Introduction
Provision of healthcare services depends on various factors, many of which are not always within the immediate control of a single stakeholder. For this reason, healthcare providers seek to establish reliable networks from which they can provide services to a level that they sustain a positive reputation and outcompete their competitors. This essay reviews a hypothetical case of a UK facility that provides mental health services to clients. The partners, whose inclusion here is based on their importance in the overall relationship, include national and local government, mental health workers and general practitioners/ members of other specialties, drug and equipment suppliers, and patients and their families. The essay highlights the nature of relationships among these stakeholders/ partners, evaluates the importance of the partnerships, overcoming barriers and dealing with conflicts that arise from these working relationships.
1.1 A Map of the Partnerships Involved in Health Delivery for a Mental Health Unit
Mental health providers are indeed specialized units that collaboratively work to deliver care that improves the health of the mentally ill. In the hypothetical case under study, the integrated care partnership (ICP) model is applied. The ICP reduces the element of competition among providers to increase collaboration among them. Besides the mental health facility providing this type of care, other providers within this model include community services, general practitioners (GPs), third sector providers, hospitals, and social care. Below is a diagram depicting the ICP partnership around a mental health facility.
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1.2 Key Elements of Partnership Working with Various Stakeholders
The complexities surrounding the relationships between/ among parties in a working healthcare partnership make it rather difficult for seamless delivery of service. However, with time, each party seeks and identifies its necessities for optimal working. The variables surrounding an optimal working relationship with other partners depends on the various trade-offs that each partner can comfortably work within. The study by Corbin, Jones and Barry (2018) identified nine key elements of partnerships in the healthcare sector. These include:
“(i) Develop a shared mission aligned to the partners’ individual or institutional goals; (ii) include a broad range of participation from diverse partners and a balance of human and financial resources; (iii) incorporate leadership that inspires trust, confidence and inclusiveness; (iv) monitor how communication is perceived by partners and adjust accordingly; (v) balance formal and informal roles/structures depending upon mission; (vi) build trust between partners from the beginning and for the duration of the partnership; (vii) ensure balance between maintenance and production activities; (viii) consider the impact of political, economic, cultural, social and organizational contexts; and (ix) evaluate partnerships for continuous improvement” (Corbin, Jones & Barry, 2018, p. 4).
The relevant among these elements will be discussed below as they apply when working with external organizations, colleagues, individuals and families.
Working with External Organizations
External organizations usually have their own organizational cultures, and this makes collaborative assignments rather difficult. These organizational cultures may touch on responsiveness to communication, urgency and crises, structure of authority among other factors. It is important to understand these structures because they may help in formalizing communication, establishing essential links and could save time when the matter at hand is sensitive (Corbin, Jones & Barry, 2018; Estacio, Oliver, Downing, Kurth & Protheroe, 2017). Establishing essential contact also means that different partners have to be aware of their roles in the overall healthcare provision chain, which calls for transparency and regular communication, including meetings among staff/ representatives to discuss essential matters, including trends and forecasted projections (Rees, Mullings & Bovaird, 2012). For instance, when there is a projected growth in the need for a particular service, the stakeholders will seek to improve their capacities through what Corbin et al. (2018) describes as evaluation of partnerships for continuous improvement. Furthermore, defining the roles of partners helps to build trust, promoting a sense of confidence when dealing with each other. It is important that individual partners know the aspirations and goals of their partners so they can align their overall objective for streamlined service delivery. At this juncture it becomes possible for the mental health facility (referring specifically to the institution selected for this essay) to decide which potential partners have favourable organisational goals that they could easily align their goals with without compromising on their aspirations. However, the facility must be aware that a partnership implies partial trading off to align properly with available partners.
Working with Colleagues
Unlike situations where the organization works with external partners whose organizational cultures are indeterminate, colleagues share the same organizational culture and should be working to complement the work of other staffs and the organizational goals. As a team, it is important that the organization/ mental health facility practices inclusiveness, and has a leadership that inspires confidence and trust (Corbin et al, 2018). The organization also needs to establish a balance between formal and informal roles so that tasks that fall under each category are classified accordingly, and records updated correctly. New employees often take time to learn and adapt to the culture of their new workplace. The organization needs to position itself in a way that makes it easier for new employees to fit in with the culture of their new employer so they can start delivering acceptable quality of service with minimal disruptions to the work schedule. Additionally, the organization may need to amend its culture so that it blends in better with new aspirations and an evolving work environment. At such times, proper leadership is needed to guide the employees through the difficulties of transition and to make decisions that are essential for attaining the set goals. Thinking from the broad context of the relationships between employees in their various capacities of employment, there emerges a need for everyone to play their own part in pushing towards organizational goals, no matter the rank or job designation.
