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Towards better collaboration: escaping the cul-de-sacs

How can we make collaboration effective if we're not sure how to go about collaborating well? Rich Taunt navigates his way out of the cul-de-sacs of conventional NHS wisdom on collaboration.

Collaboration is all the rage. Or it’s a pipedream. But definitely one of the two.

The case for: we have the talk – everyone from the Prime Minister down espouses the language of the age of the standalone organisation being over. It’s become obligatory that three letter acronyms must end with togetherness – APCs, ICSs, PCNs.

The case against: name me a target that applies to a system not an organisation?  Name me an acute chief exec who’s been asked to step aside because they fell out with GPs?

So which is it – are we doing collaboration or not? Part of the problem is the disconnect between us wanting to do it, but not knowing how. At Kaleidoscope we spend a good wodge of our time looking at those who do collaboration well, and trying to understand how they go about it.

We’ve just set out eight characteristics of collaborations we see as high-performing. There’s a handy guide (free!), and you can also join us for a digital event on 10 December (also free!) to hear more.

What stands out is that a large amount of conventional NHS wisdom about collaboration is simply tosh. Here are four cul-de-sacs that need careful reversing out of.

Cul-de-sac 1: Collaborative relationships are all organic

Let’s start at the very beginning: how does collaboration happen? Give yourself a pound for how many times you’ve heard that ‘relationships matter’. Mortgage paid off? Me too. If so, then I bet you’ve also had a conversation about how building such relationships is in some way ‘organic’: beyond the reach of forced interventions, can’t be rushed, and, more than anything, the result of serendipity and luck. This is nonsense, and unhelpful nonsense too.

What these theories completely neglect is the role of the environment in which relationships are fostered, and whether it’s helping or hindering such relationships to start and sustain. Culture of turning up late for meetings? That’s a cross. A space to talk about shared issues without short-term performance issues on the agenda? Tick.

In our eight characteristics we talk about the deliberate cultivation of trust and generosity; in short, it won’t just happen through hope alone.

Cul-de-sac 2: You’re either good at it or you’re not

This ‘organic’ view also assumes that being able to form such relationships, you know, that ‘human stuff’, is innate, an ability some have but not others. There’s some truth in this, but only in as far as some of us are more or less able to do pretty much anything.

The problem is that viewing collaboration as this mystical thing stops it being translated into a set of actions and behaviours that can be learned and improved upon. In the formation of ICSs there’s been little mention of the specific collaboration skills required from leaders to make them work.

This is particularly important because the grounding – both formal training and informal expectations – of our entire leadership cadre has been in the opposite direction. Our characteristics stress leaders actively spanning boundaries, a position not many NHS leaders will have been incentivised to fill previously. If you’ve spent your life being asked to play golf, why would you be expected to be good at rugby?

Cul-de-sac 3: Collaboration and competition can’t co-exist

Which brings us to the most widely held of collaboration’s simple, elegant, but wrong beliefs. It’s competition or collaboration, but not both: which do you want? Not quite.

Let’s think about construction: pretty much every major building company in the UK has been collaborating together to build High Speed 2, while simultaneously bidding furiously against each other to win other work. Or processor chips, where Intel, AMD et al battle it out in one of the most competitive industries in the world, yet still choose to collaborate (for example on industry standards) when they have mutual interest to do so.

If you want to collaborate with someone else you don’t have to agree about everything or, in fact, very much at all – there just needs to be enough alignment of purpose to make it mutually worthwhile. There’s a reason that having a ‘purpose-driven strategy’ is the very first of our characteristics. Simply, how can a collaboration succeed if it doesn’t know what’s it trying to do?

Cul-de-sac 4: Collaboration is all it’s cracked up to be

Arguably, this painting of competition (very bad) versus collaboration (very good) leads us to think we’ve uncovered a panacea. Every policy document shouts that only by working collaboratively together can the NHS confront its slings and arrows.

Again, there’s truth there, but a collaborative approach isn’t always going to be the right one, and even when it is, we need to be realistic about the benefits it can bring. The NHS’s desire for world class services at the same time as unparalleled cost savings won’t be solved by a greater dosage of collaboration.

We need a far more sophisticated understanding of when – and what type of – working together is appropriate, and what’s reasonable to expect it to deliver. Measurement (another high-performing characteristic) is key. Far too often, collaborations don’t have a way to track their progress, which makes their very existence hard to justify when challenged.

The art and science of collaboration is endlessly fascinating, so do join us on 10 December if you want to think through how the characteristics apply to you and your work.

Collaboration is not black or white, it’s a panoply of colour that warrants further dissection and discussion – undertaken together, obviously.

A version of this blog originally appeared on the website of the very excellent organisation, NHS Providers.

Rich Taunt24 November 2021


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