'LIFTing the Lid': Finsbury Health Centre

LIFT – the Local Investment Finance Trust - is a financial scheme instigated by the Government to enable the redevelopment of health facilities in the UK. Finsbury Health Centre was identified as one of the first phase developments. To support this work Islington Primary Care Trust wanted to identify how this opportunity could be maximised for both the centre staff and the patients it serves. This was then followed by three consecutive events to help kick start the change process.

NOTE: All client quotes in italics.

Situation

In 2002 Finsbury Health Centre, a Grade 1 listed building/health centre in EC1 comprising two GP Practices and a number of community services, including Podiatry, Physiotherapy, Community Dentistry and Speech and Language Therapy, was selected to be one of the LIFT first phase developments in Islington Primary Care Trust (PCT). Sparknow was invited by the Locality Director of Islington PCT to help them understand the challenges which surround a development of this nature and to support the staff in the move towards designing an integrated care centre.

Intervention

An initial investigation was carried out by Sparknow in the form of confidential interviews. The findings highlighted that a “silo” way of thinking existed between the various professional groups working in the centre. Importantly this was shown to be exacerbated by the physical layout of the building.

Reflecting on the investigation results, Sparknow and the team at FHC knew that their first challenge was to begin breaking down barriers between the groups. If they were to provide the best possible service to their patients, they knew they had to develop more effective relationships and a new way of working together.

“This was a building that was really struggling and wasn’t helping communication. People didn’t even know who else was in the building”

As a first step Sparknow arranged a study tour for the centre inhabitants, seeking to explore how the design of other physical spaces has helped to deliver new working practices. This involved a day trip in a mini bus to visit other sites which were exemplars of innovative design and integrated working. The real value in conducting study tours like this is that they help people see what’s possible. Taking people away from their familiar surroundings also helps create a buzz and an opportunity for people to get to know each other better.

The team were equipped with disposable cameras and notepads to collect observations about things they would like to see incorporated into the design of their own health centre.

“The flexibility came across not just in physical structures but also the integrated working was obvious”

“Probably the most important thing for me was looking at the health centre not as being ‘ours’ with the patients coming to our space, but instead the local community having a sense of pride and ownership and we come to work in their building"

“The sooner we lose our feeling of possession of space, the better”

"On the bus on the way back many conversations were going on between people who hadn’t met before. The journey itself had begun to create new ways of seeing – both in terms of how staff members perceived each other and how their new space might be configured."

The day was reckoned to be a huge success and having planted the seed the next step on the path was to build on this event and start to think in a more integrated fashion by holding a space workshop in December for the multi-disciplinary team. The objective was to give the inhabitants the opportunity to contribute to the design of their own space, building on shared experiences and ideas of how they might work more effectively together in future. The event looked to pick out the key qualities they felt were important for a modern integrated health centre and to start to actually design some of the common spaces such as the integrated reception and shared team spaces.

“All of us are getting involved in the project – we've made it ours”

“We feel we are becoming more integrated as we take things further”

"We're already starting to enjoy working together"

“When people present their ideas they feel very listened to."

In April 2003 Sparknow ran a second event, the purpose of which was to widen participation to include users from voluntary and social services. The participants developed patient pathways in an attempt to explore how both internal and external agencies - health, social and voluntary groups - should work together to solve complex patient needs. By putting the patient at the heart of the process this helped the group to improve the design of the space, understand what new roles should be created and how that would impact on new ways of working.

Impact

All the work done at FHC was summarised into a building brief by Sparknow in the summer of 2003. The brief provides an overview of the challenges they face along with some less functional, more aspirational illustrations – a collection of drawings, anecdotes, quotes – which reflected how they felt their new building could operate.

The brief was passed to the architects to directly inform their designs.Some time later Sparknow discussed this work with the new project manager from Islington PCT to find out what difference we made:

“It was very noticeable how much further ahead this centre is in thinking about the effective use of their space and new ways of working within it as compared to the other Lift sites. This is supplemented by much more enthusiasm from the team about the proposed change.”

Our conversation also revealed that in hindsight, it was felt that Sparknow’s involvement could have been extended to ensure the more concrete needs and requirements for the space were passed on to the architects in the final brief.

The team has really moved from a position of lack of trust, poor communication and their old “silo” mentality to become a more cohesive unit who are ready to embrace change. Follow-up interviews with staff members at the centre testify to this difference:

“I really do think it has started to change the ethos of the health centre and the thinking of people in it – I’ve noticed an increased communication,….it has improved teamwork… and…..its made me more optimistic about the future…..a massive achievement”