Public Health

Building a prevention approach to anything – part 1. A flat pack (with Allen keys) in 4 parts

We should take a preventive approach to xxxxxxxxxx.

A flat pack with Allen keys in 4 parts

This is the first in a set of 4 blogs on what becoming a preventive organisation looks less like. That was the original ask of the chief. It’s been a team effort.

Much of the hard work and credit to Dan Spicer, Rob Huntingdon, Hilary Coulson, Nicola Shearstone, Amy Claridge, Issy Howie and the many whom I’ve forgotten.

It has been a trauma to organise into some coherence. So I’ll just put it out there, see what people think.

It’s in 4 parts

Part One is the original ask and the broad story of what has happened to date.

1 What was the mission – We want to be more preventive. We are thinking this through a whole organization.

• The ask of the Chief Executive was “be a preventive organisation”

• It’s a tricky concept. There’s no single organisation framework or concept, no single idea. If there is a single idea it is that there isn’t a single idea. There are some broad principles.

• We all look at the world through a specific lens, there aren’t right and wrong answers.

• All across any city there’s  recognition that business plans for increasing numbers of services were referencing prevention as part of planning.  Its not just about services, it is about places, environments, cultures and capital.

• There is no lack of will within management teams. But – like “parity of esteem” in mental health – saying “we will be more preventive” is easy to say, and tricky to actually make progress.

2 Overarching approach and strategy

• We are trying to build a whole organisation approach. This is easy to say, tricky to execute. It is quite hard to change a culture. It is also quite hard to put a boundary around “prevention”.

• There probably wont be a single all encompassing plan. Certainly there won’t be a plan with highly granular detail. The plan we’ve tried to set out is organisational and high level – setting mission / key building blocks.

• Some of the necessary activity is quite invisible, some of it visible. On the invisible parts of course there will be frustration about “lack of progress”, “no tangible action”.

• Positively, there IS lots of good stuff happening, and it’s important to not forget this.  Scale and mainstream good stuff is important.

• We are taking an approach mindful of primary, secondary and tertiary prevention. Also of the need to address the big organizational chunks of service delivery, organizational processes or policy responsibilities.

• No individual or team, or single idea will make it happen. Needs focused effort across whole org, over a long period

• Strategic commissioning ask around this is setting the right environment for the best outcome to happen. Best outcome for the city and people, not the service

• Our aim is to de escalate the de escalatable, prevent the preventable, delay the delayable

• Its not all about people focused services. Place is important – planning, housing, roads, transport, leisure. We won’t sort out social care till we sort out the drivers of demand – poorly people. We won’t sort that by more or even better health and social care, need to look to upstream issues. The place is important.

• The challenge to the organisation is – “What is your story around prevention with the big chunks of service delivery, policy responsibility or organisational machinery.”

• We still have some work to do on the logic model & the narrative, to develop skills, tools, thinking

• We have directly addressed the must do v nice to do point and the urgency issue . We are clear this is urgent, it’s not nice but necessary in fact essential

3 Language. There may not be a single set of narrative. But some broad principles

• Different stakeholders have different worldviews and goals

• Sometimes these align, sometimes they don’t.

• Is the vision broadly the same, is it ok that the mechanisms of getting to the vision differs

• Some of the things we will know in advance, some we wont, some may change direction along the way. That may actually change the activities. Thus test and change cycle

• Different stakeholders have difft lenses and entry points. There ARE legitimate ways of achieving the same goals.

• Realised early on we are unlikely to find a single defining narrative and it was a concept that might look ok different in different worlds and service areas.

4 It’s more than a set of projects

Though in each individual space progress does depend on some ideas – that have to be pertinent to that area. Actionable propositions are needed (see below)

Our whole organisation approach includes

• Engaging outside of SCC

• Broaden prevention, key working & localities conversation with partners

• Engage with political leadership

• Ensure “prevention” is part of all our plans

• Embed the approach within a Workforce Strategy, the Customer Experience Programme

• Develop prevention toolkit for service use

• Package and brand this work for communicating to staff and beyond

• Develop data and intelligence systems to support work

• Test approaches with pilots – at service delivery and organizational level.

5 We are developing a toolbox

Overall approach Primary, secondary, tertiary

6 We have established some broad principles


Every Contact Counts

• People don’t operate in organisational boundaries

• People’s lives are complex: solutions must understand and harness this complexity to improve long term outcomes

• Reduction in work in isolation – multi-systemic change and input

• Holistic approach to tackling issues and understanding root causes that may be “beyond your field”

Utilise strengths to bring about change

• Use individual, family and community strengths to develop approaches – individualised and focused

• Wellbeing as an outcome of a sense of belonging and pride in a place and connection to people and their peers – develop social and community capital

• Ensure focus on developing strengths at all levels of the portfolio

“Cooperative practice” at heart

• Our work is built on repairing, developing and nurturing relationships to promote resilience, recovery and ambition for the future. It is underpinned by a thorough understanding of the impact of ACEs and how every contact is an opportunity for support and the promotion of protective factors.

Data and research informed practice

• Data needs to drive our prevention – how can we harness the information we gather to influence how and where we deliver services

• This includes customer views (community strengths)

• Utilise evidence based models but drive the research based on the strengths we have

7 how it all operates. Hierarchy, command and control approach or complex system

We have avoided (so far) setting up “a big board”.

There is no hierarchy. This all operates in a complex system

Command and control is hard in something that affects everything.

Certainly some merit in joining the dots between chunks.

It is easy to say we should join dots but we definitely can’t do it well, don’t have infrastructure to develop a single programme.

Read Team of Teams it will give you a sense.

In short:

• We can’t command and control our way in this one. We need to be mindful of, comfortable with and able to use / influence a complex system. So this might include

• setting a broad framework, build in adaptability and regular review points

• Don’t try to work out every aspect up front

• System will adapt.

• Set system on right trajectory

• In control vs in charge

• Set out what broadly needs to happen

• Complex systems don’t conform to laws of linear models. These are a bit old hat in complex systems – Proximal doesn’t lead to distal outcome in the same way we’d like. Things go wrong, other things affect the chain. Some of these are predictable, some are not.

One reply on “Building a prevention approach to anything – part 1. A flat pack (with Allen keys) in 4 parts”

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