SECOND OPINION
assessment or local challenge. But work together through the good and the bad. No provider does what it says on the tin all the time.
• At the very start it is important to agree what will be the deal breakers and acknowledge them.
• Even if the people get on, the geography is right and the early discussions seem to identify a mutual benefit, sometimes it just doesn’t happen.
The key win A benefit for people who use the services
Rationale
The two organisations must have at the heart of what they do a commitment to delivering the best services possible to people who need them at the time.
A benefit for the organisations and the people who are employed by them
Timing, organisational
readiness and local context is key. Barchester Healthcare has examples of developing the same idea with two different organisations in different parts of the country. One has taken off and one hasn’t. While this shouldn’t put you off, don’t flog a dead horse.
• Have a clear risk matrix, either written down or discussed together, that you use to keep checking out ideas so that even if the venture doesn’t happen you will learn from the experience.
• Don’t overstretch the number of true collaborations you have, otherwise the value is diminished.
• Keep reminding people who should benefit from what you are doing.
• Productivity, like quality, is often measured differently: check what you mean and how you can evidence it. It might be as simple as the price of a bed, or cutting x assessments out of someone’s contact with the system. Importantly, agree who needs to be involved in defining and measuring it.
Why it is different: organisational benefit and choice points not care pathways
Partnership approaches often struggle because although the people involved can articulate the benefits for service users, they cannot see the organisational benefit.
The organisational benefit should be based on offering something they don’t have. For example, widening out a customer base is one of the clear reasons businesses enter into a collaboration. Outside the challenges of provider organisations trying to work together, even pooling health and social care budgets has proved challenging. In 2009 the Audit Commission identified 32 PCT/LAs that had pooled budgets but recognised that very little work had been done on evaluation, reporting that “the focus locally and nationally has been on process rather than outcome measures, which are rarely quantified or monitored”.
18 | national health executive Mar/Apr 12 A benefit for the public purse
The most important asset to both organisations is its staff, and investment is key. At the same time the venture must support the business plans and aims of both organisations and demonstrate the joint venture helps progress the plans of each in an equal way.
The joint venture must be able to be
accountable to the public, elected members and the local community and evidence that services funded through public sector commissioning processes are offering high quality, high value and high productivity.
In addition, there is scant evidence that integration across health and social care systems produces cost savings. However, few studies have actually addressed the issue of cost and fewer still have attempted to quantify it: ‘therefore there may be a problem of absence of evidence, rather than evidence of absence’. So it needs to be clear from the outset that if the joint venture or a specific project cannot bring wins for the organisation it probably won’t succeed. The table above shows three key wins and the rationale behind them.
One area Barchester Healthcare has been very aware of since the outset is how to achieve these wins and still support the concept of personalised approaches and choice for individuals and commissioners. What is needed is a common sense of what ‘quality provision’ means and a jointly developed understanding of how two organisations can pragmatically develop sensible options that work. For example:
• A shared sense that choice isn’t about which A&E department you want to go to within a 70-mile radius when you have been in a catastrophic accident is helpful.
• Recognition that even though you can offer someone a joint long-term package of support, they may choose another option.
• Commissioned care pathways that offer a range of qualified providers at different parts of the pathway may be one solution, and you should relate to that system.
• Be clear that you offer choice points throughout the process developing together, recognising that commissioners (including people with personal budgets or,
in future, personal health budgets) will be expecting that.
Recognise but don’t reinforce the myths and dragons
Acknowledge that people working in health and social care do stereotype. At Barchester Healthcare, we developed a summary of some of the myths and dragons that are used by different parts of the system, to enable early and open conversation (see panel on facing page).
Although blunt, it proved extremely helpful in assessing organisational and individual readiness,
internally and externally.
It can form the basis for discussions about behaviours and, in particular, how organisations support each other internally. But if people are not prepared to meet people rather than myths, you have to accept that it probably won’t work.
Issues to consider: • Everyone has experiences that will reinforce the myths and dragons: joint ventures are about individual organisations and the people who work in them.
• If things keep not working, it’s probably because of the myths and dragons held by the people and, if they can’t be changed, it’s not worth the investment of time.
• Make sure you don’t reinforce them in the way you behave.
• Recognise that some things are out of control of the individual or the organisation they work for and are an external requirement. Separate this out from myths and dragons. Some process is good and linking joint ventures to delivering business plans is important.
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