Care Design 2016

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#5 The network as a key organising principle

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Our fifth proposed redesign principle is all about the network as a key organising principle e.g.

  • Shared approaches to patient management
  • Staff working across boundaries
  • Standardised workflow / data at interfaces
  • Tiered services based on need and risk and easy transfer
  • Cross system accountability, governance and decision-making (“beyond winners and losers”)
  • Knowledge sharing and quality improvement across the network
  • Focus on relationships more than structures
  • Back-up with technology
  • Decentralise where possible, centralise where necessary


This is what we think, but how about you?

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  1. Hugh MacLeod
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  2. Elizabeth Bradbury
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Lots of good ideas in the bullets. The addition that I suggest is timing. Many situations that patients find themselves in require the timely assembly of a team or of coherent information flow and decisions for effectiveness. Flexible relationships and agile structures should be built into the design to accomplish this. Timely dis assembly when the need is met or can now be met in a less costly way is the converse.

Thomas Nolan
by Thomas Nolan
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Thomas Nolan

I agree with the principle that working as an organised or orchestrated network gives a model flexibility and strength. This works on two levels: - the network as a service delivery model (as per eg.'s identified) - the network as a knowledge sharing and creativity vehicle (needs reflecting in the narrative here) The network needs to be anchored to the agreed shared purpose by having clear governance and arrangements for each party to hold the others to account.

Wendy Lane
by Wendy Lane
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Wendy Lane

A smooth and integrtated Care Design 2016 is not the product of a series of isolated actions – but from orchestrating the right combination of interactions. However, “alignment” is not a concept that is particularly well understood in healthcare. Rather than aligning the components of culture, skills, structure and strategy – the actual requirements for alignment – we tend to focus almost exclusively on the component of “structure.” This is what Peter Senge referred to as a “mental...

Hugh MacLeod
by Hugh MacLeod
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Hugh MacLeod

A smooth and integrtated Care Design 2016 is not the product of a series of isolated actions – but from orchestrating the right combination of interactions. However, “alignment” is not a concept that is particularly well understood in healthcare. Rather than aligning the components of culture, skills, structure and strategy – the actual requirements for alignment – we tend to focus almost exclusively on the component of “structure.” This is what Peter Senge referred to as a “mental...

Hugh MacLeod
by Hugh MacLeod
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Hugh MacLeod

A smooth and integrtated Care Design 2016 is not the product of a series of isolated actions – but from orchestrating the right combination of interactions. However, “alignment” is not a concept that is particularly well understood in healthcare. Rather than aligning the components of culture, skills, structure and strategy – the actual requirements for alignment – we tend to focus almost exclusively on the component of “structure.” This is what Peter Senge referred to as a “mental...

Hugh MacLeod
by Hugh MacLeod
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Hugh MacLeod

A smooth and integrtated Care Design 2016 is not the product of a series of isolated actions – but from orchestrating the right combination of interactions. However, “alignment” is not a concept that is particularly well understood in healthcare. Rather than aligning the components of culture, skills, structure and strategy – the actual requirements for alignment – we tend to focus almost exclusively on the component of “structure.” This is what Peter Senge referred to as a “mental...

Hugh MacLeod
by Hugh MacLeod
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Hugh MacLeod

Networks are best facilitated rather than "administered". Trust and reciprocity are the twin pillars for sustaining any network.   Imagine the healthcare system to be a multi-storey building. We have stairs, halls, ladders and balconies. We call them networks, institutes, agencies, foundations, et cetera. In addition, we have independent stairs and ladders called the delivery system. Too often, leaders are more concerned with the drama in the upper floors than the relationship flaws...

Hugh MacLeod
by Hugh MacLeod
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Hugh MacLeod

The way this is worded is all about the system and could end up in first order change not second order. To help with second order it might help to conceptually consider network more generally, and help us locate patients, public, service users,carers, the police, school's, Brownie's even, in the network. Health, and indeed ill-health flows, it's progressive. Similarly care flows across and between nodes and is progressive - or not! The central problem I think is that some people are...

Candy Perry
by Candy Perry
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Candy Perry

The process of design needs to be more network like. More conversations and less events or workshops. The key to network design is that clear questions are articulated and released into both a formal and informal network of professionals and public to work through.Initially questions released into the network could be quite wider, with them becoming quite specific later, as ideas and solutions begin to converge. There does need to be regular communication and attention to fostering and...

Steve Sewell
by Steve Sewell
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Steve Sewell

Its hard to argue with networks as an organising principle, but as it is presented now the principle is written from the professional's perspective rather than the network or web of care concept for service users which have a strong emphasis on friends, family, local community, employers etc. Perhaps they are two separate things and the service users web of care is more aligned with what they value and principle 1.

Elizabeth Bradbury
by Elizabeth Bradbury
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Elizabeth Bradbury
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