Collaborate has a resolution for 2019: to be bold about the future we want to create. Specifically, what a Collaborative Society could look like, how you build it, and where the green shoots are already paving the way.
We have invited a number of leading thinkers and do-ers to contribute their ideas about this concept and its implications through a blog series, as well as events and a podcast series in the autumn.
In the second guest blog in our series exploring the idea of the Collaborative Society, Richard Taunt from Kaleidoscope Health and Care explores how the normal command and control might not be the right approach to engendering a collaborative culture within the NHS and local health systems. How we create new forms of mutual and local accountability, governance, and leadership feel like they are at the heart of Myron Rogers’ maxim “the process you use to get to the future is the future you get”.
Exploring the Collaborative Society:
How do we build and support collaborative culture within public services?
If we want a society with collaboration at its heart, what will we do to get there? It’s a question we ponder with regards to the NHS at Kaleidoscope — a social enterprise which brings people together to improve health and care. In thinking this through, a story caught my eye:
Under-fire chair to step down
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.
Norman Hunter said he would leave the trust at the end of August, stating that he wanted to “regain a better work life balance.”
The trust’s Lower Pagwell Hospital received four enforcement action notices from the Care Quality Commission last year 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.
Local MPs raised concerns over the independent review commissioned by Hunter and NHS Improvement in order to look into doubts raised by senior clinicians about the trust’s poor performance against national standards for effective collaboration both inside and outside the Trust.
In a statement, 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.”
Pagwell MP Heath Robinson said: “This is clearly for the best for Pagwell’s hospitals as well as for Norman personally. I look forward to working with his successor as they bring in the new leadership that the trust needs to deliver the effective joint working that local people deserve and the hospital’s staff care so passionately about delivering.”
If we want a more collaborative society, 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 chair or chief executive who have ever been fired for their inability to collaborate with others.
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 the experience of many organisations that collaboration comes in spite of the policy context, rather than because of it? For all the talk there remains a disconnect to how power is wielded; senior managers are fired for failures of finance or performance, clinicians are celebrated for individual brilliance, and national leaders are still appraised on the success of their organisation, not the system in which they work.
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 which actively encourage 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 (evidence-based) collaboration metrics as the basis of a new form of accountability which could lead to hiring and firing if standards weren’t met.
There’s an attraction to this; if we care about collaboration, surely we want to use the strongest possible means to make it happen. We would certainly benefit from data to measure the strength of the NHS’ collaborations, and policy-makers fixated on partnership working — neither of which we currently have.
However, let’s step back and think about the behaviours we would want to see in any system which does prioritise collaboration. As Collaborate CIC wrote in their April blog, “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 build a policy context which best supports collaboration, we need to be mindful not just of the end result, but the importance of the process in which we get there.
Rich Taunt is part of Kaleidoscope Health and Care. You can find out more about Kaleidoscope’s work at kaleidoscope.healthcare