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A Development Approach to Improving Inter-Agency Working
DELIVERING "OUR NATIONAL HEALTH" THROUGH STRUCTURED DEVELOPMENT SUPPORT
"Many people and organisations contribute to the development of health and to the delivery of health services. The quality, speed and responsiveness of the journey is determined by how effectively these different people and organisations work together."
Our National Health 20001
The need to develop effective joint working between care agencies is recognised within the health sector as an essential foundation to improve services for local people. This imperative from the Scottish Executive, expressed through "Our National Health", requires the development of new models of joint working, between professionals, between professionals and the public, and across organisational boundaries in the public sector.
"It is not just the NHS which provides health care services. Local Authorities, voluntary organisations, independent providers and community health groups all have key roles to play. We expect the NHS to adopt a holistic approach to the delivery of healthcare and to work closely with a range of others to meet local needs effectively."
Our National Health 2000
BACKGROUND
The Scottish Executive Health Department has identified, as a key priority, the need to support health care organisations to develop and accelerate partnership working both within the NHS and across other agencies.
In September 2000 the Strategic Change Unit started working with three Local Health Care Co-operatives (LHCCs) across Scotland to pilot development approaches to partnership working to improve local services.
The inter-agency pilot project was designed to improve joint working between public sector agencies in order to deliver specific service improvements. It endeavoured to help pilot sites to identify and tackle the challenges of inter-agency working, and agree shared local action plans.
It became clear during the pilot work that the experiences of individuals and organisations that emerged are not unique to LHCCs and consequently:
LEARNING FROM THE PILOT SITES IS TRANSFERABLE TO OTHER SITUATIONS INVOLVING CROSS BOUNDARY WORKING. |
THE LHCC PILOT SITES
Each pilot site was introduced to the project for different reasons. Two were building from the
basis of an agreed strategy for specific services, and sound and mature relationships between the partner organisations at both strategic and operational levels. They saw the opportunity to identify and learn from their successes and to extend this success into other service areas. Equally, they recognised that to achieve lasting partnership across the whole of the local health and care system, they needed to identify and address the barriers that were preventing them from taking the next steps. In particular, to involve agencies beyond health and social care, and to integrate users and carers into the decision-making and implementation processes.
One site saw the project as primarily a development tool for tackling the perceived organisational differences that existed within the health and social care system. They identified barriers between and within the organisations responsible for planning and delivering services and deploying resources across primary, community and social care services. The different geographical, social and client groups in each site provided a cross section of demographic characteristics.
The pilot sites were: |
Airdrie LHCC | Services for Older People |
East Highland LHCC | Services for Older People |
Glenrothes Area LHCC | Drug and Alcohol Services |
THE RESOURCE GUIDE
The Resource Guide summarises the outcomes and captures the learning/themes from the three pilot sites. Each theme is illustrated with specific examples from the pilots and with quotes from managers, clinicians, users, carers and facilitators who participated in the work. These are included in the shaded boxes in the text.
Part A: Summary of the Development Approach in each Pilot Site and the Learning Points
The themes include:
Building effective partnerships
Using a development approach to support inter-agency working
Roles and responsibilities
Involving users and carers
Facilitation of the development events
Achieving long-term commitment to the process
Using a development approach to support inter-agency working
Roles and responsibilities
Involving users and carers
Facilitation of the development events
Achieving long-term commitment to the process |
This Guide provides a "snapshot" of the learning from the pilot sites, at a point in time. Each of the sites has continued with their local initiatives beyond the formal completion of the pilot project.
Part B: Guide for Managers and Organisation Development Practitioners
Aims to provide assistance/advice for managers, developers, and trainers who wish to use a development approach to support partnership and inter-agency working.
The approach taken by each pilot site required a high level of understanding and skill in organisation development by the project co-ordinators. The Resource Guide will help you to determine whether you have the necessary skills to lead such a project yourself or identify who in your organisation has the necessary skills.
INTER-AGENCY WORKING - DIFFERENT APPROACHES
Effective inter-agency working is not solely dependent on adopting a development approach. Within Scotland, other approaches, such as joint training and learning opportunities for staff and also designed healthcare initiatives, are well under way.
Joint Learning
There is evidence of good practice in partnership working in Scotland from which we can learn. For example "Learning Together: A Strategy for Education and Training and Lifelong Learning in the NHS in Scotland", provides a framework to improve the existing education, training and development opportunities for
all staff. An Inter-Agency Project Group was set up to examine the extent of joint working and learning between care agencies, engaging with local authorities, voluntary and private sectors. A range of joint learning initiatives has been identified and more work is underway to identify priority development areas still to be addressed locally and nationally.
Designed Healthcare
The redesign philosophy concerns itself with the radical rethinking and design of healthcare processes to achieve dramatic improvements in the efficiency and effectiveness of those systems that deliver care. The key aim of the methodology is to adopt a whole systems approach and, therefore, to improve the quality and experience of care for patients across the complete journey from primary care through to secondary care sector and back into the community. The objective being to streamline services in order to reduce waits and delays, to speed up access to diagnosis and care and to improve communications between staff, patients and carers. Tackled in parallel with the patient journey are the professional demarcation boundaries, which create inefficient processes and the bureaucratic structures that support them.