Working with Individuals
Individuals in the current context represent the employees in their individual capacities. They are tasked with the role of ensuring timely and quality delivery from their units towards the pooled objectives of a partnership. They have to be realistic about their own capabilities and always focus their efforts towards attaining the best results. Mental healthcare is particularly challenging because many patients have serious mental challenges, and getting proper feedback from them is not always possible. For the healthcare facility, it is important to uphold high ethical standards and show sufficient empathy towards the clients. This requirement begins with the individuals who are the representatives of their employer in their individual roles. Since many patients manage to recover after undergoing treatment, the facility needs to ensure that its facilities and staff have performed to a level the clients are impressed. This entails keeping to the most recent, evidence-based practice and constantly reviewing emerging trends and their benefits to continue offering high quality service. Individuals are at the core of this requirement because it is their individual efforts at learning that pool together to improve the quality of service.
Working with Families
As indicated above, many mental health patients are unable to provide dependable feedback about their treatment. However, the institution needs family representatives to follow up with the patient’s progress whenever possible. Therefore, the family members serve as the ‘guardians’ to the patient, despite their age, and they can be relied upon to provide an honest account of the kind of service offered to their kin. Corbin et al. (2018) stated that one of the elements of partnership is to include a broad range of participation. Involving the family members in the treatment of their kin is important because at times, they are required to follow up with them after they are discharged from the facility. In this case, they need near ‘hands-on’ knowledge on how to best handle the patient because failure to observe this may mean relapse and further expenses.
1.3 Evaluation of the Importance of Partnerships
External Organizations
Partnerships help to tackle the problems involved in a broken chain of treatment. This happens because partners offer complementary services with a clear understanding of each other’s specialty and expertise. The core benefit of partnerships is that they help each organization in the chain to easily reach out for specialized care for patients. For instance, a mental health patient under the care of a general practitioner who is a member of a partnership involving mental health will easily refer the patient to the right facility, saving important time for treatment. According to Estacio et al. (2017), partnerships strengthen the position of each partner by pulling resources together, helping weaker institutions to build a reputable brand as they overcome major financial and resource hurdles. Additionally, partners work on a refined objective that captures the overall contributions of each party. This helps individual partners to optimize their resources both in allocation and utilization and gauge their relative capacities compared to similar facilities.
Colleagues
Working with external partners means that the work of each individual facility becomes under stricter scrutiny. The processes involved in delivery of services are open to criticism and even ridicule should they fail to meet stipulated standards. Working in partnership helps individual partners to constantly appraise their quality of service so they match up to other providers and uphold the stipulated standards of the partnership. The vigorous processes involved in appraisal help colleagues to easily identify those among them with commendable leadership qualities so they can steer the organization towards pooled objectives. Simply put, the appraisal of individuals’ work increases, making employees’ output to be more aligned to the larger shared values. According to Corbin et al. (2018), the requirement for increased individual participation in a partnership setup helps to get the best output from individual participants. Furthermore, the level of responsibility due to external links and constant inter-partner communication enhances the level of responsibility from individual employees, requiring them in turn to work towards positioning their organization at a better rank among the partners.
The Individual
As a worker within the highly dynamic and demanding value chain created by a partnership, the individual has no choice but to prepare to provide their best input into the process. Employees often appraise each other to assess where their organization could be facing challenges, and this creates a platform to provide feedback towards the input of individual employees. This way they grow their skills and attempt to perfect their delivery to their employer. The overall impact is an enhanced individual output. Exposure to external appraisal has a similar effect on individuals’ output. Individuals get to benchmark their own skills and knowledge with those of employees in similar capacities, driving towards personal improvement.
Families
Families reap the benefits of partnerships in that they get faster access to the specific service providers who should be attending to their kin. In the case of mental health, treatment involves a largely long-term process of treatment that advances through various stages of recovery. As patients recover, they need to transfer to facilities that are better suited to handle them in their improved situations, and often back to their homes. This chain of patient transfer creates a unique benefit for patients because partners have prior knowledge of the capacities and vacancies in their partner facilities, making it easy to recommend the one with available accommodation for a patient. Families get the best service for their kin through this appraisal process. This is important because it improves the level of quality across the partner chain, with members focusing on quality of delivery, to the benefit of individuals (Estacio et al, 2017).
