The features of effective partnership working are groups that have a responsibility to cooperate in undertaking mutually agreed service goals. In doing so no one has full control in every situation however some health and social care partners will be more independent and will exert more power and influence than others. The main feature is an acknowledgement that a true partnership empowers the service user, their carers and professionals.
Partnerships emerged as a result of the 1980s policy drivers for joined up services (Ling,2000) this led to the culmination of the Health Act of 1999 which imposed a new duty on health and social services to cooperate and have the operational flexibility to enable joint working. Policies were developed to ensure that individuals were at the centre of any partnership and would therefore have a stronger voice and more choice in how services were to be delivered. The importance of partnership working with colleagues and other professionals is community empowerment and to empower clinicians so that they can improve the quality of collaborative services.
Partnership working delivers better outcomes by having the ability to develop a strategy that providers can agree on. The key relationships must be between the service user and those that care for them. The shared sense of purpose has to be the quality of the service from the user’s perspective. Often nowadays the funding and organisational arrangements support a dependant agency relationship despite initiatives to move towards personalised budgets. However the personalisation agenda which is the building of a system of care and support, in which individuals define their own requirements, give the service user the opportunity for self-directed support and could transform types of partnership engagement. There are barriers to partnership working such as the day to day issues involved in coordinating the unrelated organisations and personnel as well as other barriers that relate to the lack of planning in order to bring people together with different responsibilities, values and expertise.
These barriers can be overcome by partnerships agreeing priorities, delegating roles, sharing values, communicating effectively and training together. Setting organisational priorities means having clear objectives. Partnerships can quickly lose sight of objectives in the hustle and bustle of an everyday activity and may assume that the unspoken objectives or a shared desire of work together are enough. It’s important to remember that not all staff are professionalised or regulated so the assumption of shared values cannot be taken for granted and should be clarified at the outset. Doctors, social workers, nurses and therapists will all claim their ethical commitment which necessitates putting the interest of the service users and their carers first and this means that there is a level of consistency in the stated values they share; however, they all have interests related to their own position and job security.
This is why health and social care workers are expected to be capable of internalising the conflicts that arise in partnership working and focus solely on their service user’s needs. My role and responsibilities in working with colleagues is to be compassionate and committed to working collaboratively with my colleagues, reporting my concerns and being able to record any information I deem relevant to ensuring the safety of service users. Although my health and social care colleagues may have disparate perspectives, they may share many professional values with me such as supporting people in difficulty and treating people with respect for their privacy and dignity.
It is imperative to develop and agree common objectives when working with colleagues. At the root of meaningful partnership working is empowerment. And the fundamental skill in developing successful partnerships is the ability for everyone involved to recognise their different roles and to share control and influence. Therefore, key considerations need to be made which will determine how much responsibility the workforce should assume and what level of informed decision making is required. This includes;
-the degree of social vulnerability of the service user
– the complexity level of their health care need
– the level of variability in the support required
One must involve all the staff from the outset in agreeing their working roles and responsibilities in order to gain trust however according to Pastor (1996) empowering the workforce involves the manager moving on from a stage where he or she makes all the decisions to consulting and informing the team through various forms of relationship building, this makes the staff feel accountable. This form of management can eventually lead to completely autonomous teams who may or may not decide to consult the manager. No matter what the complexity of relationship building, according to Moss Kantar (1994) it is a process that can be simplified into eight components. She suggests that there are eight ‘I’s that create a successful ‘we’ of true partnership working. These can be applied to health and social care practice as follows:
Individual – Partnerships are built on individual excellence first. This means that organisations fully appreciate the expertise of their entire workforce and gives users a real choice.
Important – The relationship should be important to all partners. Users must be assured of the continuity of professional services.
Interdependent – Relationships are interdependent and that there is an assumption that all professional want it to work.
Investment – The partners invest in skills aimed at maintaining and developing team working
Information sharing – Sharing of information is central to successful partnership working
Integration – Integrating service provisions so that professional partners learn from each other and their service user.
Institutionalisation – Institutionalisation of the service ensures that the service user’s involvement is given formal status
Integrity – Partners behave towards each other with integrity.
I feel that when working in relationship with colleagues I must try to enable staff to share ideas and efforts in order to bridge the gaps in delivering services. By colleagues I am referring to service sector providers, professionals such as nurses, doctors, therapists, institutions and communities, public private and voluntary sectors and all care groups for acute and long term care including those with mental health and learning disabilities.
I need to reflect and honestly evaluate my own performance, and discover ways to improve it through skills development. This requires me to work with others to identify my strengths and weaknesses, find out what information and support is available to help me develop a plan covering my personal and professional aspirations, and then put those plans into action.
