Creating the conditions for successful NHS collaboration
Successful collaboration requires openness and honesty, a recognition of your own strengths and weaknesses, and a commitment to resolving difficulties says John Copps.
Over the last decade the pendulum has swung from a focus on competition between NHS providers to an emphasis on collaboration.
Despite the many hours of policy debate, hard-won incremental gains over the years and newly-minted legislation, perhaps the decisive moment in this was the Covid-19 pandemic.
As the new virus took hold, neighbouring trusts were forced to work together, putting aside any reservations or difficulties they might have. New arrangements for sharing resource, expertise and information were cooked up overnight to manage an evolving situation.
One of the impacts of this experience was to open the eyes of both managers and clinicians to the benefits of partnership working. Many (perhaps most?) already believed that this was the right direction of travel, but there is nothing more powerful than actually seeing it in action yourself.
The journey to collaboration
Today, there is a push for joined-up working to be formalised in the form of ‘provider collaboratives’. NHS England has told all acute and mental health trusts that they must be part of at least one provider collaborative, whilst other providers that they should be.
But this expectation is not accompanied by a how-to guide. Providers are left to find arrangements that work for them.
Whilst Covid-19 provided a powerful proof of concept, many of the arrangements relied on temporary powers and structures that were not built to last. In contrast to this, creating sustainable partnership does not happen overnight – it is a journey that takes time.
Crucially, this journey is a very human one. Working through the technicalities of governance, care pathways, financial flows and contractual arrangements are all vital but, at its heart, effective joint working relies on relationships.
So what do providers need to do to set the right tone for discussion and create the conditions for successful collaboration?
The most obvious and necessary ingredient for partnership is an agreed vision. Leaders need to coalesce around a shared purpose and commitment to the same aims – and take their teams with them.
It is also important not to overlook what you are already doing together. This is probably more than you think, and more than any one person knows. Put together a list of successes that you can build on. For example, I worked with two trusts that identified a number of 'acts of generosity', where they had taken decisions that impacted their own organisations adversely in the short-term but had benefit the system and the local population.
Don’t forget the little areas where you share common ground. In neighbouring trusts there will be staff – perhaps in senior positions – that have worked for both organisations. The workforce may have a shared experiences on local forums or training rotations.
Equally, understand your differences. Where do you not see eye-to-eye? Partners should get all the thorny issues on the table early on in discussions. For example, acknowledging your history of competition, or any previous disagreements, including around finance. Working these differences through helped a collaborative of three trusts in the east of England revise the approach and put together a joint bid for a service that historically sat with only one of the partner organisations.
Potential partners need a recognition of their strengths and weaknesses, and a sense of humility. For any provider, there will be things that you aren’t good at and can learn from your neighbours. There are also things that you will be able to help them improve. Acknowledging this is necessary for the relationship to work well. For example, a collaboration of London trusts was able to increase the resilience of several under-resourced teams across all partners.
Towards greater collaboration
The case for NHS collaboration may seem compelling, but that doesn’t mean it is easy. The collaboration journey is about human relationships. To be successful, leaders need to work together to create an environment where people are valued, where they can be open and learn from their mistakes, and there is a commitment to resolving difficulties.
Without this focus on people and relationships, collaboration will not be sustainable. The test for this comes when things go wrong. How will you solve difficulties? What approach do you take to accountability and how do you avoid a culture of blame and finger-pointing? This requires trust, the ability to be honest with each other, and have a mature conversation.
Ultimately, the case for collaboration has to be a case for improving patient care. It is always worth remembering that the patient usually sees no distinction between who cares for them – so where it makes sense for patients, organisations have a duty to work together.