1.4 Overcoming Barriers to Working via Partnerships
Being a multi-sectoral venture, partnerships have many shortcomings and barriers that hinder effective service delivery. They not only prevent proper engagement, sometimes it becomes difficult to hold onto the promises that were initially presented by partnerships. Rees et al. (2012, p. 22) classified the barriers into three main categories: problems to forming partnerships, barriers related to the implementation plans for a partnership, and those that prevent the formation of the best type of partnership. These are broken down as follows:
(Under problems to forming partnerships): · trust and ‘due diligence’ or more informal ‘getting to know you’ activities required for trust to develop; · cultural – due to the perceived importance of their organisational mission; · personality is very relevant – often leaders are not partnership-minded/ suffers ‘founder independence’. (Under barriers relating to the implementation plans): · resources – lack of time and finances needed for effective collaboration; · skills – particularly in relation to working in large consortia, where there is relatively little experience as yet, and in working with lead partners or prime contractors, where many TSOs are still in the early part of the learning curve. (Under barriers that prevent formation of the best form of partnership): · inappropriate, even arbitrary, interpretation of EU procurement rules · commissioning and procurement procedures are often inappropriate · the way in which providers are paid (Rees et al, 2012, p. 22).
A near similar categorization of the barriers can be seen in Taylor-Robinson et al. (2012), who broadly classified the barriers as cultural issues, resource and financial constraints, and politics-driven agenda/ uncertainties.
Overcoming Barriers to the Formation of a Partnership
One of the previously highlighted problem preventing partnerships to come into force is lack of trust among potential partners. This may be due to a few reasons, among them the existing reputation of one of the proponents to a partnership, or just lack of knowledge/ intelligence about each other. It is reminiscent to note that partnerships work because of trust, and this comes from a sustained positive interaction over a period of time. Therefore, partners need to allow time as they go into a collaborative arrangement before they can really decide that they cannot trust their co-providers. Since no party can easily allow itself to suffer consequences of over-trusting another from the beginning of a working relationship, it is important that they engage in legally binding, realistically tenable, and ethically/ morally acceptable relationships that clearly define the roles of each party. The agreement document should also indicate clearly where the role of one party ends and what should follow in order to avoid gaps that may expose parties to legal challenges (Health Research and Education Trust, 2016).
Once a partnership has come into force, it is likely that failure to build trust within its immediate post-formation period could ruin any possibilities of it working. In this regard, team building is recommended. Team building in this case entails bringing together the different teams from the individual partners to share ideas, know each other, and devise ways to deal with emerging issues (Rees et al, 2012; Arksey et al, 2004; Taylor-Robinson et al, 2012). This way, individual partners get better acquaintance with the workings of other partners, making communication smoother for quicker response to situations. Additionally, it is important that parties declare their capacities and capabilities with honesty at the inception of a partnership so that they may not be seen to be unresponsive when they are facing constraints beyond their control (Moore et al, 2017; Corbin et al, 2018). For instance, a care home to which a mental health facility refers its moderately healed patients may need to indicate its real capacity, projected inflow of recovering patients, and whether its nature of work complies with the overall vision of the partnership.
Overcoming Barriers to the Implementation Plans for a Partnership
Lack of skills, time and resource constraints are listed as the main barriers preventing the implementation of partnership plans (Corbin et al, 2018; Rees et al, 2012). Steihaug et al. (2016) noted that individual partners have their own financial strength, and this critically affects their capacities to meet partnership obligations. In addition to financial constrains that prevent the implementation of partnership goals to desired standards, it is also important to note the impact that differential in capacities could have on the overall quality of service. In such cases, it is unavoidable that the financially stronger or better resourced partner will want to carry a higher capacity than immediate partners can refer, all towards meeting their optimal working capacities. The affected partner is advised to seek more, supplier or referral level partners to meet the shortfall (Percy-Smith et al, 2010; Steinhaug et al, 2016). For instance, if a mental health facility has a capacity to optimally care for fifty patients and care homes/ third sector provider partners only have a capacity of twenty, the facility will need to seek additional partners at the level of the care homes/ third sector to cover the gap in capacity. However, Percy-Smith et al. (2010) warns that this may be construed as breach of trust, because some providers see the entry of ‘competitors’ as exposure to competition. Ideally, they would like to have full control of their partners’ inflow/ outflow by meeting the required capacity. Since this is not always possible, the partners need to work out a formula that stipulates how each partner is assigned roles. Additionally, the NHS’s principle of partnership that designates working collaboration as a support system rather than a competition should be reiterated.
