If you want to go fast, go alone. If you want to go far, go together.
We work collaboratively to design, plan and improve Nottinghamshire Healthcare services. By working together and bringing in a range of views, skills, knowledge and experiences we can make better informed decisions that lead to services that are more caring and better meet people’s needs.
The Involvement, Experience and Volunteering Team advise and support services in working together with service users, carers and families, volunteers and other partners (e.g. staff, local charities and organisations, social care services). We are here to help you, and we have collated and created lots of resources on this page that will assist you in planning, running and evaluating collaborative work.
The Collaborative Model
In 2017 a group of around 40 people began meeting with the aim of creating a model that could be used to for healthcare services when they are thinking about making a change. The group was made up of volunteers, people that used services, staff from housing and charitable organisation and staff from the healthcare Trust. It was facilitated by Mark Doughty and Tricia Boyle from the Kings’ Fund. The group worked over six months to produce the model and in doing so learnt a lot about tools and models that help keep a group collaborative. The model clearly outlines a process that can be taken if you’re thinking of working collaboratively, but it doesn’t really tell you ‘how’ to work together. Keeping a Collaborative Partnership functioning can be the real challenge, have a look at the information further down this page on the Tools and Theories of Collaboration for ideas, advice and resources.
The Big Idea
The idea can be about a specific service, a group of services, Trustwide or across an area. Is the idea for service change from:
- Service users/carers
- Policy change
With a group of people (including service users and carers) decide if the idea can be done as a collaborative service change project or if not can you make it more collaborative. You will need to consider these questions:
- Are you clear on the purpose and scale of the service change?
- Is there the time and resources to build and sustain a collaborative partnership and work in partnership on the service change?
- Will the collaborative partnership be able to influence the service change?
- Will you be able to follow the collaborative service change principles?
- Are you clear on who should be involved in the collaborative partnership – this should include patients, carers, staff, local statutory and voluntary organisations as appropriate?
- If you are not able to undertake the service change collaboratively have you identified how you can involve service users, carers and other organisations in a meaningful way?
- Have you identified a Collaborative Partnership co-ordinator or lead?
- Is there a person who is ultimately responsible for the service change and approves the collaborative approach?
Building the Team
To build a diverse team with a common purpose. You will need to consider:
- Have you identified the skills, knowledge and experiences (including from different communities) that will be needed by the collaborative partnership?
- Have you invited patients, carers, staff, local statutory and voluntary organisations that reflect the service and the communities it serves to be part of the partnership?
- Will you spend time making sure the aims, purpose, timescales, decision making process etc are clear?
- Will you spend time to build relationships, dialogue, agree principles and ways of working and skills needed to ensure the partnership can work effectively to a common purpose?
- Have you ensured you are open to differing and challenging views?
- Are you all clear about how you are going to work collaboratively?
Understand What’s Around
Gather information from as many sources as possible in order to understand the context.
- Do you know plans for the service in the future?
- Is the Partnership aware of what might impact on the service in the next 3 years?
- Do you understand the needs of the community you serve?
- Does the Partnership understand the service you provide?
- Is the Partnership aware of the finances available in order to deliver a changed service?
- Do you know feedback themes in the last year for staff?
- Do you know the feedback themes in the last year from service users?
- Does the Partnership understand national policy and guidance?
Seek out feedback and ideas, and listen to different communities.
- Have you identified everybody you need to talk to?
- Have you discovered where people are doing this type of change well?
- Have you a clear plan of how you are going to talk and listen to people?
- Do you know which teams might be able to support you with the change?
Make the Change
Doing it! Co-produce the change in your service.
- Have you worked collaboratively in the design of the service?
- Have you worked collaboratively in the set-up and implementation of the service?
- Have you continued to use an approach based on the dialogue model?
- Are you including expert teams e.g. Quality Improvement, Learning
- and Organisational Development, HR to help you make the change?
Keep the Conversation Going
From the start have an open mind and honest dialogue with all of your communities about challenges and changes and keep it going.
- Have you a clear plan of how you are going to continually feedback and update the people you have listened and talked to?
- Have you maintained a regular conversation with everybody you’ve talked to?
- Have you provided regular updates on progress?
- Have you provided regular updates on your thinking?
- Have you provided further opportunities to be involved in the change?
Checking the Impact
How are you going to measure the impact and capture the learning?
- Have you agreed what is important to measure from the start?
- Do you know what can stay the same and will be ok if it does?
- Do you understand what hasn’t worked and why?
- Have you shared the difference the change has made?
- Are you continually capturing your own learning from the process?
Take a look at this playlist of videos about working collaboratively, which includes Paul talking through each of the step of the Collaborative Model. What do you think about this model? Would it work for you? What would you change?
Tools and theories of collaboration
So we developed a model for collaboration, but what we found when talking and working with people was that the model didn’t explain ‘how’ you go setting up a strong collaborative approach. The model has a set of principles and a step by step guide, however it is possible to simply jump from one step to the next stating that’s it’s all been done in collaboration! Of course we all start out with the best of intentions, but often deadlines and the sheer logistics of getting everybody in a room take over and decisions end up being made a little less together than was agreed at the beginning of a project.
A lot of our thinking about collaboration has been influenced by some of the ideas in the film below. The language it uses to describe collaboration is really helpful when reflecting on whether a project has been worked through collaboratively. The film explores terms such as:
- Collaborative Inertia – the natural state of play where nothing happens, meeting and meetings
- Collaborative Advantage – Keeping the collaborative group moving and continuing to work productively
- Structure – getting the right people in the room
- Process – focus on how the right people in the room then communicate with each other
- Constitutive communication – how we understand each stakeholders point of view and find the similarities
Each of the tools below are useful for any group to be aware of a they provide and group vocabulary and agreement on ‘how’ we will work together, and ‘how’ we will communicate. A group being aware of these tools means that they can comment on the process of collaboration, which helps with things like power imbalance in a group.
