Curating health system integration through value-driven change: Adaptive leadership in a complex environment

Abstract

This paper describes the contextual factors that led to the establishment of a new primary health organisation, but moreover describes the challenges of change management in an environment that has a range of competing forces. This includes the internal challenges in developing a value-driven, collaborative and participative organisation dispersed across a significant geography with an external environment that traditionally has been self-regulated silos, yet recognised as unsustainable into the future. The paper sets out some of the challenges in working beyond the traditional methods in order to create new and different outcomes. Readers will gain an understanding of the principles of collective impact and place-based health and how these are applied within a start-up organisation that is tasked with facilitating integrated and coordinated health care at the local and system levels. The Western Australian Primary Health Alliance (WAPHA) has had a dual function in establishing an operating model, which effectively models the way using a suite of co-design, collaborative approaches to commissioning within a system where partnering and participative processes are the exception not the norm. Patient-centred care is now firmly embedded in the health lexicon; however, new ways of working shift the paradigm — to build a system where the clients, consumers and patients determine value, and clinicians are the builders of systems that are part of a wider transformation of primary care's role within our health system.