Skill differentials imply situations where different partners have different accumulated collective experience in handling partnerships (Rees et al, 2012). Such situations are complicated by differing levels of expectation along the chain of delivery. The situation is caused by the lengths of time each partner has been working collaboratively with other providers. Start-ups and the relatively new healthcare/ social care facilities need to learn fast and seek the advice of field leaders (through training) to upgrade their experience fast and cope with their partners’ demands and expectations. This helps to bridge the gap in knowledge and experience fast. Additionally, they need to be clear about what is expected of them from the beginning, learn what different situations imply for their reputations and overall situational response threshold (Ham, 2018).
Overcoming barriers That Prevent Formation of the Best Form of Partnership
Unlike the two preceding categories of barriers, these barriers are largely beyond the control of the partners. They basically include those barriers arising from political and legal decisions made by other authorities based on their own interests or those of parties to disputes. These may include redefinition of legal provisions for procurement or provisions touching on the roles of partners and their work. At the moment, the UK is still bound by European Union (EU) regulations, and some have been controversial in the way they interpret processes such as procurement. For instance, Rees et al. (2012) noted that in a partnership, the lead partner is required to contribute 65% of the total procurement cost as a basic requirement of EU statutes. However much this stipulation applies to the type of partnerships being formed in the medical field, the resultant relationships are merely collaborations and do not necessarily fit into the normal definition of partnerships. This is because partners in the latter category have specific, defined, and unrelated roles, unlike partnerships where members contribute towards the same role all-through, albeit with differing contributions. It is unavoidable for partners to try to lobby for their positions when legislative work is being drafted so that they do not lose their positions and possibly weaken the quality of their delivery in a partnership. Importantly, close monitoring of upcoming policies and legislation could help different players to plan accordingly and forecast the implications to their businesses, thereby providing lead time to guard against uncontrollable losses.
Dealing with Conflicts Arising in Partnerships
Several types of disputes often arise in the course of partnership. These may include legal, financial, conflicts in leadership, supremacy/ imposition of some partners over others, and perceived competition (Omisore & Abiodun, 2014; White, 2010). One way of dealing with conflicts (particularly where some partners attempt to boss others) is to initiate inter-partner communication and highlighting the issue. Omisore and Abiodun (2014) noted that while this issue may represent an entity’s overall attitude towards its partners, it may equally be the feeling of a single or a few representatives. Highlighting the issue and setting strict limits in a partnership could help dispel the notion that some partners are junior. Sometimes such an approach may fail to yield any positive results, implying that the affected partner would need to call over other partners to discuss the situation, understand the root cause, and deliberate together on a solution. Such a meeting may also involve authorities at various levels. Leadership conflicts arise when some parties attempt to superimpose themselves, creating special attention towards a specific firm/ partner and its representatives, instead of seeking equal representation of all the partners. Again, this situation requires parties to communicate their opinions and positions, seek mediation and hold talks among themselves.
Legal and financial disputes are sometimes more difficult to resolve, which calls for involvement of legal practitioners and the courts/ dispute resolution tribunals (White, 2010). White (2010) underscores the need for alternative dispute resolution to avoid full, time-consuming and expensive hearings in the courts. This includes referring such matters to dispute resolution tribunals. Alternatively, parties may sometimes be referred by courts to consult between themselves under the guidance of mediators to avoid unnecessary court battles, especially where it is imminent their partnership cannot be easily terminated (due to high dependence on each other). Where compensation is disputed, the parties may allow the opinions of experts in tribunal hearings to determine the strength of their positions, therefore easily determine whether to pursue their legal positions against their partners.
Conclusion
The essay traced down some important partnerships involved in healthcare/ social delivery in the UK. Taking the example of a mental health facility seeking to build partnership with complementary service providers, the essay identified hospitals, general practice, social care, social services and third sector providers as the likely partners. Nine elements of partnership working with different stakeholders in mental health were identified and traced to the specific partners. Importance of partnerships to external organizations, individuals, families and colleagues were identified and ways to overcome barriers to the success of partnerships identified based on categorization of each barrier. Strategies for dealing with conflicts arising in partnerships were identified, with emphasis on median and conciliation.
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