This emerging practice guide provides a range of practical advice, ideas and learning from those in the role, to help systems establish and support the single coordinator role to operate successfully.
The Home First ethos and Discharge to Assess approach are critical planks in the implementation of the Hospital discharge service: policy and operating model. This emerging practice guide provides a range of practical advice, ideas and learning from those in the role, to help systems establish and support the single coordinator role to operate successfully.
The role of a single coordinator, reporting to an Executive Board lead, was introduced in the March COVID-19 Hospital Discharge Service Requirements to deliver change in each acute centre and to ensure accountability for implementing the requirements. Community health providers were instructed to “set up a single coordinator in each acute centre, accountable to a named Executive Board lead in their own organisation, to ensure accountability for delivering the change” (para 1.10). Although the single coordinator role was not defined explicitly, throughout the document, various responsibilities and tasks were assigned to it.
The single coordinator role was developed further and formalised in the August 2020 publication of the Hospital Discharge Service: Policy and Operating Model:
Critical success factors
Conversations with those involved in implementing the policy over the summer identified four key factors that may determine the success of a single coordinator:
- A common purpose and shared vision – a clear and consistent focus on Discharge to Assess and Home First will help to generate commitment from all partners.
- Enough decision-making authority – this will not only shape how quickly change can be made but also its impact.
- Sphere of control – this will determine how the single coordinator can bring about change, whether through direct decision-making or by influencing partners.
- Working with partners – working with partners earlier rather than later will make for more credible implementation.
The size and complexity of local systems vary across the country. The strength of existing local relationships and the success of hospital discharge arrangements will have a significant bearing on the size of the challenge facing someone taking on the role of single coordinator.
- Consider where the role will best sit within the local health and care system architecture you are building, both for now and for the future.
- Ensure the role is senior enough to be able to challenge system partners and has, and is seen to have, legitimate power and authority. Seniority is important to the success of the role - being able to challenge other parts of the system, and, if necessary, to pull rank to see decisions through.
- The single coordinator needs to be seen to represent the whole system and not as being aligned to any one particular part of the system. Who employs the role doesn’t matter if the role has good networks across the system and a positive reputation.
- Give the single coordinator a clear ‘sphere of control’ and the backing of a committed and engaged senior executive-level colleague to whom they can report. The sphere of control needs to be wide enough to be able to be effective – this means being able to work, with credibility, across the whole system.
- Be clear how the role will relate to the local relevant emergency planning arrangements - what level will it report into? Being able to report in at a sufficiently high level will mean it will be quicker for the post holder to introduce changes to local policy and procedure.
- How will resilience be built in? Two senior people sharing the role has been found to be helpful. For example, this can provide more sustainable support and create opportunities for the post holders to play to their strengths, to bounce ideas around as each person’s energy levels inevitably peak and wane.
[The role has enabled] things [to be] much more responsive, changes are made much quicker because you haven’t had to seek permission; although if there was a big governance issues, I’d take it through Silver and Gold. But if it’s about improving practice and doing a PDSA (plan, do, study, act) then you just get on with it and prove it works. It’s enabled by the fact you’ve got a single unifying purpose.”
Secondee to single coordinator role
Appointing a single coordinator
Conversations with colleagues suggest considering the following when appointing to the role.
- Relevant operational experience and knowledge is vital, as well as context and content knowledge. Being a senior officer with project management experience is not enough.
- Ensure they can connect and be seen to be working in the interest of the whole system.
- Consider appointing someone who is already working on integrated discharge arrangements as part of their wider role, or in a relevant joint point. Someone who is already embedded and known across their system will be able to get started more quickly, and they will not need to spend time understanding a local system and building a network.
- Single coordinators with therapy backgrounds can be well placed to work across acute and community settings and to discuss approaches to managing risk, although, of course, other backgrounds offer relevant other experience as well.
- Example job descriptions and person specifications are available on the Better Care Exchange [log in required].
Experience has shown that having the following attributes can make all the difference to embedding change:
- an ability to be impartial and not seen, or perceived, to be aligned with any one organisation
- able to take on strong characters
- assertive enough to challenge lack of progress and resolve conflict
- able to build strong networks and alliances to deliver change
- being willing and able to “raise head above the parapet”
- comfortable to act as a sounding board
- ability to identify issues early
- able to focus on what’s best for people rather than staff.
I haven’t got a fear of doing the wrong thing. It’s too dangerous to do nothing.”
Secondee to single coordinator role
Being a single coordinator
Feedback strongly advises developing a common purpose to build receptiveness to implementation.
- Promote a clear and shared focus: ‘a single vision’, ‘a unity of vision’ or ‘common purpose’.
- Use the policy and operating model as a positive opportunity to embed discharge to assess arrangements. This is more than an administrative procedure bolted onto existing discharge to assess processes.
- Be a champion – cascade the policy, encourage others to read them and get up to speed with the detail about what is required. Ensure colleagues understand that the policy and a Home First ethos are not optional.
Anything we’ve come up against, my role is to unblock that blockage.”
Secondee to single coordinator
Those fulfilling the role also offer the following advice based on their experience:
- Foster good working relationships between partners pro-actively and when necessary use conflict resolution approaches to facilitate change.
- Establish project management, management and reporting arrangements.
- Set up relevant meetings to keep staff up to date and to coordinate discharges.
- Be actively involved in the regular telephone calls used to manage and monitor the system response and escalation arrangements.
- Bring colleagues together to end long email exchanges and reach quicker resolution.
- Find out how well-established and successful trusted assessors are.
- Facilitate opportunities for team building; for example, organise inductions, facilitate rotations to help staff to learn from one another, provide training and coaching in having difficult conversations.
- Play to the strengths of each partner in the system; for example, local authorities are expert in working with care providers and they can lead in making placements and negotiating rates.
- Establish one version of the truth. Build good relationships with informatics colleagues who can help tell the story and translate local data into currencies that partners recognise; for example, bed days saved.
- Take the opportunity to review decisions and make changes where needed; for example, a deep dive to review Pathway 3 placements. When designing arrangements, be alert to the risk of ‘single points of failure’ and plan how to avoid these.
National, free-to-access support offer
The Local Government Association, Better Care Fund Team and NHS England and Improvement programmes including Emergency Care Improvement Support Team and Continuing Healthcare have developed a joint support offer. It is intended to support local health and care systems to plan and deliver their winter resilience plans including fully implementing the Hospital Discharge Service: Policy and Operating Model and the High Impact Change Model for managing transfers of care.
Support is on hand to support local systems develop the role of single coordinator, as well as supporting processes and model. There is a range of options available to support local systems which includes a gap analysis, peer-led workshops, reviews and bespoke support as well as case studies and good practice. For more information and to discuss what support would be best for your system, speak to your Better Care Fund Manager, Care and Health Improvement Advisor, or find out more about the integration support offer.