The People Powered Results team recently completed a 100 Day Challenge in Lincolnshire, working with leadership and multi-disciplinary teams in 4 neighbourhoods across the county, with a focus on improving the lives of people living with frailty.

Over the course of the 100-days 53 frontline practitioners came together to participate as team members, with representation from 22 organisations across the statutory, voluntary and community sectors. Each of the 4 teams tested out practical ideas for working differently with a diverse range of people affected by frailty, including:

• Preventative support for people who are at high risk of having a fall
• Early identification and proactive support for people with mild and moderate frailty
• Providing more joined-up care and support for people with severe and complex frailty, including those with mental health diagnoses
• Creating stronger connections between services working to support those who are homeless and frail

8 local staff members were also trained to take on the role of providing coaching support to the frontline teams. The Frailty 100 Day Challenge represents one of several initiatives in Lincolnshire that focuses on supporting practitioners to rapidly test out their ideas, in order to generate learning that will inform the system’s longer-term change plans. As such, building capacity within the system to use skills such as coaching, facilitation and prototyping has been a key area of focus for our work in Lincolnshire. We have also worked closely with local leadership to understand when the use of these skills is most impactful, and when other kinds of change method are needed.

To work with local Coaches, we provided training in a wide range of coaching and facilitation techniques including active listening, open questioning, goal-setting, managing group dynamics, idea generation and giving / receiving feedback. Coaches in a 100 Day Challenge need to be able to use these skills flexibly, because no two teams are ever the same and rapid testing creates an environment where things change quickly! There are many ups and downs during the course of a 100 Day Challenge; we use the analogy of a chameleon to illustrate how Coaches need to be able to switch between different roles so that they can keep their teams motivated and on track.

We’ve also learnt a lot from our work with local Coaches in Lincolnshire and in other parts of the UK. Below are a few key reflections on building capacity for coaching and facilitation within systems:

• Getting the right pattern of engagement. Working with Coaches who also hold busy day-jobs within the local system means that there’s a fine balance to be struck between protecting dedicated time to step away from the ‘doing’, whilst also being responsive to people’s individual situations and supportive of their need to juggle multiple priorities. Providing adequate information about the nature of the Coach role and the time commitment is key from the start, so that the group have shared expectations about taking time to reflect and practice coaching skills together.
• The value of ‘insider’ and ‘outsider’ perspectives. In Lincolnshire, each of the teams worked with one Coach who was familiar with the neighbourhood context and one Coach who didn’t have as much connection with the area beforehand. Feedback from Coaches suggests that this mix of perspectives offered a helpful balance between being able to build on existing knowledge and relationships, whilst still being able to ask ‘naïve’ questions that challenge assumptions. We also learned that it’s important to be explicit about this dynamic from the start, so that each coaching pair feels clear about their individual roles and strengths, and how they can work together most effectively with the team.
• The ‘how’ is as important as the ‘what’. Coaching and facilitation skills are very transferrable, and many people who received the training were able describe a wide range of situations where they’ve found themselves applying these communication techniques. However, we recognise that skills alone are not the full picture: there are a range of personal qualities and behavioural characteristics that affect how well someone can step into the Coach role. These qualities can include: emotional intelligence and empathy, self-awareness, curiosity and openness towards others, and resilience when working with high levels of uncertainty. Recognising and valuing these qualities is equally important as training people to learn the technical skills.

Finally, it’s important to recognise that training and supporting local Coaches isn’t the only aspect of capacity-building that’s needed for systems to make good use of rapid testing and other innovation methods. Leadership have an active role to play throughout the process, by:

• creating the permission and capacity for frontline staff to participate, and communicating this at all levels of management
• taking practical actions to unblock challenges that teams may come up against
• building trust in the process by engaging proactively
• communicating how the team’s learning is being fed back into wider strategic work.

The Frailty 100 Day Challenge generated a range of ideas and learning, much of which is now being connected to longer-term development work including the design of a system-wide Frailty Model and the embedding of Neighbourhood Teams*. The progress so far is a result of the dedication, passion and vision of all those who participated in the Challenge, and of a shared commitment to work together differently to improve health and wellbeing for people in Lincolnshire. However – change in complex systems is often messy and hard, and practitioners and leadership can be stretched to meet both the current need whilst also trying to create foundations for a better future.

In the final stages of the Challenge, we worked with local leadership using the Three Horizons model to bring together different strands of work that focus on sustaining what works from the current system, use of innovation to create pockets of alternative practice and learning, and developing the vision and infrastructure to enable more radically different ways of working in the future. Working on each of these three horizons in tandem requires high levels of collaboration, and the ability to see how different perspectives and priorities can ultimately move together in the same direction. We believe that processes such as the 100 Day Challenge, and other collaborative innovation methods, are one piece of the jigsaw in enabling this to happen.

*To learn more about Neighbourhood Working in Lincolnshire, please visit https://lincolnshire.nhs.uk/what/out-hospital-care/neighbourhood-working or search #LincsF4F on twitter

To find out more about the work of the People Powered Results team read our report reflecting on five years of the 100 Day Challenge.