Implementing national healthcare reforms: essential ground rules for collaborating across healthcare disciplines and services Anne Smyth Organisational Consulting Cathy Balding Qualityworks Pty Ltd 30 August 2013
What we will COVER • Setting the scene • Drivers for collaboration combining with changes prompted by the National Health Reforms – specifically, the National Safety and Quality Health Service Standards • Collaboration: what we usually do • Collaboration: what we need to do differently • Ground rules • What enables effective collaboration • What to pay attention to • What you can do
Context • Setting the scene • What’s happening now • Drivers • Standards
The National Safety and Quality Health Service sTandards …Are a team sport! • The National S&Q Standards are focused on the process of care: what happens and how things are done every day at point of care, whereas previous accreditation standards were more management system focused • The Standards aim to promote consistency and use of evidence, and reduce variability in clinical practice across the organisation • The Standards raise the bar: • Some requirements are more demanding than the practices most health services currently have in place • They require consistent use of evidence based practice and tools across the organisation • Achieving the standards across the health service is not a desktop exercise: requires focus, planning, effective change management and everyone working together from the Governing Body down.
NSQHSS – a team sport Some Standards can’t be met without effective collaboration – between staff and staff; and staff and consumers: • Standard 2: Partnering with Consumers • Standard 6: Clinical Handover • Standard 9: Recognising and Responding to Clinical Deterioration How will you achieve the requisite collaboration: • Across departments/services? • Across disciplines? • With consumers?
A scenario - What typically happens • Require people to collaborate (internally) or set up an MOU (externally) around a task or project or tender • Put people in a room and expect or hope collaboration will…….. well, just happen • First significant difference or conflict occurs………. • Response - flight, fight, work around, ignore • Agreements made are not activated or done poorly • Feels - unsafe, unpleasant, stuck • Outcomes – at best sub-optimal, sometimes failure, unable to trust, won’t go back for more What assumptions are we making here…..?
A Different scenario: what If……? When the disagreement occurs someone says……. ‘what just happened here…….we need to talk about that’
This involves • A preparedness to ask: • What do we do when we don’t agree? • How do we want to deal with one another when (not if) that occurs? • What do we need to do to equip ourselves to do this? • What doubts do we have about working collaboratively? • Work through the conflict without abandoning the goal or purpose – ‘hold’ difference • Ability to have robust conversations about things we are invested in and that really matter • Capacity to listen, ask questions and give/receive feedback – engage in dialogue • Go beyond the MOU - attention to relationship dynamics not just structures and processes
Could look like………. The Nutrition story………………..
So to the ground rules • Work hard on talking through together our purpose, why we are here and what we are trying to achieve – don’t assume • Check the task/project is fit for purpose ie best served by a collaborative approach – don’t assume • Find the win/win – what is in it for all of us, what do we hold in common and differently – don’t assume
More ground rules 4. When people offer/asked to do something don’t assume they know how 5. Don’t start with a hard/very resistant group – some degree of readiness is necessary 6. Invest in skilled facilitation - action learning, reflective practice and appreciative inquiry methodologies also help 7. Leadership to authorise, inspire, hold and support (see Australian Journal on Psychosocial Rehabilitation, Winter 2012)
So to summarise…….. Do Don’t Assume anything Just focus on the MoU, strategic plan, systems and processes, organisational and role structures Expect people to know what to do & how to do it Try to persuade people who are not interested and/or very resistant Go it alone Set and forget • Work persistently on relational elements • Clarify roles and expectations • Ensure differences are explored & understood • Ensure dialogue and robust conversations • Establish and maintain team identity • Invest in adaptive leadership and guidance • Pay attention to collaboration as an ongoing process - it is about change