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Personalising care: Insights from the frontline

People Powered Results recently worked in Hertfordshire to run a 100 day challenge as part of the Integrated Personal Commissioning programme, which focuses on personalising care for people. We worked with leadership to reflect on the challenges of personalising care and translated these into four questions based around: care and support conversations, personal health budgets, coordinating delivery better, and empowering people to support their health and wellbeing.

To respond to these four questions, three multidisciplinary teams were pulled together and given 100 days to test a range of ideas in personalising care in their local areas. The teams involved frontline practitioners from the health, social care and voluntary sectors. After 100 days, I spoke with three team members to understand what it takes to shift into a personalised way of working from a frontline perspective. Here are their insights:

What’s been the most powerful moment for you in personalising care for people?

  • Speaking with people: speaking with one of my patients and getting her reflections on care and support. I always thought the care I gave was personalised but this conversation added a whole new depth. It made a lot of sense - how she is now. Another lady was desperate to talk about her End of Life plan - this was out of my comfort zone.
  • Connecting with the community: we did a marketplace event and lots of people came! We were all theorising for weeks. Some came to have a conversation with us - they were glad somebody had asked them about their care and support.

What have been the most significant shifts you’ve made?

  • Understanding multiple perspectives: seeing things from each other’s perspective, including the GP, has been amazing. It’s shifted how the team thinks about things now – it’s made me better in my job.
  • Building relationships and understanding roles: we have a better understanding of each other’s role. Knowledge is shared equally and we’re challenging each other’s assumptions and roles - we’re growing our comfort levels in doing this with each other.
  • Working with carers and people: it brings you back to the centre. You can get blinkered in professional mode. They see things simpler - they’re blunt and clear. We realised that the information we want as organisations isn’t particularly relevant to people.

What does it take to shift into this way of working?

  • Having people’s voice in the room: understanding people’s journey without having their voice in the room means you have to imagine their voice. This made us recognise the assumptions we hold - it’s really important to have people’s voice in the room.
  • Understanding the challenge: learning about people’s experiences prompted us to have a conversation on how we integrate and work better. Also, having our leaders share the challenge through some questions helped us to understand and engage with this.

Which rules did you feel most uncomfortable breaking or challenging?

  • Making the time for it: there’s a guilt that comes with doing things we should be doing in personalising care - and balancing this against our caseloads. Then, there is the disapproval from other colleagues for example when they say things like “we need to rein her in a little.”
  • Shifting away from process and focusing on what we are good at: having conversations with people made me think I’m actually doing social work, rather than ticking a box. You’re doing what you’re meant to be doing!
  • Being outside my comfort zone: the system is not encouraging curiosity and learning due to limited capacity and the target culture. But doing things that are outside your comfort zone - it felt good.
  • Involving others and having fun: it was really fun! I didn’t realise how helpful other people can be. Telling people what we’re doing and then realising they’re up for it was unexpected.
  • Sharing our insights with leadership: when our leaders listen to us, it’s a turning point on the way in which we work with them. Having this conversation helps us to understand multiple perspectives and what’s driving some of the behaviours we see in the system.

What advice would you give to your younger self?

  • We are responsible for the change in the system: we can make change happen. Don’t be afraid of it - embrace it!
  • Stay connected to your purpose: empowering people in their health and wellbeing. Keep the passion, seize opportunities that lead to change and learn from them. You see those moments where you do manage to change things.

Invitation to comment: What strikes you the most from these insights? Do these insights resonate with you? What have been your experiences in making shifts happen when personalising care for people? What has been your learning? Leave a comment below

Author

Rajwinder Cheema

Rajwinder Cheema

Rajwinder Cheema

Programme Manager, People Power Results

Raj joined Nesta in April 2016 as a Programme Manager for the People Powered Results team in our Health Lab.

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