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Speeding up consultation

 Scenario planning for Urgent and Emergency Care.

We were commissioned to support the development of strategy for re-design of services for urgent and emergency care in two London boroughs. 

One challenge was how to do this in a way that rapidly completes the feedback loop, so that people who participate know that others have heard what they have to say even if they do not change their plans as a result.  Another challenge is that although these conversations and understandings need to occur at a system-wide level, there is no single boss or integrated implementation structure, so there has to be a way of linking the process into the implementation mechanisms of each of the organisations involved.

We also needed to build on the extensive work that had already been carried out locally, but which was not widely known or accepted due to recent major organisational changes.  Our choice was to engage a wide group of stakeholders in scenario planning, and to use the work that had already been carried out to inform the scenarios.

Scenarios are not the same as options among which participants are asked to choose their favourite. Scenarios have to be plausible futures, but they can be radical and may not be desirable.  One purpose is to stimulate discussion about ‘what we are really trying to do here’ in a way that is grounded in the realities of service provision.  Another is to ensure that plans are sufficiently robust to be able to accommodate future uncertainties.  And scenarios provide a way for the commissioners of the consultation to clarify what they understand to be ‘givens’, by including these in all the scenarios.

In the course of preparing the scenarios we developed a new framework for thinking about ‘urgency’ and ‘emergency’ that facilitated understanding and dialogue between health and social care and provided a shared language for describing access to services.

We researched and wrote scenarios that we used in a ‘futures’ workshop.  We designed and facilitated this 1-day workshop for over 100 participants and de-briefed strategic teams to make use of the materials generated from the workshop. These included spatial and workforce issues.

Regional restructuring.

We contributed to the design and facilitation of a process for restructuring the operations of an international organisation into a regional framework.

Most large organisations have to make decisions about the relationships between the centre and periphery. Robust organisational structures rest on a wide ownership of the idea that they are ‘fit for purpose’. This requires attention to the nature of exchange between the parts with particular emphasis on the nature and purpose of review processes for control, for motivation or for learning.

We used a Strategic Dialogue process to take diverse and often divergent groups through a cycle of conversations to surface areas of common ground and then on to areas of joint action.

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