Can we command and control our way to collaboration?
'Collaboration' is the watchword in the NHS at the moment, whether through primary care networks, integrated care systems, or other three letter acronyms. So why is it the experience of many organisations that collaboration comes despite the policy context, rather than because of it?
The under-fire chair of the Pagwell Heights NHS Foundation trust has announced he will leave the position after local MPs called for him to resign.
The Trust has received four enforcement action notices from the Care Quality Commission over its ‘inadequate’ approach to partnership working, and Hunter has also faced criticism from politicians over delays to the publication of a high-profile review investigating the trust’s approach to learning and sharing with neighbouring trusts, and its failure to meet national standards for effective collaboration both inside and outside the Trust.
In a statement, NHS England and NHS Improvement said: “While the Trust was experiencing significant additional demands, the failure to build constructive relationships with its key partners including other NHS organisations, local authorities, and charities, was simply unacceptable. The public would struggle to understand how such little effort given to collaboration could be met with anything other than an immediate change in leadership.”
If we want a more collaborative NHS, is this the future? Do we want it to be?
As you might have twigged, poor Norman Hunter hasn’t been fired from his fictitious trust, nor do I know of any NHS acute chair or chief executive who has ever been fired for their inability to collaborate with others.
Lack of alignment
I write this genuinely torn about whether I want the experience of Pagwell to be one we see transferred to reality. ‘Collaboration’ is the watchword in the NHS at the moment, whether through primary care networks, integrated care systems, or other three letter acronyms.
Why then is it the experience of many organisations that collaboration comes despite the policy context, rather than because of it? The fundamental building blocks of national policy still run counter to the talk: senior managers fired for failures of finance or performance, clinicians celebrated for individual brilliance, single sectors (most often primary care) blamed for system problems.
If we mean it when we say collaboration is the priority, there’s no place for a set of incentives that actively encourages the opposite.
This lack of alignment clearly needs rectifying. If we mean it when we say collaboration is the priority, there’s no place for a set of incentives that actively encourages the opposite.
The crude option is to do as Pagwell does: transfer the tactics of command and control – targets, aggressive performance management, regulation – to a new target of collaboration. One could imagine the use of collaboration metrics as the basis of a new form of accountability which could lead to hiring and firing if standards weren’t met.
Fizz or flop?
Is this what we need in order to embed collaboration in the heart of the NHS? At Kaleidoscope we’ve spent the past five years being fascinated by the art and science of what makes some collaborations fizz – and others flop.
This world of collaboration, command and control style, isn’t without attraction. You’ll find within our characteristics the importance of measurement, and of partners committed to a clear purpose. Collaborations suffer when they’re unclear on what they’re there for, and/or struggle to find a way of measuring whether they’ve achieved it or not.
But then it starts to fall apart. Our characteristics also stress the need for deliberate cultivation of trust and generosity. Of leaders actively working across boundaries. Of governance designed to enable action, not suffocate it.
Yes, effective collaboration requires structure, but it also requires a completely different way of thinking and relating to each other.
As Collaborate CIC have written often about, “It’s crucial to create space to enable leaders to develop the new mindsets, behaviours, relationships and practical opportunities to work together towards shared goals, and support each other as peers in tackling the challenges that come up along the way.”
At the heart of collaboration is shared purpose. At the heart of extreme performance management is the opposite: division, challenge, and the use of fear as a motivator. As we learn how to support high-performing collaborations, we need to be mindful not just of the end result, but the importance of the process in which we get there.
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A version of this blog originally appeared on the website of the really rather wonderful Collaborate CIC