Making it safer to cross professional boundaries

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The evidence is clear: NHS organisations that are enthusiastic about co-operation and teamworking, both within and across boundaries, are more likely to deliver compassionate, high-quality care. Successful teams take the time to stop and ask themselves what they could change and do better. But few teams in the NHS – at all levels – take the time to reflect. With the pressure they are under, it’s simply seen as a luxury.

However we believe it’s not a luxury but an essential, basic requirement of high-performing teams – especially when team members come from very different professional backgrounds.

A new toolkit, commissioned by NHS Future-Focused Finance and developed by The King’s Fund, aims to help address this by supporting collaboration between finance and clinical staff. These teams, with their different cultures, perceptions and hierarchies, often have to work hard to find common ground. Indeed, when cost and quality are presented as competing priorities, it can be hard for finance and clinical staff to agree.

Research from across the NHS and other industries has shown that strong collaboration across professional groups can improve organisational performance in terms of both efficiency and quality. As Michael West, Head of Thought Leadership at The King's Fund and creator of the toolkit, says: ‘The breadth of perspective offered by cross-functional teams produces the questioning and integration of diverse views that enable teams to challenge basic assumptions and make radical changes to improve their products, services and ways of working’. This success may come at a cost in terms of time and conflict. But if these factors can be navigated effectively, the range of skills and the diverse knowledge of team members will ultimately result in better clinical outcomes.

The toolkit is designed to encourage teams to be reflective. Taking the time to reflect on what works, and why, is one of the most important factors in building an effective team. And yet teams comprising both finance and clinical staff often focus on the outcomes achieved – whether it’s money saved or the number of patients treated – and not on how they work together as a team. As one of the trusts that piloted the toolkit explained:

We tend to meet when we need to achieve a specific outcome, for example the cost improvement programme to reduce costs in the trust, but we weren’t really meeting to say 'do we actually function as a team?'
Quote from one of the trusts that piloted the 'Crossing Professional Boundaries' toolkit

But we also know that producing a toolkit is the easy bit. Ensuring it is used in a way that staff find helpful is the hard part. Too often, a toolkit lands on a desk out of the blue and remains there, unopened. To be honest, when Future-Focused Finance first asked us if we’d work with them to produce a toolkit to improve collaboration between finance and clinical staff we were slightly sceptical. We weren’t sure how yet another toolkit would be received. But of the 17 out of 24 trusts that were formally evaluated having piloted the toolkit, all have been unanimous in their support and have agreed to support others who want to try it. So we would encourage all trusts to consider how to get the best from their finance and clinical staff – it will be to their advantage – and that of patients.