'Designing for Integration': Kentish Town Health Centre

Sparknow worked with Kentish Town Health Centre to help them produce a brief for architects in planning a new integrated health centre. The brief formed part of an architectural competition, and the winning design reflected the work that Sparknow did with a diverse group of front-line staff. Building in part on the integration work carried out in the design brief, and on an independent cultural audit which reviewed work practices in the existing building, Sparknow then worked with the Health Centre to further improve integrated working and internal communications in the existing building. As a direct result there’s now a real and sustained improvement in patient care.

NOTE: All client quotes in italics

Situation

In April 2002, the project team of Kentish Town Health Centre announced a competition inviting architects to submit innovative designs for a new integrated primary care centre in Camden, London. They wanted to use this opportunity to improve the way the various health and social care agencies would work together. They were keen to offer a way for the people themselves to design their own work place.

When we met, they told us that they wanted a session in which they would create the brief to inform the designs submitted by architects to the competition. We and the sponsor both agreed that the most important thing was to avoid getting dragged into policy definitions of integrated working, and instead to concentrate on uncovering and sharing the personal experiences of frontline staff. In this way we could make sure that the design brief was rooted in the principles of integrated working which emerged from real experience and individual ideas about how to provide the best possible service to patients.

Intervention

Reflecting Sparknow’s principles, and the project team’s wishes, participants were drawn from a cross-section of care professionals and administrative staff to a one-day event which would allow everyone to have a voice.

To make sure the design brief would be rooted in practitioners’ experience, the day began before the day itself, with participants tasked with collecting images for an exhibit which would help explore patterns and provoke discussions on the day itself. The formal proceedings started with a story telling and Appreciative Inquiry exercise to identify real life examples of integrated working and the spaces in which those events took place. This instigated a very positive atmosphere and helped to break down the organisational barriers that would have prevented the day from being participative for all. It also allowed for individuals to be heard and listened to very early on, and to see themselves as part of a bigger shared picture.

“It was very well organised and we actually got talking to people you don’t normally talk to. Everybody was made to feel that what they had to say was equally important. It was quite exciting”

Outside speakers were invited to talk on a broader scale about developments in healthcare architecture and the preliminary findings of the cultural audit on which we were later to build. Having created the right atmosphere and relationships the workshop moved into actively creating a design using all the material generated so far - story, presentation, postcards, pictures taken by attendees using disposable cameras, and drawing exercises. There was great energy in the room and all members participated in the design exercise with great gusto. Four designs were created and presented back to the group with much passion, laughter and enjoyment – from this a brief for a truly grounded and innovative centre design was created.

“Interestingly enough, by the end of the day it was obvious that everybody wanted the same thing really, they… had different ways of coming at it but there were lots of similarities between groups.”

Impact

Looking at the architects’ pitches, the value and influence of the contributions made that day were clearly evident. As we all hoped, the day helped encourage a culture of integration by allowing space for new relationships and networks to flourish.

To sustain the benefits and move forward from all of this good work, we were then invited to facilitate the formation of a Community of Practice (the ‘Link’ group). As a cohesive team, they would champion the change process, promote new ways of working and help build and strengthen internal networks which had to survive being moved out and separated while the new building was under construction. Being truly representative, the Link group comprised people from all levels and functions. We worked with them to prioritise their needs and ambitions, thinking practically about steps they could take towards developing a truly integrated service.

The first Link group event was a workshop on improving communications across the practice. Facilitated by Sparknow, and using the principles of Appreciative Inquiry and story telling, this really got people talking.

“Everybody was bubbling about it for days afterwards. It made a real difference. Before it was very much “them,”, the community services and social workers, and “us”, the GP practice. Since that half -day communication is much better. Doctors are going into social workers’ offices or having conversations in corridors… and with more conversation happening, the district nurses find the doctors… more accessible.”

Ensuring that multidisciplinary groups of health professionals shared the same coffee time was one of the simple changes that came out of Sparknow’s work.

“Recently, there was a case of a lady with a ulcer and the district nurse spoke to the GP at coffee time instead of having to wait to see the doctor at the end of surgery. The woman was admitted to hospital within the space of an hour.”

“This patient phoned up and said, ‘what a wonderful service, I could not believe that somebody turned up on my doorstep three days after I had spoken to you.’ In the past, you might have had to wait weeks for this to be sorted out”

Presently Sparknow and the Link group are considering the best way to create a guide to the Centre’s services and people.