Marching to the beat of the same drum
Integrated Care Pathways (1) (ICPs) provide a co-ordinated and evidence-based template for multi-disciplinary care.
Integrated Care Pathways work because of the phenomenon of synchronicity, encouraging team spirit and motivating staff to follow processes.
Armies train by marching in step. Religions incorporate singing and chanting into rituals. Citizens sing their National Anthem before sporting events (2).
A study, published in the journal of Psychological Science (3) in 2009, explores whether synchronous activity may serve as “a partial solution to the free-rider problem facing groups that need to motivate their members to contribute toward the collective good”.
Wiltermuth and Heath suggest that when people engage in synchronous activity together, they become more likely to co-operate with other group members. Thus, the synchronous participants co-operated in part because they felt as though they were part of a team.
Integrated Care Pathways set the beat for clinicians. And a good rhythm encourages participation, and increases motivation in completing tasks.
Local approach, national standards
NHS Ayrshire and Arran have risen to the challenge of introducing National ICP Standards for Mental Health (4). We take a stepped approach at a steady pace – one standard at a time, one change to a clinical process at a time, even one Team at a time.
Our pathways are composed using Quality Improvement Methodology, and the tempo further regulated by e-Health solutions – electronic patient record which allows us to easily analyse our variances. We help our staff keep in rhythm with each other by building audit into their Clinical supervision.
We march not in a figure of eight, but in a PDSA cycle: Plan Do Study Act (5).
By breaking the introduction of ICPs down this way, change management is easier and the impact easier to monitor.
We continue to monitor this 6 monthly, and the numbers are still rising.
In Scotland we have a rich cultural history of marching, still popular today; from the Edinburgh Military Tattoo, Highland Games, the Royal National Mòd, to local festivals; all stirring our celtic souls with the sounds of the pipes and drums.
Societies rely on co-operation amongst their members to thrive and be successful.
Wiltermuth and Heath’s study on synchronicity concludes that “synchrony rituals… endowed some cultural groups with an advantage in societal evolution, leading some groups to survive where others have failed.“
For Integrated Care Pathway developments to be successful, a consistent and compelling drum beat needs to be provided. A clear path for clinicians to walk will foster co-operation and team spirit.
Distribute the hymn sheets, get the drummer ready…
(1) Scottish Pathways Association (formerly Formerly ICPUS (Integrated Care Pathway Users Scotland) http://www.icpus.org.uk/
(2) Association for Psychological Science. “Marching To The Beat Of The Same Drummer Improves Teamwork.” ScienceDaily, 28 Jan. 2009. Web. 27 Jun. 2012.
(3) Scott S. Wiltermuth, Chip Heath. Synchrony and Cooperation.
Psychological Science January 2009 20: 1-5, doi:10.1111/j.1467-9280.2008.02253.x
(4) NHS Scotland Standards for Integrated Care Pathways for Mental Health http://www.icptoolkit.org/home.aspx
(5) Plan, Do, Study, Act (PDSA) http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/plan_do_study_act.html