Health and social care agencies have been working together for years – but badly. So what can front-line managers do to improve collaboration?
Strategic decisions about partnership are made by senior management. However, at the level of service provision, regardless of how services are purchased or funded, it is front-line managers who need to provide a coherent package of care to service users. And here, partnership is crucially important.
One man, who cares for his 93-year-old mother, described the response when she developed ulcers on her legs: “When the social services came to see me, she said ‘We didn’t realise your mother’s legs were that bad’. I said, ‘Well I told you when she was in hospital’. When the district nurse comes they say they don’t do legs any longer, they’re too busy, they haven’t got time to wash people’s legs, that’s the social services’ job. So they’re arguing in my mother’s house, who’s going to do what.”1
The conflicting pressures and constraints that the managers in each organisation experience provide one set of reasons. People also bring different professional backgrounds and expectations to partnership and collaboration and come from different organisational cultures. The emphasis in social care on sharing power with other workers and service users often conflicts with the more traditional frameworks held by some health professionals. One consultant complained to a newly appointed mental health team manager that the team had worked perfectly well before she came along – he used to be able to do what he wanted.
While all parties may agree to the purpose of working together they will still have goals that are specific to their own organisation. Both types of goal need to be tackled for successful partnership. When people embark on a health and social care partnership without a clear idea of what they hope to achieve, they are surely doomed to fail.
Front-line managers must ask themselves some key questions to manage work with health effectively:
- Do you understand the context of interagency working in your area and the overall aims of joint working? Look out for potential blocks in your own and the other organisations.
- Are you clear about the purpose of the partnership or collaboration, and why you and your organisation are involved?
- l What are the cultural differences and expectations?
- Why are there power imbalances, and how might you work to ensure accountability, representativeness and cultural change?
- How far is your role in multi-agency work recognised as a legitimate part of your management role, for which you need time, resources and training?
When answers to these questions are unsatisfactory, you have a responsibility to pass on your concerns to senior management.
Arrange joint training programmes for people involved in partnerships, which will pay dividends. Not all on the programme will be managers: finding out how others see things and networking are important starting points. Skills for partnership include being able to communicate and use appropriate language, negotiation, listening, and understanding and respecting difference. Learning these skills can help build a team identity.
Through joint sessions rules can then emerge about how often does the team need to meet, what are meetings for, who needs to be there? At a practice level you can also encourage co-workers to agree on how they will work together – what skills they bring, their working styles, what annoys them – and to give each other feedback after a joint session. Hearing people give brief talks on their organisations and their responsibilities can help unlock some of the hidden assumptions and expectations of working together.
Building trust is essential to successful joint working. Stereotypes of other professionals can get in the way, as well as unrealistic and unchecked expectations of what each person can contribute. Successes should be acknowledged and celebrated: a good outcome helps develop the trust and advance the collaboration.
So it is all in place. We breathe that sigh of relief and go onto the next project. Of course we don’t. Partnerships need constant maintenance, training, commitment and communication – a bit like a good marriage. And when outside pressures emerge, so do the cracks.
Integration needs to be managed or cultures will collide and conflict. Remember: understanding is the road to acceptance.
1 Julie Charlesworth, “Managing across professional and agency boundaries” in Janet Seden and Jill Reynolds (eds), Managing Care in Practice, Routledge, 2003.
Julie Charlesworth is a lecturer in management in the Business School, and Jill Reynolds is a senior lecturer in the School of Health and Social Welfare at The Open University; Claire Smart is purchasing manager, Gloucestershire Council.
“When I was…
…about to work more closely with other professionals in an integrated trust I was worried that managers thought social workers and community nurses were doing similar jobs and they could be knocked together into one worker. I think what’s happened is that we’ve become more understanding of each other’s role. We have been able to stand together with the social workers and defend our role, so the difference between social work and nursing has become amplified and more clear.” (A community nurse)
…trying to negotiate a service I was told by a colleague that they would not need one of those ‘silly, bureaucratic agreement things’ as ours was a true partnership. Needless to say when funding became an issue they were pretty keen to refer back to the details of that ‘silly bureaucratic agreement thing’.” (Claire Smart)
- Partnership working is easy – it’s just common sense.
- It’s not my responsibility – senior staff deal with all that stuff.
- A quick fix will enable your agencies to grab partnership funding.
- Partnership work will save money for your agency.
- Identify the resources needed for multi-agency work and argue for them.
- Work out good protocols for joint working relationships.
- Expect multi-agency work to take more time.
- All partners must understand what they are gaining and losing with the partnership.