Practical tips and skills for developing leadership The tips in 3 aim to provide practical actions for PHNs to develop this competency at the following levels: System – Those within the PHN region that are strategically influencing system wide reform Organisation – PHN leadership / executives Individual/team – operational of the PHN Tables with this structure of ‘system/organisation/individual’ are used in each subsequent chapter of this guidance to provide practical actions for PHNs for each of the other competencies. Table 3: Practical tips and skills for leadership System Organisation Individual / team Use relationship management skills to leverage networks within and across regions to collaborate and streamline commissioning resources. Use the PHN network to further develop leadership skills and help increase PHNs’ influence at the system Focus on the PHN being a collaborative leader, to share and devolve leadership, such as joint decision making with Aboriginal and Torres Strait Islander organisations, including ACCHS, and enable this through ‘convening’ (rather than ‘leading’). Use such as Memorandums of Understanding, collaborative governance arrangements, and regional plans that facilitate shared leadership. Practice communication and presentation skills to lead and effect change at scale. Articulate a strategic direction and inspiring vision. Dedicate time to plan and prioritise resources in line with impacts on outcomes, and articulate strategic direction. Promote a high representation of clinicians and diversity in leadership positions. Create a communications strategy that provides consistent messaging on the PHN priorities and embedding a commissioning approach. Build and maintain strong relationships with key stakeholders at a local level to steer the market towards priorities. Use coaching as an approach to support team development, involves the leader/coach actively listening, challenging beliefs and allowing team members come up with their own solutions to be accountable and learn from mistakes. Set expectations and conditions for teams and individuals to take risks, considering reputation and stakeholder management. Encourage and support individuals to practice and build their communication and presentation skills to help lead and effect change and foster innovation from the market.
Practical tips and skills for change management To undertake effective change management, PHNs should consider the tips in Table 5. Table 5: Practical tips and skills for change management System Organisation Individual / team Achieve a shared understanding of the existing problems by the sector, i.e. case for change, and commitment to solve these problems. Build relationships with other commissioners and the market to leverage opportunities (e.g. utilise their capacity and capability to support a shared agenda). Collaborate and share change management strategies, approaches and experiences across the PHN network. Form strong relationships with community and representative groups, including to agree and communicate what the change is, what has been achieved and what is needed to fully realise the benefits. Communicate evidence specific to the PHN region to support the change. This may include investments or partnerships with research providers to obtain this data, link it and communicate it in a clear and transparent manner. Negotiate with key decision makers across the system to influence their agenda to support local change. Implement a single, clear and best practice change management methodology such as ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) as the basis for a change implementation plan, with cultural safety embedded at a grass roots level. Measure and report on key change objectives, celebrating successes and assessing the PHN’s development of cultural safety and other competencies in commissioning. Build the PHN’s cultural competency to build trust and respect to communicate and achieve buy-in (in particular, work more closely with Aboriginal and Torres Strait Islander people and communities to effect change). Communicate clear and consistent messages about the benefits of change, and the PHN’s actions to support change across the system. Provide staff with the time and training to develop their commissioning competencies and embed new practices into business-as-usual activities as part of their performance plans. Consider quality improvement methodologies to assist in driving contemporary practice. Develop leadership skills to motivate teams to implement the change and leverage passionate individuals to be community change champions. Co-develop contracts and manage performance to provide scope for partners to transform themselves and achieve change, while still ensuring continuity of services during transition. (Contracts of appropriate length, and which include appropriate transition and service continuity requirements are important here.) Constructively challenge behaviour that does not support collaboration or build the desired culture.
Identify leading General Practitioners who have a good understanding of population health needs and the data that supports improvement. Utilise the expertise of other PHNs in relation to data analysis. Look beyond the obvious partners; keep looking for new connections and build on existing connections to co-commissioners and link providers together. Communicate with a variety of sectors (not just health) in a way that resonates with sectors and better targets different populations. PHN leaders to support the organisation to move out of its comfort zone and from single organisation to integrated and inter-sectoral planning to better target different populations, particularly Aboriginal and Torres Strait Islander people and communities and those at risk of poor health outcomes. Use techniques to better connect with different cultures, and follow and plot the patient journey. Improve the analytics capabilities of the PHN to collect, access and analyse multiple data that accurately presents a holistic picture of the health of the population now and in the future, including inequities in population groups, and to effectively illustrate change. outcomes, where access to care from improving trust may be particularly important. Better connect with local communities in a way that the population/ patients are comfortable with. Use contract management and evaluation skills to effectively monitor and evaluate provider performance, identifying inequities that impact on the health of the whole population. Collaborative arrangements This competency involves: Strong partnerships and robust working arrangements with commissioners to help PHNs achieve more effective outcomes. Building bridges across organisations and creating formal arrangements to work collaboratively with partners and stakeholders. Collaborative arrangements context for PHNs Designing and delivering the changes needed to transform the primary health care system involves collaborative efforts by PHNs, partner organisations, clinicians and providers. As highlighted in the PHN Grant Programme Guidelines PHNs are expected to: Develop collaborative working relationships with Hospital Networks (LHNs) and public and private hospitals to reduce duplication and increase the PHN’s ability to commission services. Act as regional champions for locally relevant clinical care pathways. Develop cross-border cooperative arrangements where patient flows cross jurisdictions.
