Accelerating Change Programmes

Seeking the approaches that enable faster change in the complex world of health and social care

Foster coordinator behaviours to accelerate change

Working with organisations that want to make change in partnership is really, really, really hard. It’s complex, ambiguous and very frustrating, but when it comes together, it is something to behold.

In health and social care, in England, partnership working is increasingly crucial for success. It is a key part of the Five Year Forward View and is at the centre of integrated care. Increasingly, health and social care organisations need to be comfortable working in partnership with each other, despite the many drivers that make this difficult;

  • different organisation accountabilities (internal and external)
  • different organisation objectives
  • different targets and priorities (national and local)
  • different professions and cultures
  • financial and performance incentives that benefit individual organisations rather than a system
  • different planning time horizons
  • no one organisation is in charge of the partnership.

Health and social care organisations operating in the same geographic area have a symbiotic relationship, their success being dependent upon each other. There are a number of examples of what can be achieved if the inter-dependencies of the symbiotic relationship are able to triumph over the differences. The most notable examples are Torbay and Canterbury, New Zealand. Both of these examples of successful  partnership working highlight the importance of the relationships and trust between organisations and support the notion that the effectiveness of partnership working has a role in accelerating change.

In partnership change, are these relationships and the trust between organisations something that these initiatives focus on? My experience is that much more time is spent understanding the orgnisation position or needs, than on the collective activities that support the development of partnership trust and relationships.  I often come across behaviours and activities that work against the development of good relationships and trust, for example:

  • Individual organisation away days, focused on the partnership work
  • Separate organisation pre-meetings before partnership meetings
  • Discussions/decisions in meetings that focus on what the organisation needs from the partnership, rather than what the partnership needs from the organisations
  • Avoiding joint governance to make key decisions
  • Joint project teams with work still managed by the separate organisations
  • Avoidance of relationship/trust issues, preferring instead to deal with the easier transactional issues.

These all highlight the difficulty of partnership working and that it’s easier to give the impression of this type of working, rather than actually focus on the relationships and trust that underpin it and create acceleration. These aren’t just about the top layer of management, rather these are features that can be seen through all layers. Joint away days, partnership managed teams, delegated authority to joint governance and challenging meeting behaviours will aid the development of relationships, however I’ve discovered a coordination role that really helps acceleration and the development of relationships and trust.

This coordination role was always present when sustained acceleration was described in a piece of research I undertook. It may seem obvious, but this is someone, at any level, who is tirelessly focused on the partnership vision and outcomes rather than any organisation agenda. These coordinators spend a lot of time meeting people from the different organisations or professional groups and articulate the agreed vision and delivery of  associated outcomes. I had thought that these roles needed to be independent, however it seems that these coordinators can be from organisations within the partnership, as long as they behave as if they aren’t. In undertaking this role, they improve relationships and engender trust, as they focus people away from the divisive organisation specific agendas.

Working in multi organisation change, is really difficult, however, if you can foster coordinator behaviours, relationships and trust will improve and change efforts will begin to accelerate.

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