Capitated Outcomes Based Commissioning (COBIC) requires a fundamental shift within organisations as it redefines value, incentives, distribution of risk, power and relationships. Alongside the changes to systems and technical models the process requires organisational development of both providers and commissioning organisations.
For commissioners, they will need to use the route to contract process (service review or procurement) to support and enable the change. This will require open communication throughout, facilitating discussion and agreement with providers to agree key performance measures that recognise the change management required. This will be especially important within the first year of the contract, and by including questions relating to managing change as part of the critical success factors in selection of the provider.
For providers, this will require them to lead and be accountable for significant change management in order to reconfigure how they deliver better integrated services. From experiences working with service users, carers, clinicians and health and social care practitioners there’s been an overwhelmingly positive response to the opportunity to design how services are provided to deliver the COBIC vision. This shift in practice will however require different working relationships, and accountabilities.
Whilst it will be the provider’s responsibility for leading the change management process within their organisations, commissioners have the opportunity to support. This should be agreed at the beginning of the OBC development and include agreed communications so that providers can manage communication to their stakeholders and staff, and secure the top-level commitment to the culture change.
COBIC is both a technical process and a cultural journey that requires a shift in attitude. Doing both will mean organisations can make the required ‘change’, releasing commissioners to performance manage effectively, and providers to design innovative services that most benefit their local population.