In health we often talk about partnerships and collaboration like they are homogenous entities to be applied liberally across public health services.
This approach fails to recognise that partnerships differ in their objectives and may mean that we forget the purpose of collaboration. The partnerships required to ensure highly vulnerable and complex patients do not fall through service or system gaps may be different from a typical partnership between specialist and GP for the average patient.
In this post, consultants Michael White and Gail Winkworth introduce a mechanism for thinking more strategically about partnerships by providing a tool for analysing existing partnerships and building the partnerships required.
Michael White and Gail Winkworth write:
The effectiveness of our public health system relies on the quality of the partnerships we establish with other organisations. No single organisation is sufficiently large that is can achieve the necessary outcomes on its own.
Without bridges, collaborations, partnerships and co-operative relationships the public health system provides a fragmented “booming, buzzing confusion” of services which can confuse and confound clients’ attempts to navigate it.
Unfortunately many partnerships in our health system fail because:
- the partners are not clear about what type of partnership they need, and,
- the partners leave some of the essential building blocks out of their planning and practice.
Leaders need to have a road map that will help them plan how to build the partnerships they really need and to assess how they are going over time. Such a roadmap is provided by the Collaboration Rubric[i] – a framework which describes the four major types of partnerships: Communication, Co-ordination, Collaboration and Creation; and connects these to the three essential building blocks – Authorisation, Capacity and Shared Value.
Four Types of Partnership for Four Different Purposes.
Research on effective collaboration indicates that there are 4 functionally different forms of collaboration, which can be used to achieve outcomes for clients. These increase in complexity as the needs of clients themselves become more complex. The 4 forms of collaboration used in the Rubric are:
- Communication – to build trust and to better understand shared client issues. This type of partnership creates a network of connected organisations that maintain their separate services but which can use simple forms of referral and information exchange to help clients navigate the system. It is the foundation of all other types of partnership.
- Coordination – to increase service accessibility. In this approach the partnerships actively work together to meet client needs and to ensure a “No wrong door” response to clients. It relies on a basic shared planning system and an active “warm referral” of clients between services.
- Collaboration – to address service gaps. The third level of partnership is more complex and builds bridges between services, using out-servicing models and service co-locations to ensure that clients with more complex needs do not fall between the gaps.
- Creation – to accomplish social change in support of improved client outcomes. These partnerships are strongly focused on the broader needs of clients. They rely on service providers to go beyond service systems and models to produce outcomes that require multi-disciplinary or cross-sectoral responses.
These 4 different types of collaboration describe the “What” of the partnership – its purpose and its intended outcomes. The “How” or process to achieve these outcomes is described in the Rubric using Moore’s concept of public value[ii].
In short, this approach emphasises that intended outcomes will not be achieved unless these are supported by:
- An Authorising Environment in which the legal, organisational, leadership, staff and stakeholders support them,
- The Capacity to deliver them, and
- A shared agreement on the Value or Purpose of the partnership and the ways this agreement is led, monitored and managed.
This framework can be used to analyse and build partnerships from the simplest to the most complex. The three essential building blocks are made up of a total of 18 elements that leaders can use to create a detailed picture of the strengths and vulnerabilities of their partnerships and gives them the capacity to plan and to lead.
The framework can be used as a self study tool as part of the organisation’s own action learning process. It provides a basis for discussion with teams or it can be administered as an online survey to generate more detailed analysis. This analysis assists leaders and their teams to shape the future of their partnerships. It enables them to set goals which are achievable and which are transparent to the partners.
In health, the nature of our partnerships can impact access to services and the experiences of our clients. This being the case they may be worthy of further consideration and investment.
• Michael White and Gail Winkworth are independent consultants who work across government. More information on the Rubric collaboration framework is available here.
[i] Winkworth, G. & White, M. (2011) Australia’s Children Safe and Well? Collaborating with Purpose Across Commonwealth Family Relationship and State Child Protection Systems, Australian Journal of Public Administration, 70 (3)
[ii] Moore, M. 1995. Creating Public Value: Strategic Management in Government. Cambridge, MA Harvard University Press
“Collaboration – to address service gaps. The third level of partnership is more complex and builds bridges between services, using out-servicing models and service co-locations to ensure that clients with more complex needs do not fall between the gaps”.
This type of partnership is virtually the cornerstone of independent patient advicacy: an out sourced professional that bridges between services to prevent patients falling into the gaps within a Health System the OECD declared (Nov 15, 2015) “way too complex” for patients. Independent Patient Advocacy inserts a solution before a problem becomes entrenched.