Reputation as a system concern

In the midst of substantial health and care reform with so much to think about, Integrated Care Systems and the organisations that make them up can’t lose sight of the importance of governing reputation.

GGI has recently stressed the importance of boards thinking more about their reputation. It is a core asset of any NHS organisation that should be measured and governed accordingly although this is not always done in a comprehensive way. Yet like some many things in the NHS, this changes with system-working.

GGI has already outlined the wider societal context that renders governance of reputation important and underlined how the NHS could best understand and apply reputation at board level. Building on these ideas, this bulletin outlines how the move towards integrated care outlined in the February 2021 health and social care white paper, and more recently in the health and care bill, not only heightens the need for organisations to have a strong reputation, but also introduces the requirement for systems themselves to consider their own reputation. To make a success of these changes, organisations will have to be outward looking, engaging and understanding the perspectives partners, patients and staff. And a strong reputation is central to this.

Trust in collaboration

Until recently the prevailing environment in the NHS was one of competition. While there were some localised instances of collaboration there was largely a climate in which Trusts’ perceptions of one another was not their primary concern. This has gradually changed in recent years, with more initiatives to encourage collaboration. The integrated care legislation is outlined in the health and care bill that concretises this change.

This ‘duty to collaborate’ forms the bedrock of system-working: aim to improve and join up services, reduce health inequalities, better coordinate the workforce and reduce duplication. To do this, NHS organisations will have to work with each other as well as local representatives from other sectors in areas such as service delivery, workforce integration and finances.

In the next year, systems will have to concretise partnership working. Making such enormous changes in just over a year, when equivalent restructuring has previously taken much longer, will pose a range of challenges and potentially test the strength of relationships inside and outside the NHS. Collaboration in areas like workforce, finances and service delivery will need full commitment from all involved. As outlined in GGI’s guide to provider collaboratives, success will require strong foundations of trust among participants to overcome previous competitive mindsets and ensure integration is not undermined if anything goes wrong. Indeed, as many GGI events have discussed, the successful ad hoc collaboration during the pandemic was built on strong trust between organisations.

A good system partner

Individual organisations will need to take action to build these relationships. To build these relationships, they will need to understand how they are viewed by other organisations and their perceived strengths, weaknesses and role in the system. Some organisations may already have strong relationships within NHS, but many will have to work hard to bring local authorities and other sectors on board.

This will be crucial, as the perception of a being a ‘good system partner’ will enable many of the benefits of system working to manifest. This is where reputation is important, particularly when understood as the expectations for future behaviour. Being seen as a predictable, dependable actor could help negotiate potentially difficult service change with local authorities, help drive commitment to provider collaboratives, ensure employees can be trusted to different organisations when delivering a unified workforce and promote requests and delivery of mutual aid during a crisis.

If organisations are aware of their reputation with others, by understanding their perceived strengths and weaknesses they will know what attributes or behaviours they will need to demonstrate to build these crucial ties. Simultaneously, NHS organisations will be able to see what the impact of certain engagement is on the way they are viewed by others, particularly if they have not previously needed to understand how they are viewed by their neighbours.

System Reputation

As systems mature and bonds strengthen, individual organisations may look less frequently at their reputation with partners and begin to consider the reputation of the whole system. This will be fundamental to many aspects and aims of integrated care. Most notably, reputation among the public will be essential to understand how best to deliver a unified population health message. Here, awareness of reputation may elucidate why communicating the public’s new role in population health is less effective in different communities, and how best to change this through coherent engagement across the whole system.

This approach may also be helpful among citizens who regard public healthcare as being delivered by ‘the NHS’ as a singular entity, without making distinctions between organisations. Additionally, if systems are to create a single workforce in their area, cultivating a good reputation among staff in other parts of the country will be key to attracting the best talent. Similarly, reputation within central government, region or other local systems will need attention if partnerships are seeking additional resources for pilot schemes or looking to influence higher levels of administration.

Strong relationships will be key as the NHS enters its latest phase of restructuring. At system and institutional level, from public to local authority engagement, understanding, guarding and shaping reputation can form the basis of these relationships and future success.

Illuminations

• As systems mature and bonds strengthen, individual organisations will need to consider both their own reputation and that of the whole system

• System and provider reputation among the public will be crucial to fostering public trust and effective community engagement, both of which will have a bearing on the success of the ICS delivering on its aims

• Cultivating a good system reputation will be essential to attracting the best talent

If you have any questions or comments about this briefing, please call us on 07732 681120 or email advice@good-governance.org.uk.