48 Health and care stewards – a new approach to collaborative leadership (2024)

Aims and objectives of the research project or activity Stewardship was born in Mid and South Essex in March 2021 and piloted in six key care areas to support the changing landscape to Integrated Care Systems. Stewardship has therefore become the vehicle for delivering the NHS Triple Aim locally. This process has involved building a stewardship community, providing education and support to review current service design and identifying and implementing opportunities to improve experience and efficiency for patients and staff.

We initially set ourselves seven objectives for the programme to deliver, these include:

1. To aid understanding of current practice and value

2. To provide a platform for bringing people and expertise together

3. To prioritise choices regarding deployment of resources

4. To facilitate flexing of resources

5. To benchmark against other places

6. To know if we’ve made a difference and enable accountability for results

7. To create the conditions for a culture of stewardship to flourish

Method or approach ‘Stewards’ have been selected openly from a wide range of professional backgrounds and across the full gamut of organisations within the ICS. They have been given the time (a session a week) to step outside of their ‘day-job’, and the expertise (through a value-based healthcare leadership programme) to think, behave and deliver differently. They have been given the responsibility for the resource within their care areas; currently this responsibility is in ‘shadow’ form but our hope is that in the future this becomes real.

Over 100 stewards have been trained across 12 different care areas, and these have had a dramatic impact on the operations, strategy and culture of the Mid and South Essex ICS.

The ICS has also developed in parallel to respond to the strategic direction of our stewardship groups, for instance through streamlined governance, integrated financial reporting and improved business intelligence and population health management tools.

Findings Since the programme started in 2021, stewards have developed over 20 different projects designed to support patients. Early results include notable improvements in models of care, performance and culture.

For example our Cancer Stewards have embedded new approaches to patient flow and care, including adoption of the ‘day-zero patient tracking list’, with dramatic improvements to the number of people on a cancer pathway waiting 62 days or more for a diagnosis. Professor Tim Briggs, NHSE National Director for Clinical Improvement and Elective Recovery said: ‘You’re lucky in Mid and South Essex to have Cancer Stewards… to lead the work and challenge the system’.

Our Ageing Well Stewards recently won an HSJ Award for Data-driven Transformation for their work on frailty. They led training for hundreds of staff across MSE organisations in using a frailty, end-of-life and dementia assessment tool, with all assessments then uploaded to a new electronic frailty care coordination system, available to staff across organisations to support collaborative, integrated care.

Overall, Stewardship has been embraced by partners across our system, not only because of the results they have been able to achieve for local people, but also because of the improved culture that the programme has engendered.

Key messages

• Stewards need to believe that they will be listened to, most are used to traditional, hierarchical power, but through distributed leadership they learn the power of their influence

• The enablers are critical. Integrated data flows, BI dashboards and system-level cost data is important, but whilst these takes time, there is no time to wait for these to become perfect

• Some people will feel challenged by it, but the stewards themselves are powerful advocates

• Time is the most important asset we have. Releasing coal face professionals to think differently and work collaboratively is crucial

• Results take time to emerge and some faith is required to persevere and avoid the temptation to divert resources to the next ‘urgent’ directive

• This has to become everyone’s business- as soon as it becomes the pet project of one organisation (e.g., the ICB) it loses its power and appeal

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