Step by Step Explanation of the Phases
Phase 1
The main aim of this phase is to establish the governance structures and support required to effectively implement WSA. It is structured into 4 main steps:
- Engage with senior leaders to obtain their support.
Support from senior leadership is integral to the successful implementation of a whole systems approach. This includes but is not exclusively: endorsing whole systems working, opening doors to help engage with stakeholders within and outside the local authority, providing advice and support, helping drive accountability, providing leverage to mobilise resources and building capacity to deliver whole systems working. There are different ways of achieving this step. Firstly, it is important to recruit a “champion” from within the organisation that is applying WSA. “A leader who understands the process and can encourage others to support the work at a senior level is crucial to help to maintain its momentum and visibility”.
In order to secure support and also funding for WSA to obesity it is necessary to highlight the connections between obesity and overarching issues such as social care or infrastructure. This can happen through one-to-one meetings with senior leaders, asking what they feel works well within their sector or organisation, how they feel obesity relates to their work, and explaining what the whole systems approach entails. The key term here is “appreciative inquiry”, which focuses on what is working well (appreciative) by engaging people through asking questions and gathering stories (inquiry). Furthermore, it is essential that the community not only feels represented in the process, but also has the opportunity to actively engage with it. “This will help ensure that the resulting programme of work takes account of the views, knowledge and priorities of the communities who are, ultimately, the beneficiaries of whole system efforts to address obesity”.
- Set-up a core working team to undertake the day-to-day operations and coordinate the approach.
The core working team (CWT) role is to coordinate the approach, which includes tasks such as coordinating stakeholders, giving feedback to senior leaders, running workshops and generating key materials. Members of the CWT must be well established within the organisation or institution that is applying WSA and be familiar with the context. As the approach develops it might be useful to include different stakeholders from across the system. Furthermore, a system network of which the CWT is part of has to be established. “The system network is responsible for the sustained implementation, adaptation and refinement of the whole systems approach and action plans”. Its responsibilities include participating in workshops and meetings, identifying stakeholders, creating key materials and maintaining momentum for WSA.
- Establish a system network to support the process.
The system network is formed of a broad set of stakeholders from the local area, both within and outside the local authority. Members of this working group are participants from workshop 1 and 2 (which are part of phases 3 and 4) and other identified stakeholders. Its responsibilities include participating in workshops and regular meetings, identifying and facilitating action across the system and identifying stakeholders.
- Secure the accountability, advice and support of a group of senior stakeholders offering a broad range of expertise to ensure the approach has sufficient challenge, governance and resource.
Phase 2
“The aim of this phase is to gather information required to understand the local picture of obesity, including its prevalence, the local impact, relevant organisations and people, community assets and existing actions to address it”. Investing enough time into this phase of the process is crucial as it creates the foundations for WSA and it will help build a compelling narrative to engage with a wide range of stakeholders from across the system. It is important to understand that the outputs of this phase, as well as the understanding of the local picture, will adapt and evolve with time.
- Collate key information about obesity locally.
This key information then needs to be send out in form of key messages and will help stakeholders understand the issues and why they are relevant to them. This should enable constructive discussions and sharing of views and perspectives on factors relating to obesity.
- Start to understand the local assets including community capacity and interest.
“Community centred ways of working are recognised as sustainable and effective approaches to help reduce health inequalities”. In order to facilitate this the involvement of communities is crucial. Involving communities can be useful to identify assets that might help tackle obesity. These community assets include skills, knowledge, social networks, resources and facilities which can be available within the public, private and third sector.
- Establish a comprehensive overview of current actions. (Action mapping)
A prerequisite to developing a local whole systems approach is having an overview of the actions currently already being undertaken. In the context of WSA this should happen in the form of action mapping. Collating actions into one document helps show the breadth of the current approach and where there is potential for improvement. An action map also connects the actions to the Wider Determinants of Health model and shows where they are targeted. This makes understanding impacts and effects of these actions significantly easier.
- Identify the departments, local organisations and individuals currently engaged in supporting work around obesity.
Most systems already have collaborative working mechanisms in place, however it is often not easy to determine which organisations, departments and communities are involved. Conducting a network analysis can be helpful to map out these systems. It helps to recognise the current network (main departments and external organisations and/or people), key departments/organisations that are missing from the process and where gaps could potentially open if people left the network. Furthermore, a network analysis is useful to determine the level of involvement each department, organisation and individual has in the network, and how they contribute to the flow of information and communication. In addition, the analysis will help identify who to invite to workshop 1, which is part of phase 3.
