Ingredients for a successful partnership


The case studies reflect different scales of partnering (individual
versus structural) and different natures of partnering (mandated versus voluntary). They suggest that all these types of partnering can make a positive contribution to improved quality, given the correct opportunities, investment and environment.

  • Individual partnering can provide a cost-effective means to introduce new practices, and enable mentoring and reflection for those leading improvements. It has the potential to drive entrepreneurial activity, injecting innovation and energy to improvement efforts.
  • Structural partnering facilitates more fundamental and sustained change across organisations and systems. The formality of agreement enables partners to have the confidence to invest capacity and energy in the arrangements and increase the scale of impact. Partnering can be successful between NHS and private organisations and bring helpful diversity of resources, skills and networks.

  • Mandated partnering by regulators can make a positive contribution to the recovery of a struggling organisation. It requires careful assessment of
the factors underlying the poor performance, and the partner to have sufficient capacity and motivation to respond to these factors.
  • Voluntary partnering has the potential to tap into
the intrinsic interests of those involved. However, appropriate coordination and governance is needed to plan and periodically analyse impact to make sure benefits are being realised.

Leading and managing partnering is different

The importance of senior and clinical leaders in achieving successful change is well established. This is also true in partnering, where engagement and influence has to cross organisational and service boundaries. Staff members not only need to have faith in their own leaders but also in those of their partnering organisations. A clear rationale is therefore needed in any partnering arrangement.

Managing across partners provides additional complexity due to different financial processes, internal accountabilities and underlying cultures.
These complexities must be recognised to enable logistical issues to be considered and addressed.
For example, HSMC’s research finds that structural
partnering requires a formal infrastructure with support from shared project management capacity. Individual partnering may start informally, but will eventually need a framework to be sustained in the face of clinical work pressure. Testing out potential partners through smaller projects provides an opportunity to explore if the considerable investment in management time will be worthwhile. Rushing in to structural partnering and a presubscribed arrangement may lead to a poor fit and considerable diversion of management time.

Individual trust will always be key

Whatever the scale of the partnering, there will always
be individuals whose personal collaboration will be key to success. Entering into such arrangements voluntarily will
entail additional risk to resources, reputation and capacity. Successfully managing this risk will involve these key people being able to trust that their partner is sensitive to their requirements and pressures, and that they will act in joint rather than self interest. Previous positive interaction provides a foundation for collaboration, but such relationships will not always be in place. To otherwise enable trust, partners need the opportunity to progressively build a relationship over time through less risky and lower intensity projects, and their values need to be well aligned in relation to the partnership endeavour.

Mandated partnering arrangements that are brokered by an external body may not benefit from a good cultural fit. In such cases, the organisations will need to adopt one of their cultures – usually that of the organisation perceived to be higher performing – or develop a new, shared culture.

Doing so will require considerable and sustained
effort across all levels of each organisation, which will take years rather than months. In such cases, trust will be fostered by transparency in what is being planned and initial agreements being honoured. Requiring a provider to engage with multiple partners as part of an organisational improvement plan will mean that multiple cultures need to be understood and responded to, which may be an unfeasible expectation at such a time of change.

Meaningful data are vital

Generating relevant, accurate and timely data to show the impact of partnering is a challenge. HSMC’s research finds that structural partnering has to consider a wider range
of factors, but its scale has some advantages in that aggregated CQC and NHS staff survey performance measures may have some relevance. Smaller, more contractually based arrangements can include targeted data gathering and connected resourcing as part of the contract agreement.

There are also practical challenges of accessing data from across multiple providers with different information governance arrangements. In structural partnering, a joint performance board – which develops the dataset, considers related analytics and acts on the findings – is essential. In mandated partnering, regulators being part of such a board can provide a similar assurance.

Given the local contextual arrangements, individual partnering may require customised approaches initially, so organisations entering into such partnerships need to recognise the capacity cost. Patient perspectives can be invaluable in testing if partnering is leading to improved experience, which will motivate clinicians to maintain their commitment.

The environment can make or break partnering

The environment plays a major role in helping the partnering arrangement to achieve its potential, or preventing it from doing so.

Overly simplistic expectations and additional reporting requirements from external bodies could provide interference and distraction. Those who create such environments through commissioning, policy and regulatory processes must therefore be aware of their influence and use this responsibly. They should also recognise the limitations and costs of mandated partnering and
that sometimes other types of partnering may be more appropriate.

Mandated partnering should not purely focus on the organisation of concern but also seek to engage the wider system. This can provide opportunities for partners to draw on additional resources and help to generate public approval for such arrangements. Quality oversight committees that involve regulators and other national bodies can provide an effective forum, enabling relevant connections and giving assurance.

Mandated partnering should be considered with caution and may be best seen as an option that
can be offered rather than insisted on. If more directive intervention – such as integration of two or more organisations – is deemed necessary, then it is crucial for regulators to be open about these arrangements to engage staff and wider stakeholders.

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