Friday, February 04, 2011

First Principles - Grounding E&D Strategy in Evidence

This is the fourth in an ongoing series of posts explaining the approach which our team at NHS North West has taken to driving up equality outcomes in one NHS region... and the spinoffs of national best practice which that work has generated.

In the beginning...

NHS North West, the Strategic Health Authority for NW England, came into being in 2007. The new body replaced a plethora of smaller organisations and, as is common when change like this takes place, there was a delay before it managed to appoint an Associate Director for Equality, Diversity and Human Rights, Shahnaz Ali.

Shahnaz took up her post in January 2008. Shortly afterwards I began assisting her as a consultant. Eventually we extended that role into being her programme manager.

The delay in appointing a strategic lead in this area is a salutory lesson as the NHS prepares to undergo an even bigger upheaval. As I explained in the previous article, the insights which E&D professionals bring to the health economy go much deeper than assuring legal compliance.

The competency of E&D professionals is a subject I'll cover in the future -- we are in the process of defining just what's required in an effective strategist, influencer and change manager right now. As I illustrated in the previous piece, however, there's a hugely important business case to be communicated to senior managers who generally think they're too busy to listen.

First principles

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We talk increasingly these days about evidence based approaches. (I'm surprised it should ever be otherwise). So when my colleague Shahnaz Ali arrived at the SHA her first substantive piece of work was to undertake some fundamental research.

A questionnaire-based survey was circulated to all 63 NHS organisations in the North West (24 PCTs and 39 provider trusts). It was a long and detailed survey, asking about senior management and board leadership on E&D; published equality schemes; coverage of protected groups; performance management; leadership and staff training / development; evidence gathering; and impact assessment / mitigation.

Amazingly 83% of organisations returned completed surveys -- including 7 of the region's 11 Foundation Trusts, who are not normally accountable in this way to SHAs. One of my first consultancy assignments was to catalogue and analyse the data and assist Shahnaz to synthesise some top level conclusions.

What the evidence showed

The messages coming out of such comprehensive data were very clear. We found that they fell naturally into three principal themes:

  1. Actions necessary to underpin the management structure, capacity, capability and leadership of Equality and Diversity across the NHS in the region. Having leadership in this area that's fit for purpose is fundamental.
  2. Steps required to improve equality impact assessment, transform evidence to action and manage risks. The way organisations analyse evidence underpins decision making and effective action.
  3. Tools required to obtain evidence in all its' forms, to support analysis and decision-making

Developing the tools for the job

We then broke each of these themed areas down into key pieces of work which have been the backbone of our programme ever since. These include the development of several key tools -- the need for which was clearly indicated by our research:

  • A project, co-funded by the Department of Health to develop a national competency framework for E&D leadership in the NHS. Other leadership roles in the NHS all have clearly defined competency requirements, person specifications, job descriptions and developmental / career pathways. You wouldn't appoint a finance manager without any of these things, for instance. Yet none of this has existed formally until now in the NHS. Many staff leading this agenda will find their line manager and organisation don't understand what's involved, or even how to grade the post and appoint at a sufficient seniority for people to be effective. No wonder Equality and Diversity can be a career cul-de-sac for some.
  • An authoritative source of quantitative and qualitative evidence and background material for E&D leads and managers to be able to make effective impact assessment and policy decisions. Many respondents claimed that, in some areas, the information was hard to find. They talked of groups being 'hard to reach' and said they couldn't find evidence in the usual clinical databases. To address this we developed a brand new online library and portal to other information sources, the Health Equality Library Portal (HELP). Anyone can access this, at http://www.help.northwest.nhs.uk.
  • A completely new approach to engaging with expert equality stakeholders from third sector organisations, in a strategic and sustainable fashion. Put bluntly, many public sector attempts at consultation with equality stakeholders are not thought through and can be hamfisted. Stakeholders report consultation fatigue and are unable to field policy specialists in the numbers required to really engage with piecemeal approaches. Consultations themselves are not structured to get the best out of specialists and events may not draw people representative of all the equality strands and who are conversant with all the issues in depth and breadth. And specialists don't have sufficient experience of the organisations they're advising to be able to frame requirements into things that the organisation can realistically do. The Health Equality Stakeholder Engagement (HESE) Approach was designed to identify and address all of these issues in a sustainable way with the best experts we could find in our region. We employed the HESE approach and we also published a full guide on how to do it elsewhere. You can download An Equal Partnership here.
  • Finally, of course, we developed the Equality Performance Improvement Toolkit (EPIT) as an objective and consistent means of measuring the progress organisations were making towards equality of outcomes with the aid of all these tools and the more general programme of leadership which we've delivered.

I'll describe the design rationale for some of these tools in later blogs. In the meantime, the links above will help you access them. Other components have also been added over time, as the strategy matured. These include, for instance, our E&D communications strategy, which is central to giving effective leadership to the system as we lead them on this journey. The communications strategy includes a regular series of quarterly development meetings, creating resources (such as the BME and LGBT history timelines) and our monthly newsletter.

A complete 'Eco-system' approach

We describe this progressive, layered, approach to equality and diversity strategy as our 'Eco-system'. Put simply, it's our belief that good outcomes can only germinate, develop and thrive if all the surrounding environment is conducive.

The approach has involved three stages to date:

  • Collection of evidence, and synthesis of a strategy based on this
  • Development of tools and techniques indicated as required
  • Performance measurement and improvement

The arrival of the NHS White Paper and the Health Bill has also now necessitated a fourth stage:

  • Preserving equity and best practice through the transition to the new system

Why the Eco-system is important

The importance of the Eco-system approach shouldn't be underestimated. As I've indicated in previous posts there is a serious risk of people looking at a tool like EPIT or its' clone, the forthcoming Equality Delivery System (EDS) and mistaking the measurement device for the solution.

EPIT and the EDS provide means to measure where you are. But you'll only get there if you've taken these pre-requisite steps, know where the weaknesses lie, have the tools, and have the right kind of leadership to put them to use to drive effective change.

I'm not convinced that everyone understands that.

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