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  • Writer's pictureMatt Carter

Creating a shared culture is essential for successful NHS collaboration

Matt Carter discusses a range of approaches to ensure the development of shared culture between healthcare providers wishing to achieve impactful collaborations.

At last week’s NHS Providers Governance Conference 2023, the themes of culture, relationships and trust emerged triumphant. There were a range of insightful discussions regarding governance frameworks and the formal arrangements that can drive and facilitate collaboration.

However, the focus has clearly shifted away from the technical aspects of governance, and definitively towards the importance of developing the right culture and trusting relationships that ensure collaboration can achieve desired outcomes.

Making collaboration happen

As a panel member on one of the breakout sessions during the conference, alongside colleagues from Browne Jacobson, Liverpool University Hospitals NHS FT and Bedford, Luton and Milton Keynes Integrated Care Board, I described the range of provider collaboratives that Mutual Ventures has helped to establish and evolve, and the factors that have ensured success.

Reflecting the themes of the conference as a whole, the session explored the legal and policy framework for collaboration, including the spectrum of informal and formal models that enable joint working and shared decision making. However, at the heart of the discussion was consensus that form, in and of itself, should never be the sole focus.

In order to make collaboration happen, protected time must be given to building trusting relationships, understanding current organisational cultures and developing a shared vision. Of course, not all collaborative arrangements have the same starting position, so I explored the range of approaches we have taken that have allowed for these critical success factors to be baked in.

An external mandate for collaboration

In my work with a Community NHS Trust and a Community Social Enterprise in London, the initial drive for collaboration came from the commissioner. Although the two organisations had already undertaken some joint working, the impetus for increased collaboration was external. This was combined with a requirement to enter in to a Lead Provider arrangement, which brought a range of issues posed by this innately hierarchical model.

Mutual Ventures led a comprehensive implementation programme, with work streams focusing on discrete elements such as governance, workforce, clinical pathways and risk. Given the tight timescales, building trust and developing the culture were achieved via a series of dedicated sessions for both Boards and as a natural by-product of working through complex issues on each of the work streams.

Throughout the programme, I acted as facilitator and broker, maintaining objectivity and gaining the trust of each of the stakeholders. This also led to the development of trusting relationships across both organisations and began the process of mitigating concerns generated by the imposition of the Lead Provider contract.

As the shared vision evolved and an understanding of the risks and benefits for both organisations increased, the nascent provider collaborative shifted focus to learning from each organisation’s strengths and a belief that they were ‘stronger together’. Shared learning, as opposed to a culture of blame and mistrust, led to significantly improved outcomes across multiple pathways.

Building on existing relationships

At the other end of the spectrum is the provider collaborative I am supporting in Yorkshire, where a Community and Mental Health Foundation Trust and a GP Federation have created a formal alliance. These two organisations had been working closely together for some time and, back in 2021, wished to formalise arrangements to allow shared decision-making and to establish an impactful ‘community offer’, bringing together all the elements of Primary, Community and Mental Health Care.

The existing levels of trust between these partner organisations allowed for the rapid implementation of governance arrangements, aided by continuous pragmatism, and an acknowledgement from both Boards of an emerging ‘one team’ ethos. Protected time for senior stakeholders to engage resulted in a comprehensive Business Plan for the first year of the collaborative, and a range of high profile transformational initiatives.

As we entered the collaborative’s second year, in April 2023, there was a clear desire to increase the aspiration and adopt even more rigorous and evidence-based methods for measuring impact, while embarking on a formal programme of OD. This programme includes ongoing 1:1 discussions with all senior stakeholders, engagement across the wider teams and managers from both organisations, and a desire to marry a bottom-up approach for identification of future areas of transformation with increased profile raising, both locally and nationally, from visible senior leaders.

All of this collaborative’s stakeholders now agree that the increased understanding of each other’s organisations and cultures has directly contributed to increased impact, increased pace and tangible service improvements

Culture as the basis for successful collaboration

As several delegates at the NHS Providers conference declaimed throughout the day, ‘culture eats strategy for breakfast’. Here at Mutual Ventures, we have seen time and time again that however formal collaborative arrangements become, providers will fail to achieve their desired outcomes without a shared culture, an evolving shared vision and meaningful and trusting relationships. Once these are in place, it becomes a relatively straightforward process to implement appropriate governance arrangements, even more so following the passing of the Health and Care Act 2022.

Commissioners and providers must allow time for the softer aspects of collaboration to bear fruit. If focus on this is maintained, providers are genuinely able to overcome the artificial boundaries imposed by NHS infrastructure and move away from the archaic ‘us and them’ mindset. Avoidance of form becoming an unnecessary distraction, ensures that the core focus of improving outcomes for all of our local populations can prevail.

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