The Forum

Stuck on the politics of reconfiguration? See how this Welsh system navigated away from gridlock.

by Rebecca Soistmann and Paul Trigonoplos

When redesigning health systems, it's easy for stakeholders to get caught up in arguments about where services might move in the future, creating a contentious 'you-win-I-lose' mentality. Hywel Dda University Health Board in Wales ran into this problem when reconfiguring the system for its 384,000 person population.

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During Hywel Dda's first stakeholder workshop to design future system layout options, conversations quickly became a territorial back and forth about winning and losing services. The transformation team needed a way to refocus everyone on why they were reconfiguring in the first place: to improve care for patients.

Enter the Jones Family

To do this, Hywel Dda created the Jones Family—a seven-person, fictitious set of avatars that represents those with the most prevalent health and social care needs in Hywel Dda's catchment area.

Hywel Dda assigned each family member a full medical and social background. This allows stakeholders involved in the design process to recognise themselves, a family member, or a friend in the Jones Family.

Mari, for example, is the family's 79-year-old great grandmother who recently developed mild dementia and has become increasingly frail. She also loves to bake cakes for her family. Lianne, Mari's 19-year-old granddaughter, has a three-year-old son and is pregnant with her second child. She is in school full-time to become a child care support worker and struggles to give up smoking during her pregnancy.

Similar to the Esther Model in Sweden, these avatars anchor system changes on actual patient journeys. Once Hywel Dda introduced the Jones Family, there was a tangible shift in the system design workshops. Stakeholders—who previously argued over which hospitals might gain or lose certain services—now focused on pressure testing each system layout option with the family top-of-mind. "Is this system good enough for the Jones Family?" became its mantra.

Running the Jones Family through different scenarios

Hywel Dda also used the family to test its new system layouts through scenario planning. In one example, Mari falls out of bed one night and can't get on her feet. Stakeholders mapped this scenario onto the system design proposals to get a clearer picture of how and where Mari would receive her acute, post-acute, and home care in each scenario.

As Hywel Dda narrowed in on just a few system layout options, it began seeking feedback from the public. At this stage, Hywel Dda  communicated each option through the family. It explained how each member would be cared for differently under each proposal for  the new system. This allowed the community to not only see the new layouts, but also understand at the patient level what care pathways could look like in the future.

Advisory Board's take: Considerations for creating your own "Jones Family"

While a seven-person family isn't the right answer for every system change, using avatars to focus stakeholders and foster buy-in is a proven success tactic. When creating your own set of avatars, we've identified three 'must-haves'—no matter how big or small your system changes are.

Your system avatar(s) must:

  1. Accurately represent your population's medical and behavioural needs. Hywel Dda gathered clinical and behavioural needs data from its population before creating each family member. This ensured that each family member actually represented a patient who could walk into a Hywel Dda facility at any time.

  2. Align with your population's culture. In addition to representing its population's health and behavioural trends, each Jones Family member received a personal backstory that brought them to life. Rhys enjoys watching the Cardiff City football matches with his mates, and Mari is the president of her local chapter of Daughters of the Dawn, a non-political organisation for women in Wales. Incorporating personal details into your avatars makes them even more relatable to your stakeholders.

  3. Scale to the breadth of system change. Hywel Dda redesigned its entire health and social care system, but perhaps you're only looking to change one or two pathways. The number of avatars you create should be proportional to the breadth of your system change; as more services are affected, more avatars are necessary to depict and test those changes.

How to achieve true systemness

Many health systems are only scratching the surface of the potential their scale offers. But today’s market leaders are leveraging purposeful integration and cohesive effort—what we call ‘systemness’—to streamline operations, deliver more reliable and coordinated care, rationalise fixed costs, and even transform entire delivery models.

Download our blogazine for expert perspectives on how your organisation can achieve 'systemness'.

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