SECOND OPINION
development approaches which only draw on the ideas and talent pool of one organisation are in danger of continuing to do the ‘same old thing we keep saying but never achieve’.
Professional and organisational confidence derived from believing the way you work is better than others is both positive and negative. But, at a time of resource constraint and the need to deliver quality outcomes, finding ways of working together that reduces inefficiency and enables access to services and support must be worth exploring.
Understand the history
It is important to understand an organisation’s historical experiences of partnership. In particular, the idea of private-public partnerships in health and social care have had a rocky past. But these partnerships were imposed, rarely sought. For example, commissioning additional capacity of elective procedures was a policy and commissioning decision; not something developed with the local NHS provider organisation.
In 2002, there were over 5,500 local partnerships spending approximately £4.3bn (Jones and Stewart quote research from Sullivan and Skelcher in 2002). Perhaps not surprisingly, this multitude of partnerships resulted in confusion, lack of understanding and accountability issues, which are considered so important in auditing use of public funding.
When questioned as part of a development programme, a small sample of people described going to partnership boards as good for networking and/or understanding the commissioning view but having little impact on their day-to-day work. But it is also important to recognise the perceptions of others, or myths and dragons, and acknowledge that some people have had bad experiences of working in partnership and these get embedded into organisational culture.
Clarity over what is possible
Be clear about what your organisation believes is possible to support collaborative working. For example:
• Partnership with a commissioning organisation isn’t possible unless every provider they commission from can do the same thing – a commissioning relationship is not a shared collaboration. However, all health and social care providers from all sectors should be included in discussions
with commissioners about how to transform services on a local basis.
• It is possible to have collaborative relationships with other provider organisations within the current procurement framework. These do not fall outside the current competition framework as both organisations involved need to have a range of different relationships.
• Being part of a partnership board approach is not a collaboration. But the value of these boards should be recognised for planning and networking purposes.
• Collaborations cannot be imposed, only developed where two or more organisations can see the benefit.
Leadership and organisational readi- ness: choose carefully
One of the key issues in developing collaborations is the human factor, highlighted by Rosabeth Moss Kanter in the Harvard Business Review 1994. While many foundation trusts may feel comfortable working with a small voluntary sector organisation, a large private provider may feel too threatening. Conversely, the public sector may perceive the private sector as a funder, investor or sponsor rather than a collaborative partner.
Essential early considerations
1. Understand both your own and your potential collaborative partner’s business plan and strategy.
2. Ensure potential collaborative partners can contribute to where you are going – and be clear about that. Similarly, use the fact that the private sector has more flexibility in some areas to adapt what you can do.
3. Don’t enter into many relationships in the same geographical area and be true to your word about how you will behave in the local region.
4. Make sure you know and agree who local compet- itors are and ensure neither you, not your potential partner, is working with them. But, be honest if you are and work through the consequences.
5. Board level linkages are important but it doesn’t always have to be CEOs at meetings – a culture of open and supportive joint venture working set by the organisational leaders is more important. But ensure that leaders get on and understand each others’ business and priorities.
Good process doesn’t stifle innovation
An early lesson Barchester Healthcare learnt was that real willingness to try something new needs process to support it.
Possible processes to consider are:
• Identify three or four people from each organisation who have responsibility to keep projects on track and ensure terms of reference are agreed and supported by whatever internal board process is in place.
• Have a symbolic ritual that confirms how you behave together. For example, broad ‘terms of engagement’ setting out the behaviours of each organisation can be useful.
• Establish how you will decide on the areas you might work on and develop measures that help articulate the benefits internally for both organisations. Use language that isn’t ‘public’ or ‘private’.
• Keep reminding people that they have organisational support to try new things to- gether.
• Make sure projects and ideas have a rationale as to why they are being done together.
• Be clear about communications and connections. Ensure early on that everything meets the legal and local political framework you are working in and agree who will be responsible for it.
• Spot the stars who ‘get it’ and support them, but recognise big organisations have culture carriers and work together to find a way of linking them in.
• Keep an eye on the investment of time, energy and development, and whether it is justified.
Celebrate the differences but keep it routed in quality and productivity
There is little point in developing a collaboration with another provider if you can’t demonstrate the gains. One of the advantages Barchester Healthcare has is that it does not compete with the NHS in relation to most of its business. It is able to take its skills base of working with people with complex needs and or long-term conditions and link those to NHS priorities. What we learnt:
• There is an understandable anxiety about how we define quality and how working with us will not diminish the perceived quality of the organisation you are working with. If we can’t evidence what we do it won’t help demonstrate the benefits.
• There can be an equal anxiety that your own organisation can lose its reputation for delivering quality services if your collaborative partner has a bad CQC
national health executive Mar/Apr 12 | 17
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