Link to support guide for network analysis, network analysis template and data collection tool
Phase 3
The main point of this phase is to deliver workshop 1, which is supposed to bring stakeholders together to map out the system they are operating in and develop a shared vision of what is supposed to be done. This should happen in the form of a co-creative process where everybody can see how they can prevent obesity and what goals they can reach collectively.
“A shared vision unites stakeholders with different backgrounds and agendas to a common aspiration. A vision is a clear and aspirational statement of what the whole systems approach is trying to achieve. (..) A clear vision allows stakeholders to stay focused and move forward in the same direction and helps everyone to see how their work fits in. Creating the vision collectively should result in increased stakeholder commitment and engagement. (It) will be the foundation for goal setting and action planning.”
- Prepare for workshop 1
- identify and engage wider stakeholders
- prepare presentation slides and add local information
- prepare facilitators to undertake system mapping
- Deliver workshop 1 - System mapping
The result of workshop is a comprehensive system map and it is pivotal to WSA. It is important to acknowledge that there are no right or wrong answers to this process, i.e. there is no definitive local system map as the map will not be perfect or include everything. Most importantly, it represents the perspectives of the stakeholders involved and it can always be refined over time and through continued dialogue with wider stakeholders and communities. However, it is also important to consider expert knowledge. Some of the key drivers of obesity could be unfamiliar to community stakeholders. Therefore, if the process of system mapping is completely community-led, important evidence-based insights might not be considered.
- Begin to develop a shared vision
Phase 4
The aim of this phase is for stakeholders to refine the shared vision and to propose actions. The main action of this phase is to deliver workshop 2.
- Prepare for workshop 2:
- create a comprehensive local system map
- prepare presentation slides and add local information
- prepare facilitators to support action planning
- refine a draft shared vision
- Deliver workshop 2 – Action planning
In this workshop participants will be identifying where, and how, to intervene in the system. The goal is to collaboratively identify actions, both new and existing, to help shape a whole systems action plan. The action scales model by PHE can be used to facilitate this process.
- Develop a draft whole systems action plan
By reviewing and aligning existing and new actions proposed during workshop 2 and ensuring they align with the best available evidence base an action plan should be drafted. It provides a framework for future discussions about progress and opportunities. Furthermore, it should also make the identification of possible partners and stakeholders easier. The plan will be reviewed and adapted in following phases.
- Refine the shared vision
This process is based on the feedback the CWT has received during workshop 2 and the results will be presented to stakeholders in the next phase.
Phase 5
The aim of this phase is to get the system network up and running by developing the structure of the network and undertaking the first meeting. This is what the workshops and their actions have been leading up to. Participants at workshops 1 and 2 are a key part of this system network. The members of the system network are highly dependent on the local context. It can range from all stakeholders in cases where there are less than 50 stakeholders involved, to creating various sub groups according to the themes of the system map. If sub groups are created, enabling a feedback process is crucial.
- Develop the structure of the system network
It necessary for the people involved in the system network to meet on a regular basis in order to reflect on responsibilities, review and monitor progress, adapt the action plan and maintain momentum. As always, the specific work of the system network must be adapted to the local context of the community and stakeholders.
- Undertake the first system network meeting
At this meeting the shared vision should be presented, the action plan should be agreed on and participants should be given the opportunity to identify other stakeholders who should be involved in the system network.
- Present the finalised shared vision
The shared vision agreed on in previous phases should be presented in this first meeting and revisited at all subsequent meetings. Keeping an emphasis on the vision allows stakeholders to stay focused and move forward in the same direction.
- Agree the action plan
The participants must agree on the whole systems action plan previously drafted by the CWT.
Guide whole system action plan
Phase 6
The aim of this phase is for the system network to have become operational. The network will come together at agreed points in time, to collectively reflect on how the local whole systems approach and its actions are progressing and to consider and agree appropriate changes. At this point stakeholders must deliver the agreed upon actions and take ownership of actions and the approach together with the network.
- Monitor and evaluate actions
- Maintain momentum through regular meetings
- Reflect and identify areas for strengthening
This should happen at least every 12 months in form of meetings between the CWT and the system network. At these meetings the system map should be revisited and updated. This will show how the actions are progressing and how collective action has contributed to changing the system in a way that supports the long-term vision.
- Monitor progress and outcomes of the whole systems approach and adapt the approach to reflect system changes over time
Integrating the action scales model and action mapping tool into this process could be highly useful.