Evaluation is to monitor my performance in partnership working regularly to make sure that it is as effective as possible, get regular and useful feedback on my performance, regularly describe and analyse any improvements that need to be made, either by me or through involving others, maintain a level of knowledge and understanding that enables me to carry out my role effectively, change the way I work in line with any relevant or new approaches or recommendations, use feedback from clients, contacts or colleagues to identify any skills gaps, develop a personal development plan and update it regularly to include new aims or achievements.
Conflict can arise if a partner’s expected contribution is determined by skill rather than personal qualities and sometimes roles overlap or merge and boundaries for roles can become blurred but sometimes maintaining distinct roles becomes important so that individuals can make their unique contribution. Dealing constructively with any conflict that may arise with colleagues can involve analysing why there was a conflict and whether it was caused by blurring of role boundaries and ensuring that no power is undermined during times of less distinct roles and ensuring that roles are still respected.
All health and social care professionals will share an imperative to protect service users’ rights and promote their interests and independence.
All health and social care workers need to have a respect for others and a compassionate nature. I take my responsibility seriously and believe that I must be able to:
1. respect the skills and contributions of my colleagues
2. communicate effectively with colleagues within and outside the team,
sharing information as appropriate
3. make sure that others understand my role and responsibilities in the team and who is responsible for each aspect of client care
4. join in regular reviews and audit of the standards and performance of the team, taking steps to remedy any deficiencies
5. apply interviewing, listening and observation skills to the joint assessments process and shared reports
6. support colleagues who have problems with health, conduct or performance
7. prioritise client safety and take action if I have concerns about a colleague’s conduct, performance or health
8. treat colleagues fairly and with respect
9. be satisfied that there are suitable arrangements for cover when I go off duty, including effective handover procedures
10. take up any post I have formally accepted; work my contracted notice
11. provide all relevant information about a service user when referring them to a health care professional
12. be satisfied that anyone to whom I delegate care has the qualifications, experience, knowledge and skills to provide the care or treatment involved
13. Be satisfied that any healthcare professional to whom I refer a service user is accountable to a statutory regulatory body or is employed within a managed environment.
14. negotiate and organise skills that enable good team working
15. Deal with difficult situations and manage conflict.
Building strong professional partnerships requires effective people and team skills where all the participants respect each other and consider the interests of their partners as well as themselves. One must create an atmosphere of trust where people feel listened to and where they listen to others, this requires considerable skill and attention. A healthy relationship is built on open, honest and flexible approaches to dealing with people with the intention to cooperate being upmost in everyone’s mind and reinforced by common policies and procedures.
Service users can be placed at an unacceptable risk if professionals do not work out their communication protocol so in order to share information on policy, available resources, user needs and service standards one requires compatible data sets and where possible compatible IT systems and these systems need to avoid specialist language that is exclusive and excluding.
To gain unity requires effort and time agreeing the partnership’s aims and objectives before moving on to an action. The objectives need to be agreed in an inclusive way and must be specific, detailing deadlines, roles and responsibilities. This process requires careful assessment of priorities and agreement on what would constitute the successful outcome.
It is good to have a checklist to start the process and to document the results:
Identify potential members:
Who should be involved? Do we have all the right people together? How many members should be in the partnership and in what proportion? What is the appropriate level of involvement for members? This is sometimes referred to as “stakeholder analysis.” Determine how many members should be in the partnership and in what proportion from across agencies.
Identify responsibilities, arrangements, and objectives of leadership: Who will take the lead? Who will have responsibility for driving the partnership agenda forward? Is there a clear written statement of the partnership leader’s objectives and responsibilities? What accountability arrangements are in place? Do all members agree to these procedures? You will want to devise a clear written statement of who will take the lead/joint lead, their main objectives and responsibilities, and to whom they will be accountable.
Identify the shared vision and goals:
Is there a genuine shared vision and set of goals across the partnership? Is there a common understanding of an agreement to the vision and objectives, and are these documented? Do all partners understand how to achieve this? It is important that members are clear about the purpose and ultimate goal of the partnership.
Determine plans and priorities:
Does the partnership have a strategy/action plan that clearly sets out why the partnership was set up, what it is going to achieve, who is going to do what, and by when? Where does this strategy/plan fit into wider strategies, and how does it link into partner strategies/local priorities? The partnership needs to have a strategy and action plan that sets out a clear structure. The strategy needs to reflect how the partnership will manage change and evaluate how well it is doing.
Determine the function and nature of the partnership:
What is the nature of the partnership? Has this been established? It is important that members of the partnership are clear at what level and function this partnership is operating (e.g., advisory, strategic, networking, joint working or project-based).
Identify benefits for target groups:
What are the benefits to target groups in establishing this partnership? Has the partnership agreed or identified outcomes for specific target groups? If not, why not? This is relevant when the partnership is setting outcome measures. Benefits to target groups need to be clearly established and agreed upon by partners.
