Why we did this work
In England, integrated care systems (ICSs) aim to realise collaborative working across health and care services, but this will require staff to employ different behaviours, skills and practices both in and outside their own organisations. Effective working across organisations means adopting new practices to navigate challenges such as conflicting organisational goals, competing institutional norms and rules, and any perceived loss of power or resource.
Learning to collaborate well is possible but few people working in health and care organisations have ever received substantial development in this area. Government policies over the past 50 years have focused on the structures and governance arrangements rather than the behaviours, skills and processes. This report shares the learning and insights from health and care leaders about what nurtures more effective collaborative working. The report combines three data sources:
- contemporaneous notes collected while the authors worked with various leadership groups over the past decade
- data from interviews with 15 senior leaders working in ICBs, NHS providers and local government
- data from a short online survey with 53 health and care leaders.
The report shares insights and evidence about how to collaborate well to build a stronger collaborative ethos across health and care services.
What is collaborative leadership?
Collaborative leadership is grounded in the belief that a shared model of leadership is more creative and effective than a leader or group of staff working alone. Sometimes leaders will adopt a collaborative leadership approach when working with their peers; in other instances, a leader focuses on creating the conditions that mean others can collaborate well.
A true collaboration values difference and prevents any one organisation or group from dominating. This may be difficult to achieve in health care systems that have traditionally valued some organisations or professional groups above others but if done well collaboration will promote staff engagement and accelerate service transformations that will benefit patients, staff and communities.
What we found
Health and care staff are beginning to successfully work collaboratively across organisational and professional boundaries. However, after many years of government policies promoting organisational independence in the NHS, the switch to working together is proving challenging even within the new organising framework of an ICS.
Our research shows health and care leaders at all levels have a critical role in modelling and rewarding collaborative behaviours but this is insufficient on its own, attention also needs to be given to six key leadership practices.
The six leadership practices are:
- creating a safe, inclusive and trusting environment in which everyone can contribute fully – leaders need to look at problems from perspectives beyond their own. This means leaders need to be open and trusting, to connect with others and create different spaces in which people feel safe to contribute and be heard; to listen to and value others’ contributions and ensure others do the same.
- building healthy relationships – this requires sustained effort but adopting a more relational way of working based on humility, respect and trust strengthens connections between organisations and individuals leading to increased staff engagement and more co-ordinated services.
- developing a shared purpose and shared group identity. It is important to clearly set out the shared purpose around why organisations or/and professional groups are working together and create a shared group identity to promote engagement across the collaboration and to address any power differentials (see below).
- actively managing any power dynamics – so no organisation or professional group dominates. Introducing processes that create a more open and participatory environment can also be useful to enable individuals to think differently.
- surfacing and managing any conflict – in collaborations you are working with different views and ideas, sometimes these will turn into conflict. It is important to approach any conflict with an open and curious mind, rather than turning away from it.
- developing shared decision-making processes – designing transparent processes that enable all key organisations or groups to contribute to a decision produces a range of benefits, although it takes longer. Benefits include greater ownership over the decisions adopted and strengthening trust across a collaborating group.
Given the pace of change and disruption needed to solve many of the problems facing our health and care system, The King’s Fund recommends health and care leaders extend the practise of collaborative leadership more widely with working more closely with local organisations, people and communities.
This more ‘civic’ style of collaborative leadership will give health and care leaders a key role in mobilising local assets and communities. This approach will place less emphasis on producing plans and give more attention to demonstrating the values and behaviours associated with shared stewardship.
Thanks for this insightful article on collaborative leadership and the six leadership practices. I'm sure these will have a positive impact on any organisation that implements them. Great to see decision-making listed here, its often an over-looked process yet it has enormous potential to transform an organisation positively.
This approach is the ideal, but is severely lacking in modern day healthcare. (At least in the USA.)
This description of collaborative leadership aligns strongly with restorative practice as a workplace philosophy.
I really hope this book, and the case studies in it, will help to develop both the narrative and the practice of leadership teams and the wider workforce to foster more collaborative and relational ways of working across health and care services: https://www.crownhouse.co.uk/restorative-practice-at-work
What a shame collaboration does not include private/for profit companies who are providing a huge amount of care for elderly and disabled across the nation. We have slowly been recognised as an essential part of the equation but despite huge amounts of experience and knowledge across the sector are rarely invited to contribute to discussions.
