System Working: what’s so funny about peace, love and understanding?

System Working: what’s so funny about peace, love and understanding?

We hear a lot about the opportunities presented by working in partnership. Whole system working and integrated approaches to service delivery have long been seen as potential solutions to the anomalies and complexities of creating better outcomes in health and care.

Almost everyone agrees that we should do this, from politicians to the front line. Patients and service users, often the bewildered recipients of the chaos of ‘the system’ are clear that professionals working together and talking to each other is one of the things that would make their own experience better.

If everyone agrees that we need to do this and that it would probably work, the interesting questions are why is it taking so long; and why does it feel so hard?

It is possible that the fundamental reason system working is taking so long and feels so difficult is that partnership working itself is extraordinarily difficult, and made even more so by our reluctance to admit it.

For me, the key to understanding effective partnership working is through identity and purpose.

To start with, partnership has to have a purpose – to do things in partnership will (in my experience) take longer, involve more discussion and persuasion, be more complicated and ultimately riskier than do so alone. It may also be better, cheaper, more effective, more efficient and a whole host of other positives; the main point is that if you don’t know why you are doing it, partnership working between people is a metaphorical three-legged race – a massive hassle with no clear benefit. And it is the same for organisations.

If joint working is simply a mandated tick-box exercise that is a product of following instructions from a policymaker far, far away, and is in no way rooted in the reality of a potential positive experience for someone somewhere within the system, it just won’t work. And nor should it – partnerships for policy are particularly dangerous, not least because they give genuine partnership working a bad name, and because almost everyone has experienced one. The result is that the myth that ‘partnership working is impossible’ becomes validated by a group of people who, for very sensible reasons, are not even trying to make it work.

Partnerships with a purpose are, of course, infinitely better in theory, but here is where the question of identity becomes particularly important.

We talk a lot about shared purpose and common goals. But these are not the same thing, and don’t tell the whole story. Each organisation has an identity, some of which is a product of its environment, its history, its leadership, its organisational objectives. This is something that is unique to each organisation. Good partnership should be about creating something that is bigger and better than the sum of its parts, but the first step in doing so is understanding the parts themselves, and the language we are using to describe them.

Real understanding involves an awareness of the history, context, governance, ambition, fear and the core goals of an organisation. It requires self awareness on the part of each organisation, followed by a willingness to perspective-take in a joint discussion. Everyone is likely to have to give something up, whether some freedom, some latitude, even the comfort of a pantomime-villain perspective on others in the room. In doing so, each organisation needs to know what it needs to make it worthwhile, and to have the confidence to say so, and be heard. This model of working requires not only honesty on all sides, but also a shared willingness to look the complexity straight in the eye and agree to work through it, rather than to attempt to bury it.

Through this process, which may feel uncomfortable and exposing, it becomes possible to create a shared purpose which is genuinely of value to everyone, rather than one everyone thinks they ‘should’ agree to. Rather than a single shining orb, the eventual shared purpose might look more like an amalgamation of requirements and constraints bundled together like a ball of elastic bands, but it will be real, and it will contain enough meaning to fulfil its own purpose, which is to enable the organisations involved to move forward together authentically.

When you look at it like this, it is easy to see where the elephant traps that continue to disrupt genuine system working lie – expecting local authorities to throw themselves into Integrated Care Systems because it helps colleagues in health to organise themselves better, rather than asking, as a partnership, what benefit is in this for local government is one; similarly, ignoring the VCS until the eleventh hour when the conversation finally gets round to provision is another. True partnerships are ones of equals – that doesn’t mean everyone is bringing the same thing, but it means placing equal value on the constituent parts, or being respectfully honest about why you can’t do so.

As a final reflection, partnership is (of course) not the only way to organise things.

Like many of the great musical partnerships, Freddie Mercury and Brian May were each individually talented musicians who could probably have had less dramatic, and more conventional, musical careers without each other. What genuine partnership provides though, is an answer to genuine complexity; a path to being able to solve the unsolvable and to create something that can genuinely change the world.

When you think about it like that, it’s perhaps not surprising that it is hard to do; and obvious why it’s worth a try.

To discuss this article, please contact PPL Managing Partner Claire Kennedy.