and societies, food production and supply industry and retailers. The governance, communication and collaborative arrangements are reviewed on an annual basis and adapted to meet the needs of the growing alliance. Practical tips and skills for collaborative arrangements 8 provides some practical tips that PHNs should consider in developing this competency. Table 8: Practical tips and skills for collaborative arrangements System Organisation Individual / team Identify organisations that out similar activities, face similar problems or with valuable networks, to determine whether there would be mutual benefit in collaborating or forming strategic partnerships. Network with other PHNs to identify successful collaboration processes. Consider risk sharing arrangements to incentivise joint working. Build on the PHN’s strategic planning skills to form joint planning arrangements. Regularly demonstrate progress to all partners in a way that aids their understanding, motivation and focus. Network and negotiate with stakeholders to form arrangements that will create a mutual benefit. Work collaboratively with ACCHS and other community representative bodies, through ‘convening’ rather than ‘leading’. Consider the use of tools that will help to build collaboration and alliances, for example, a memorandum of understanding. Identify potential conflicts of interest prior to forming collaborative arrangements to determine what safeguards can be put in place and manage probity considerations. Convene forums with potential partners and share data and information (as appropriate) to build trust and encourage collaboration. Establish formal agreements practical to document accountabilities, including clear and transparent governance arrangements to regularly and jointly monitor and review the partnerships to ensure they are achieving the objectives. Design processes with market soundings and interactions and less prescriptive requirements to encourage partnerships and collaboration. Encourage and reward ownership of partnerships across all levels of the PHN.
9: Practical tips and skills for market management System Organisation Individual / team Utilise strategic skills to develop a sense of the desired outcomes the PHN is seeking to achieve and ensure that activities to change the structure of markets are targeted and aligned to the desired outcomes. Expand data capabilities by considering what data can be gathered from government bodies both at a federal and state level and other data sources. Collaborate and with other funders to create additional scale as a means of attracting innovative providers from other locations / areas to enter the market. Network with state/territory and local agencies to hold industry wide capability development programs and events to support individuals to get the required skills to enter the market, including partnerships with local TAFE or private education providers. Network with PHNs to identify innovative ways to manage markets. Design systems to record insights and market analysis from informal (once validated) and formal market engagement. Use analytics to present market analysis in a meaningful way, such as by market segmentation and geographical information systems that identify service gaps. Build a communications strategy to raise awareness of the market opportunity, focusing on both traditional and providers who could provide services, and present the PHN as attractive to work with. Communicate and engage with the market (such as through market forums or soundings) to ensure a detailed understanding of underlying issues and test remedy approaches. Structure arrangements to stimulate market interest whilst achieving outcomes, such as bundling or breaking-up of contract packages as well as appropriate risk allocations. Consider seed funding or initial financial performance waivers to allow small providers to transition and establish in markets with limited competition. Improve facilitation skills for hosting knowledge sharing and brainstorming events with diverse stakeholder groups to develop innovative ideas around specific service areas. Engage with providers and develop standardised engagement material throughout the commissioning framework to evolve the relationship with providers, minimise inefficiencies and improve consistency. Organisational capability This competency involves: Governance - Clear accountability and timely decision making, including proactively managing risk and probity considerations.
One analogy in thinking this through is the delivery of workplace health and safety in Australian companies. Whilst companies may have specialist teams focussing on health and safety, it is the responsibility of all employees and have regard for workplace health and safety needs and requirements. In commissioning terms, PHNs can establish specialist commissioning teams if preferred, but they should also embed a commissioning mindset across the whole organisation, so that all parts of the PHN are familiar with the implications of commissioning and what they can do to support it. Practical tips and skills for organisational capability Table 11 provides some practical tips that PHNs could consider in developing the organisational capacity competency. Table 11: Practical tips and skills for organisational capability System Organisation Individual / team Introduce standard templates and agreements that could be used as a basis for contracting with third parties, to reduce administrative and commercial inefficiencies from reconfirming and redrafting what is market practice. Proactively manage heightened bias that may occur in markets with limited competition, such as challenging provider opinions from a system lens and involving patients in the discussion, and address probity considerations. Regularly review governance arrangements to ensure are balanced discussions around past performance, current activities and future plans. Regularly review the governance composition for the right mix of skills (clinical, transformational, strategic, risk and professional) and diversity that represent the local population, particularly for joint commissioning. Regularly conduct a skills audit at all levels (including the board) against the commissioning framework and key commissioning competencies to identify capability gaps and develop strategic workforce plans for improving capability. Invest in robust systems and processes for contract management, risk management and quality improvement, that enable PHNs to automate some tasks (as appropriate), track progress and operate more strategically. Establish and use effective technology that encourages and facilitates communication across organisational silos. The whole organisation participates in developing Build relational skills through training to increase the commissioning capability of the PHN. Involve contract managers in new procurements and redesigns for similar services, to pass on their experience and to build on their relationships and understanding of the market. Collaborate and plan tools such as a responsibility assignment matrix RACI (which defines who is responsible, accountable, should be consulted or informed) to manage projects and minimise overlaps/efficiencies across teams.