The effectiveness of any professional partnership can be judged on its failures and success, therefore, the ability to be clear about the purpose of professional partnerships and monitor their actions the resources they use is essential for any organisation.
Once objectives are agreed one must discuss how ones partnership actions will be measured and specifically how information on those actions will be collected and collated.
Appropriate governance structures (SCIE, 2011) need to cover issues such as:
Supervision and performance appraisal
Professional regulation and accountability
Risk management and an audit of accidents and incidents
Continuing Professional Development and learning
Complaints and compliments
The evaluation of the above should help professionals to remain focussed on the outcomes of the joint actions, on how well they are progressing and what needs to be changed to improve further services.
Studies suggest that there can often be conflict regarding the separation of responsibility between a partnership and the individual partners. The difference between strategic and operational decision making is often the most difficult to resolve, with a reluctance by key partners to delegate authority to the partnership. Clear procedures are needed for everyone to understand how agreements on action will be taken and to help create a sense of shared accountability for achievements and failures of the partnership. These procedures should be agreed upon in writing, setting out the key aims, objectives, and outcomes of the partnership. This will give the partnership structure and boundaries to work within, allowing flexibility to change and grow.
The partnership needs to constantly review its purpose, goals, and targets. In order for members of the group to have an idea of what they are meant to do, an agreed-upon work program/action plan must be broadcasted.
The importance of working in partnership with others is essential to delivering improvements in care to service users and adding value by introducing innovation and change. An example of this is early intervention service that help people with early episodes of mental illness or psychosis and voluntary services such as the Prince’s Trust who help vulnerable adults with education and employment. The voluntary sector brings a number of benefits such as possessing complimentary skills, offering practical advice and help on issues such as housing and finance, having advocacy campaigning experience, providing employment, education and leisure opportunities and having experience of user led and managed delivery being trusted by the wider public because of their independence.
It cannot be assumed that all service users want to be active participants in their care and may be reluctant to be a partner and prefer service providers to make decisions for them. In order for service users to become active in the management of their care services they need to be knowledgeable, motivated and confident. They can achieve this by enlisting the support of advocates to act on their behalf or they can engage with ‘project work’ which trains service users to speak out for services they want.
His criticism of inter-agency partnerships has been that the focus is often on process issues such as agreeing objectives etc. rather than concentrating on the quality of outcomes. Therefore, the government has introduced the new ‘outcomes framework for adult social care services’ (department of health 2011). The framework details four domains for development in future services which are:
Domain 1: Enhancing quality of life for people with care and support needs Domain 2: Delaying and reducing the need for care and support Domain 3: Ensuring that people have a positive experience of care Domain 4: Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm
Agencies with different backgrounds, training and understanding of their service user’s issues need to work together effectively on such outcomes, they have to develop shared vision based on common values of service delivery.
In order to agree common objectives when working with others within the boundaries of own role and responsibilities one must have a joint management structure to clarify the roles of authority, responsibility and mutual accountability. Joint working can not happen without all parties perceiving a mutual benefit in a shared vsision and common service goals.
Having a clear justification that a partnership is required for service users helps to realise the values upon which they can create a shared vision and a rational for action.
The key issues around which realistic reliable and valid objectives for the partners must be built are: Developing mechanisms for communication and sustaining good personal relationships
Providing combined training and development needs with specific attention to mutual trust and attitude Agreeing leadership
Identifying agreed staff and finance resource pools
Agreeing accountability in respect to commissioning, purchasing and providing. Determining agreed boundaries
Agreeing specific policy and procedures
It’s important for partners to get regular and relevant information about the impact of their efforts. Monitoring and evaluating processes allows collaboration at governance, management and practice level so that plans can be adjusted based on the effectiveness of outcomes. Assessment must be considered from various angles such as:
Value for money
The Audit Commission (2005) needs reassurance that public money will be spent wisely and the quality of life for service users will improve as a consequence of this type of working because interagency working can result in ambiguity that may cause risks to organisational accountability.
When inter-agencies work together it is not always clear about where the responsibility and accountability for delivering services lies so clear control structures are needed for:
Policy and procedures
Sharing our differences fairly and openly and looking for positive solutions enables us to get a better understanding of the best way to manage a particular issue. One needs to deal positively with conflict as this helps challenge ‘group think’ a term coined by Janis (1982) which is when a group becomes so insulated that norms develop where certain ways of behaving become accepted and can go unchallenged even when they are wrong or dysfunctional.
Dealing with conflicts challenges the different agencies involved to remain responsive to those that hold different views on how services are delivered and who is bearing the burden of responsibility.
Dealing with conflict involves looking at the following:
Expectations (these can become unrealistic)
Resourcing (can be inadequate, there can also be a fear the resources may be cut or reduced due to the ever increasing involvement with the voluntary sector) Roles (can be misunderstood)