Creating value and successful collaborations between organisations

When collaboration works, it is a powerful way to improve care, outcomes and the experience of both patients and staff. So this week we reflected on what we need to think about to make collaboration more concrete. There was so much to take away from the conversation (you can see a recording here if you’re curious) but here are three things that I’ve been particularly reflecting on.

1. The importance of shared purpose or belief

A common thread in stories about innovation or change in health and care is the person who just kept going — despite the challenges in the system, or number of times the computer said no. Invariably at the centre of a story like this, you will find someone with a belief so strongly held that it anchored them. They were able to overcome the barriers and describe their belief (the purpose of their work) in a way that people could understand and get behind.

Clarity of purpose sounds so simple, but it’s often the phase of collaborating that we skip. This resonated for me because clarity is only possible if we’ve spent time defining what our end goal is (and isn’t). Generally, we’re good at identifying a broad sense of direction, but getting granular about what success looks like, is not often prioritised.

We also need clarity about the value the collaboration gives us. Again, we’re often able to describe at a high level why we’re working together, but we’re not often explicit about the value our collaboration will give us.

Our view at Kaleidoscope is that there are four ways collaborations can create value (you can read about them here). Over the lifetime of a collaboration we may move between all four. Being clear at any given time about why we are collaborating not only fosters alignment but also mitigates confusion. And in turn, this clarity of purpose, alignment of membership and lack of confusion results in a more impactful, better functioning partnership.

2. The context of the collaboration

Anyone who has worked in or around health and care in the UK will know that structurally we aren’t set up to work together. For lots of historical reasons parts of the system have been in competition (at best) and oppositional (at worst). System risk isn’t shared, funding flows de-incentivise collaboration and a “us and them” narrative can still pervade.

…it’s understandable that the people you are working with can often bear the scars of this history.

When you take this into account, it’s understandable that the people you are working with can often bear the scars of this history. One of our speakers, Adam Doyle (CEO, Sussex ICB), described this as leaders having “moral injury” which they need to recover from.

If you are trying to create a high-performing collaboration where a lack of trust exists, then before you can do anything, you need to be able to shift the dial on interpersonal relationships. That takes time and work.

On that note, Adam also touched on a system habit to “hide” in governance complexity. We will have all encountered the “My board won’t sign off on that” response in discussions about change. Adam hypothesised that rather than this being an indicator of inflexible governance, it’s more likely that your partners don’t trust or feel safe to bear risk. And whilst it’s true that pre-existing governance mechanisms don’t always serve an emerging purpose, you can make them cleaner, simpler and more effective — but only once trust has been built.

Again it seems simple: people in systems have history which needs acknowledging and (in some cases) work to repair. But we start on a path of collaboration with the view that the collaboration goal is enough without taking time to acknowledge the history of the organisations and people participating.

3. Hard data, hard graft

All too often we can view collaboration as a “fluffy” thing that distracts from getting the real stuff done. There are plenty of “hard” things about successful collaboration. My third take away on concrete collaborations is that doing them well is hard work, and needs hard data.

Effective collaborations take work – they don’t just happen because a piece of legislation or a restructure requires them to. It can be hard to do the work to repair relationships and trust.

Good data is a powerful tool in understanding your context, the impact your work is having and empowering those who are part of it to stay committed. At Kaleidoscope, we use a diagnostic to produce data on which of the characteristics of high performing collaborations we need to focus on.

Effective collaborations take work – they don’t just happen because a piece of legislation or a restructure requires them to. It can be hard to do the work to repair relationships and trust. Create the space and capacity for the people who are in your collaboration to trust each other, and that this work may be hard to get started, but it will pay dividends in the end.

Listening to our speakers, I was struck by the generosity and candour with which they shared their learning, and by the energy and enthusiasm to build on these experiences shown by others joining us.

So my final lesson: we’re all learning together about what works in collaboration, so it takes a willingness to collaborate even to understand how we continue to improve our collaborations in practice!