Debate vs Dialogue
This is an approach that a collaborative partnership should accept individual responsibility for, and have the ability to reflect on whether they are working in a dialogical way. ‘Dialogue’ is not in itself better the ‘debate’ however the group needs to be able to work in a dialogue in order to truly collaborate. This video is a brief introduction to the differences between “Debate” and “Dialogue” and which style may be more beneficial when working with others.
- Debate assumes that there is one answer and that you have it.
- Dialogue assumes that many people have a part of the answer.
- Debate tries to prove others wrong.
- Dialogue tries to work with others to find common understanding.
- Debate listens to find flaws and make counter arguments.
- Dialogue listens to understand and seek agreement.
- Debate defends assumptions as truth.
- Dialogue reveals assumptions for examination.
- Debate seeks closure around own view.
- Dialogue seeks to discover options.
It is an essential component of coming together and working collaboratively and if a member of the partnership is unable to work in this way you can slip into other modes of working which are non-collaborative – see the Thomas-Kilmann model.
A technique based on identifying what is working and working from that as a starting point. A lot of the time we default to identifying the problem and then decide what the solution to it is, this flips that thinking around. In the video below, Jonathan briefly explains Appreciative Inquiry.
This is a useful video supporting Appreciative Inquiry, and quite fun!
Fields of Conversation
This tool gives insight into conversations, and how relationships operate within conversations sometimes helping to generate new ideas and solutions and sometimes getting us stuck. This film is a really clear explanation of the theory. It’s also worth mentioning Amanda Riding’s book Pause for Breath which develops on this theory and gives you the opportunity for some more in-depth personal reflection.
Kantor’s Four Player Model
David Kantor has produced a model on structural dynamics, basically how we have conversations and how they can be mapped. For collaborative groups it’s helpful to be able to understand the conversational patterns that they use individually or as groups. It’s worth taking a look at Kantor’s book ‘Reading the Room’, but for those with slightly less time here is a short summary of the first aspect of the 4 Player model.
Thomas Kilmann’s Conflict Model
It is essential the whole group has a clear understanding of when they are collaborating and when they are not. It should be made clear that you cannot collaborate at every decision you may need to make; however the group need to be able to identify when something will happen collaboratively or not. It is ok for the group to ask members of the partnership to work through a part of the project non-collaboratively and deliver an agreed aim, as long the agreement to do so is reached collaboratively. Below is the ‘Thomas-Kilmann Conflict Mode Instrument’. The group should be aware of this model and it should form the partnership’s collective learning. It is a useful tool when considering which tasks need to be done collaboratively or not.
Ladder of Inference
We all make assumption and then work from that position, this model explores how you can take to pieces those assumptions which helps to find more dialogue approaches to finding collaborative solutions.
Are there any other tools or theories you’ve used to work collaboratively? Get in touch with us to let us know!
Some practical learning from our experience:
- It’s always important to explain the principles of collaborative working to the group, in order that you all agree to move the project forward in this way. Introduce Debate versus Dialogue, this is often a useful starting point.
- Everybody should introduce themselves and what they would like the group to achieve; in short why are you here? This starts to understand everybody’s values and you can then identify shared aims and goals
- Always think about breaking larger groups into smaller groups, this helps less dominant people in the room be heard during discussions
- Role model how the group should behave, refer to Debate versus Dialogue or point out when a ‘Move’ has been made (4 Player model). And remember keep it non-judgemental!
- Allow space for the group to get to know each other socially, this is how strong relationships are formed and the work will need these
- Highlight ‘Action Bias’ early – groups often run to solutions or actions, that is assuming we know what the problem is and how to fix it.
- Two leaders is helpful as a minimum; one to project manage and keep the pace, the other to check the group is managing to work collaboratively, or identify when it’s not and for the group to be ok with this.
- Words build worlds – create a collective understanding using the vocabulary that comes from the group
- Always reflect in pairs after each meeting. were there problems with the process? How collaborative did it feel? What needs to happen next time in order for the group to feel meaningful?
In our time working collaboratively, we’ve come across, and have been recommended by others, a number of different books that further explore elements of collaboration and tools that help make it happen.
- Leading Groups Online: a down and dirty guide to leading courses, meetings, trainings and events during the coronavirus pandemic
- The Happiness Advantage by Shawn Achor – very accessible and gives really helpful information and stories/case studies on how we frame problems in our mind. Useful book if you’re wanting to explore Appreciative Inquiry.
- Reading the Room: Group Dynamics for Coaches and Leaders. Author: David Kantor
- Managing to Collaborate: The Theory and Practice of Collaborative Advantage. Authors: Chris Huxham and Siv Evy Vangen
- New Power; how anyone can persuade, mobilize, and suceed in our chaotic, connected age. Authors: Jeremy Heimans & Henry Timms
- Who Moved My Cheese? An Amazing Way to Deal with Change in Your Work and in Your Life. Author: Dr Spencer Johnson
- The Patient Revolution; how we can heal the healthcare system. Author: David Gilbert
- From Contempt to Curiosity: Creating the Conditions for Groups to Collaborate Using Clean Language and Systemic Modelling. Author: Caitlin Walker
- Time to Think: Listening to Ignite the Human Mind. Author: Nancy Kline
- Our Iceberg is melting. Authors: Dr. John Kotter and Holger Rathgeber