A DEVELOPMENT APPROACH TO INTER-AGENCY WORKING
Research shows many initiatives that adopt a policy or structural approach to change, without addressing the cultural and behavioural issues, have failed to reach a successful, long-term conclusion. |
"Despite the good work put in, the project can be seen, with hindsight, to have never been capable of achieving the ambitious agenda set out for it - at an early stage in the project a diagram was devised - to encapsulate the key themes that were likely to emerge - these included co-ordination, communication and continuity. All these were indeed important. But this was too mechanistic a view and missed a key factor: culture and ethos- The emphasis from the evaluation on culture might seem trivial. It is not. It is fundamental to joint working in any sphere.'
2
Each pilot site engaging in this project could identify local examples of good practice in inter-agency working. However, they recognised that in order to achieve long-term, sustainable change in services across the care spectrum, each agency must learn to value and work with the diversity that they encounter in other agencies.
The common theme within each pilot site was that they wanted to engage with partners in the local health and care system to:
increase their understanding of the service improvement issues;
identify the characteristics of successful collaborative working;
identify the blockages that were preventing them from extending partnership working.
The aim was to develop joint strategies to accelerate inter-agency working across the wider health and care system.
Each pilot site tried to help local professionals, users and carers to make connections and find sustainable solutions to local complex multi-organisational problems. |
BENEFITS IDENTIFIED BY THE PILOT SITES
1. Understanding Roles and Improving Communications
Participants from all sites indicated that they had developed a greater understanding of roles and responsibilities across professions and agencies. Participants were encouraged to understand each other's cultures. This led to a greater acceptance of how people from different agencies and, most importantly, users and carers, actually view service issues and problems.
"The workshop set a foundation for greater understanding which allowed initiatives to proceed with more ease" "We had an improved understanding of the role of the agencies, particularly those within the statutory sector" "As a consequence, GPs are beginning to forge new and closer working relationships with the new consultant"
"Communications between agencies and sectors (statutory and voluntary) have improved." |
2. Agreeing Strategic Priorities
The development process provided a structured period of time when everyone could review current strategies and local priorities.
"The development workshop was instrumental in changing the focus and organisation of the DAAT" "It helped DAAT to develop its corporate plan and prioritise issues" "By participating it helped me to achieve a greater level of understanding of planning and implementation constraints that exist within other services." |
3. Delivering Service Improvements
A number of service benefits were identified.
"Users are being trained alongside staff in drug and alcohol addiction services, enabling increased education amongst users" "An alcohol advisory service is working in partnership with the accident and emergency services to promote the voluntary sector services" "A funding bid for integrated health and social care delivery of services resulted from one workshop" "Joint training initiatives have increased" "A multi-agency task group are implementing a joint assessment tool for older people's services" "A review of access to health and care services for older people is underway with the intention of changing access to benefit patients and use scarce resource more effectively." |
4. Focusing on Inter-Agency and Inter-Professional Working
There was an awareness by clinicians, health and social care practitioners and managers, of the need to work across boundaries to improve the patient's journey and the delivery of services/care for patients. There was also a clear recognition that joint working requires a time commitment in order to build new relationships and deliver agreed outcomes.
"The event highlighted the need for multi-agency working. There was also a greater understanding of the realities in terms of time constraints, decision-making and resource implications. It was an extremely valuable experience" "We clearly identified the need for a team approach, involving a range of professions and agencies, to make this work." |
RECOMMENDED RESOURCES
Heron J (1999)
The Complete Facilitators Handbook Kogan Page
Loxley A (1997)
Collaboration in Health and Welfare Jessica Kingsley Publications
Margulies N & Adams J (1988)
Organisational Development in Health Care Organisations
Addison-Wesley
Pratt J, Plamping D and Gordon P
Partnership: Fit for purpose Kings Fund
Pratt J, Gordon P, and Plamping D (1999)
Working Whole Systems: putting theory into practice in organisations Kings Fund
Sainsbury Centre
Taking Your Partners: using opportunities for inter-agency partnership in mental health (2000) The Sainsbury Centre for Mental Health
Scottish Executive Health Department (2001)
Organisational development in the NHSiS: Recognising Roles, Skills & Capability Organisational Development Practitioners Working Group with the Strategic Change Unit
Smale G (1998)
Managing Change Through Innovation The Stationery Office
Stacey RD (1996)
Strategic Management & Organisational Dynamics London, Pitman
ACKNOWLEDGEMENTS
Many people have committed a considerable amount of time, energy and enthusiasm to the three pilot projects. We would like to acknowledge the contributions of staff from Fife Primary Care NHS Trust and Glenrothes LHCC, Highland Primary Care NHS Trust and East Highland LHCC, and Lanarkshire Primary Care NHS Trust and Airdrie LHCC.
There has also been an invaluable contribution made by many staff and managers from the wide range of organisations and agencies involved in supporting and providing health and care services to the local populations of these LHCCs.
We would like, in particular, to acknowledge the invaluable contribution by Anne Tofts of Healthskills, both to the delivery of the learning events and the composition of this Resource Guide.
In particular, we would like to acknowledge the invaluable involvement of the Users and Carers in the development events.
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