not only enabled the programme team to work well with each other but also effectively across the organisational boundaries.

The ambiguous nature of this complex programme meant the team had to continually adapt to rapidly evolving scenarios in an ever-changing system landscape that required a degree of innate flexibility. Furthermore, a critical success factor was the ability of the team to expertly use the internal and external network connections to navigate the way through a fog of uncertainty – a must have when implementing a system-wide change we feel.

Fast forward to present day…

"The RDC clinical team is well-embedded within the NCA system and continues providing outstanding clinical service to patients referred with vague symptoms suspected of cancer. The team has effectively delivered its service to more than 900 patients to date, with a cancer conversion rate of 6%, and average time from referral to first diagnostic test of six days.

"The next phase of our programme will focus on spreading this innovative model of care to wider cancer groups and other elective pathways, and to deliver our grand ambition to provide diagnosis outside of the hospital setting, in Community Diagnostic Hubs. As we embark on this complex and challenging journey, with humility, we remain confident that programme management combined with a system convening approach will hold us in good stead to deliver our ambition.

The team are:

Anand Iyer, Programme Manager, Northern Care Alliance

Barney Schofield, Director – Planning and Delivery, Northern Care Alliance

Rebecca Duggan, Lead Rapid Diagnostic Centre Nurse, Northern Care Alliance

Sue Sykes, Rapid Diagnostic Centre Programme Lead, Greater Manchester Cancer

More information on system convening and the 7 spread and adoption principles is available on the NHS Horizons website.

If you're interested in how to enable the spread and adoption of innovations in healthcare, there are previous blogs and further blogs to follow. Please do subscribe to this blog and follow @DianeKetley @HorizonsNHS, #nhsspread.