Fragile marriage

With multi-agency working on the rise, Kirstie Redford looks at how to build relationships to keep all parties happy

Many organisations are reaping the benefits of multi-agency working, such as fairer decision-making and avoiding duplication. But, like any relationship, multi-agency teams have to work hard to get the best out of each other.

The most important facet of multi-agency working is clarity over roles and responsibilities, says Harumar Rashid, manager of Tower Hamlets Council’s MAP (Multi Agency Preventive) project that involves social workers, psychologists and youth workers. “Everyone needs to be aware of each other’s roles so they can draw on each other’s skills and work in partnership,” he says.

This can also help avoid unnecessary conflict. “If there is no understanding, there is no respect and it makes it harder to resolve differences that can emerge because of different professional backgrounds,” says Rashid.

For all the benefits, some believe multi-agency working puts professional identity at risk. Maggie Draper, specialist palliative care social worker at Selby and York PCT, says: “It’s important not to have too much of a hierarchy so you are not threatened by other groups. Everyone has their own unique contribution, which they should be allowed to give. It’s important that all members of the team recognise this.”

Draper cites a recent example where a new occupational therapist joined her team. At first everyone used her solely for equipment referrals. But then she did a presentation demonstrating her other specialist skills, which the team had been unaware of. For every individual to contribute fully, their colleagues must understand what they have to offer.

It sounds obvious, but good communication is of paramount importance. Some organisations provide training on communication and working in a multi-disciplinary team. Without the right training, teams often get off to a non-start. Rashid says: “More needs to be done to improve training around joint working. Teams need clear strategies.”

Kathryn Caley, associate director of community services at Cambridge City and South Cambridgeshire PCTs, has tried to address this by providing organisational development days for multi-agency teams. She says: “These take people out of the work environment to look at the objectives of their teams, helping to identify any anxieties they may have. People learn about each other’s roles and how they can complement each other’s skills rather than duplicate them.”

Co-ordinating training for practical tasks can also iron out potential problems and allow people to air their views on everyday issues.

Rashid says it is equally important to assess the outcome of projects. “Did working together have a meaningful outcome? If not, what went wrong?” he says. “You need a clear understanding of what the outcome should be if agencies are to adhere to agreed principles.”

Without the right training, team members will be uncertain on how to deal with conflict. Draper says: “A nurse may say that a patient is ready to go home, but a social worker may say that the carer doesn’t want to look after the patient. Ideally, team members should come to joint decisions. But all too often it can end in a discussion about where the power lies and whose budget the decision affects.”

There will be times when a joint decision cannot be made and management must intervene. Caley says: “This is why we have both a social care and nursing presence on the management team, so there is a fair mix of skills.”

Draper thinks there is no quick route to effective multi-agency working – it just takes time and a lot of commitment from all parties. She says: “When you work with the same team over time, a coalition develops. You gain a greater understanding of how each other work and ultimately how to work together effectively.”