Part of my submission has been lost. Maybe itwas my fault. I did refer to the fact that whilst I am totally committed to shared decision making these efforts to move towards consultation and collaboration by The Kings Fund and NHS England will result in better decision making within the NHS organisation. Well done.
It was good to read the themes previously espoused by others historically still ring true in the modern day scenario - for example Patrick Lencioni back in 1965 identified the foundation of good collaborative working is trust. Trusting relationships allow constructive disagreement, establish commitment to taking responsibility and achieving results. Similarly in the Kings Fund's own publications Partnership: fit for purpose, a part of the whole systems thinking working paper series set out how the objectives of a partnership set the tone and subsequently the outcome - co-odination gets a project done but often doesn't change the context making change less "sticky"; competition has winners and losers, co-operation usually occurs with a potential rival such as in war time and once the battle is done cooperation ceases - the pinnacle of a long term partnership was described as co-evolution where partners we working to achieve a better future and set aside / compromised in the interests of aggregate good - one of the themes that makes this a challenge is the constant reorganisation of health and social care and its political environment. The aspiration of the report to inform how to do things better is in my view sound - time will tell whether the current reality we be more successful than history has seen
The six key practice elements for a “collaborative leadership” are very useful and well thought. Although focusing on a high-income country, I see them as very well applicable in a low-income and middle-income country health system, such as in Tanzania. The need for strengthening management and leadership in our primary health care facilities https://www.scirp.org/journal/paperinformation.aspx?paperid=124486 as a foundation for a strong, resilient and sustainable health system, make the six key practice elements for collaborative leadership very useful in our health system.
This is addressed primarily to NHS England and The King's Fund. It is in no way meant in a disheartening way but is my view on collaboration, teamwork or any other name for the name attributed to the way we all work towards common objectives. I feel that you treat your staff leaves much to be desired. Straight to the point, your persistent call to the work force to move towards Collaboration is fast becoming boring boring boring. Hospitals Surgeries and Social Services are people who work hard to integrate as a cumulative force for the betterment of the Health of our nation. Hospitals are by and large happy places working very hard already AS TEAMS, Your 'cri de coeur' does not acknowledge this in the slightest. I trained as a teacher firstly as part of the Bristol University Institute of Education with French as my main subject. However having arrived in 1959 I switched to Main Physical Education as I loved all sports and felt that they instilled into me the power to be reliable as an individual. But more importantly it gave me the notion of teamwork. Football, cricket, tennis, rugby all demand individual and team skills. Most of us have played sports and I am proud that I had one of the best jobs in the world. Your comments on collaboration and your saying that we need to start paying attention to this as if you have invented something innovative which hitherto never existed is both unfair to people like me I retired from employment in 1992 and will have been Chairman of our surgery's Patient Participation Group for 20 years in February 2024. All I am saying is that collaboration does exist in the NHS. Just remember that Goethe pronounced 'Gerta' (German equivalent of Shakespeare.) said ' Correction does much, Encouragement does more'. Be kind to us!
The doctors' today not like our doctors' of years ago, who cared for us with deep feeling for us. I have stories of years ago. Today the Consultants' on strike, greedy to the core. 2006 I had to have an macular hole operation. I was left to long and the hole was 100% I was frightened. I looked after my mother at xmas, wanted her to stay as usual with me. I enquired private £4,000 from consultant. I mentioned my stress re aged mother missing her xmas. The nhs offered me an appointment to be able to do so. I mentioned to Consultant and he said "you could easily be bumped off my list if you do so." I had no money, had to borrow £4,000 he had scared me so much I did not want to be blind. This operation same time and day of the nhs one. I was not even seen to until 7am and got to my ward very late in the night. Then I got an infection. The operation not a success only 8o%sight.
This is an exciting piece of research into making collaborative leadership a reality in Health and Social care. In our leadership and coaching programmes, we have noticed it's about leaders unlearning behaviours which have made them successful leaders, as well as learning this new approach.
There is a need for leadership development and coaching for our senior leaders to role model this new approach to collaborative leadership to change the culture.
Thank you to Kings Fund for sharing this piece of work.