More than any other previous government policy this latest white paper has been developed through consultation, listening and providing people with opportunities to say what they wanted. Here I outline why factors such as these and most importantly collaboration and trust will be key to the successful translation of the policy into practice.
Organisations representing the views of 100,000 people were involved in the development of the Independence, community. A subsequent listening exercise called Your Health, Your Care, Your Say then sought the healthcare views of over 40,000 members of the public. This was done through an online survey and face-to-face regional debates with randomly selected participants.
The main outcome from two “listening exercises” was an overwhelming endorsement from those who took part for more choice, high-quality support and services personalised around their needs. When they access community services people said they wanted to do so in places and at times that fit in with the way they lead their lives. And they expect to see support for those in greatest need and care on offer closer to home, with services shifted from hospitals into local communities. These views are clearly represented in the recommendations in the white paper.
The willingness to engage with and listen to others and provide real opportunities for people to have their say was crucial in defining the white paper. Many believe that they will also be important as we work together to translate the policy into practice. The key words here are work together. For me the white paper could and should have placed more emphasis on working together.
But why should we work together? The hypothesis is simple but powerful, collaboration is more effective than working alone. Collaboration helps us to:
- develop a better sense of belonging and ownership
- understand one another and value our diversity
- improve outcomes that would not otherwise be attained
- improve performance and increase productivity
- enhance capacity
Collaboration delivers collaborative advantage. That is something is achieved that could not have been achieved without the collaboration. Sounds straightforward enough. So how do we begin to collaborate successfully? Successful collaboration requires:
- trust – critical to motivation
- all partners need to want to try
- committment – it takes effort
- implementation requires work on mind sets, processes, structures, and skills
- manage expectations
- talking is good – just do it – communicate, communicate, communicate
But what about the barriers that might prevent us from working together. Put simply, they include:
- differences in status and culture
- technical complexity
- dynamics within and between groups
So how do we avoid these pitfalls. There are a plethora of techniques which can be used to facilitate successful collaboration. By far the most important is building trust. Trust is the basis for active participation and effective collaboration. Without trust people are unwilling to participate and cooperate with one another.
However, building trust is not a linear progression to a magic place. Building trust is cyclical and involves iterative development. To build and reinforce trust it is important to:
- recognise that everyone has something to learn and everone has something to share
- have enough trust and take a risk to initiate the collaboration
- form expectations based on reputation, track record, agreements
- set common and realistic objectives, start with something small and build on it
- have and share common experiences
- deliver and celebrate achievements however small as this can form the motivational basis for more ambitious collaboration
So how do you know when sufficient trust has been established so that collaboration can begin. From my experience you don’t. Sometimes it’s best to get started on some action without fully developing trust.
The challenge for organisations such as the CSIP, responsible for supporting local communities to implement the recommendations of the white paper, will be to motivate, mobilise and broker some action leading to improvements. We will achieve this by:
- championing collaborative working
- recognising the role of trust in successful collaboration
- embracing diversity, complexity and conflict
- empowering people to have a voice
- encouraging inclusion and active participation
Finally, and in the spirit of the view that everyone has something to learn and everone has something to share, I think that we should take a step back and look to see if we can learn from elsewhere.
The European Social Research Council and the Nuffield Trust recently funded a research-based seminar series seeks to address some of these issues around the role of trust in public sector service organisation and delivery. For more information visit the JISC mail listing, entitled ‘trust’ http://www.jiscmail.ac.uk/lists/trust.html> or see this accessible paper, ‘Trust in the Public Sector’, by Professor Huw Davies and Dr Mark Dibden at the Centre for public policy and Management at the University of St Andrews.
Leading UK social software developers, Headshift, have sparked debate on the role of social technology in implementing the vision of Our Health, Our Care, Our Say? Read the fascinating article by Lee and Stuart here http://www.headshift.com/archives/002780.cfm>. Patient Opinion www.patientopinion.org.uk> is one small example of this new thinking – a website where patients can share their experiences and rate hospitals and services – and is very much in line with the white paper’s call for everyone to have the opportunity to share their views and experiences. It uses social software tools and techniques such as patient weblogs, location-based services, RSS and social tagging to create reliable patient-generated reputation information for individual departments and services, and the site shares these with prospective patients at the point when they are choosing a hospital.
Within CSIP we are actively using social software to support our work. The award winning knowledge community http://kc.csip.org.uk> is a great example. The kc is a shared space where people can exchange knowledge, information and experiences relating to any aspect of health and social care in order to contribute to the improvement of care services and the well-being of vulnerable people. It connects a wide range of people, groups, organisations and information in a way that is designed to make it easy for people to find who or what they are looking for, taking into account a variety of different perspectives and points of view.
As a personal advocate for the collaborative power of social software I wonder how long it will be before we see policy authored collaboratively using a wiki. For more information see wikipedia http://en.wikipedia.org/wiki/Wiki.
Interesting items on the white paper
- Carers UK http://www.carersuk.org/Newsandcampaigns/Newsreleases/1138702234>
- Healthcare Commission response http://www.healthcarecommission.org.uk/NewsAndEvents/PressReleases/PressReleaseDetail/fs/en?CONTENT_ID=4022709&chk=s3U9T8>
- Royal College of Physicians/Royal College of General Practitioners http://www.rcgp.org.uk/press/2006/0008.asp>
- Sainsbury centre for mental health responsehttp://www.scmh.org.uk/80256FBD004F6342/vWeb/pcKHAL6LMDHG>
- Kings Fund response http://www.kingsfund.org.uk/news/press_releases/government_plans.html>
- British Medical Association response http://www.bma.org.uk/pressrel.nsf/wlu/SGOY-6LJJSN?OpenDocument&vw=wfmms>
- Royal College of Nursing http://www.rcn.org.uk/news/display.php?ID=1860>
- Headshift response http://www.headshift.com/archives/002780.cfm>
- Transcript of the white paper webchat with No. 10 Downing Street http://www.csip.org.uk/whitepaper_webchat_transcript.html