Being a good partner

Introduction

Partnership Bank Account

Benefits

Dangers

Basics

Creating success

Developing the relationship

Measuring success

Introduction

This section provides a number of resources which can be used to make sure you get the most out of your partnerships. The focus is on being clear and transparent, taking a positive approach to partnerships while not being afraid to tackle problems if they arise. There are checklists and tips for you to use. You could use these as part of a development programme for your partnership.

At a strategic level, partnerships require clarity about the objectives for the service, the priorirties for achieving those objectives, and the resources needed to deliver them.

This strategic clarity has to be endorsed by all the agencies involved in the partnership. To achieve this, a 'whole-systems approach' is advocated by the Change Agent Team established by the Department of Health:

'Taking a Whole-systems Approach' - the work of the Health and Social Care Change Agent Teams The Health and Social Care Change Agent Teams (CATs) were established in January 2002 in England and in Wales in October 2003 to tackle delayed hospital discharges and associated arrangements. Their purpose is to work across health, social care, housing and the independent sector to: Offer targeted help to health and social care agencies in reducing delayed discharges Support implementation of the key aspects of the national service framework for older people in England that impact on delayed transfers of care Assist with development of a more integrated approach to commissioning and providing services. In England, this includes exploring opportunities for developing Care Trusts and the use of Health Act flexibilities.

The Change Agent Team, in England have produced a number of useful publications. Details can be found here.

Their report - 'Changing Places' provides details of the 'whole systems' approach which they take:

"A whole system is a mixture of different people, professions, services, buildings and organisations, all of which have patients and service users as their unifying concern and which deliver a range of services in a variety of settings to provide the right care, in the right place, at the right time...The use of the flexibilities in Section 31 of the Health Act 1999 and considering the Care Trust option are positive evidence of a commitment to whole systems working."

The 'Changing Places' report can be found here. Joint Review Team reports have also highlighted the importance of investing resources in developing and supporting partnerships.

"The new Partnership Boards represent a big Council investment and are intended to be the main engine for change and service improvements. They have members from service user and carer groups as well as health, social and other public services and the independent sector with significant decision-making powers. There is one for each area of service. The Partnership Commissioning Managers supporting each Board come from a range of relevant health, social care and housing backgrounds and have a brief to be 'the grit in the oyster'..."

Joint Review Report Kirklees March 2003

"New locality managers will lead on integration for older people, physical disability and sensory impairment services, with a view to establishing joint primary health and social care teams by 2004. There are also jointly funded development officer posts attached to the Primary Care Trusts and they have contributed additional change management capacity in mapping Intermediate Care Services and in supporting Best Value Reviews. Joint approaches to project management are now well embedded."

Joint Review Report Worcestershire April 2003

Partnership Bank Account

Partnerships take time to develop and involve investment in staff time and financial resources. If partnerships become more formal, there will be legal and other costs involved in setting them up. Investment is also required to enable staff in the organisations to work together in the partnership and establish the new ways of working, such as management reporting arrangements and decision-making structures.

As well as dealing with all of the technical issues involved in establishing the partnership, there is one issue above all others which will determine whether the partnerships will deliver the benefits anticipated of them: the organisational cultures which exist within the agencies which make up the partnership, and which will need to be developed within the partnership when it becomes operational.

This is presented as the 'Partnership Bank Account' (Exhibit 5). Successful partnerships will demonstrate the attitudes and culture, both within the organisation and with others, illustrated on the 'credit' side of the bank account, while seeking to minimise or eradicate those which appear on the 'debit' side.

Ideally, those organisations which are coming together in the partnership will already exhibit many of the attributes on the 'credit' side. This is most likely when there has been a history of good working relationships at both a strategic and operational level. Where this has not been the case, the organisations may well exhibit those attitudes illustrated on the 'debit' side.

Investment in tackling organisational cultures to develop an account which is in "credit" will be necessary, and the partnership should carefully monitor the impact of this investment.

Note that any organisation contains many different cultures. It is common to find that relationships between those leading partnerships are better than the relationships between professionals on the ground - or vice versa. Identifying the barriers to successful joint working between staff is critical to the process of establishing integrated teams and services, and requires a sensitive approach to change management.

Source: Joint Reviews

Benefits

The investment of time and resources needed to establish a successful partnership should deliver a range of benefits to the partner agencies and most importantly to users of the service. All the benefits should contribute to the improved use of funding. These benefits might be modest or substantial. Examples include:

In establishing the partnership, the contributing organisations should be clear about those benefits which they expect from the partnership arrangement, the priorities for delivering them, the performance targets to achieve them and the indicators which will measure success.

Dangers

Partnership working is often not easy. It requires new skills and approaches. Handled badly, resources can be wasted by squabbles and inertia.

You can take steps to avoid circumstances that promote conflict and difficulties within partnerships:

Tackling problems and difficulties in partnership working

• Identify and share problems openly and honestly.
• Once identified, tackle the problems quickly.
• Make compromises to gain consensus - even small compromises can have a big impact!
• Solve things together - it helps to build trust and confidence.
• View the problems as shared ones, rather than someone else's.

Basics

Partnerships work best if there is clarity about direction and priorities, agreement over basic principles and some specific objectives which have clear and measurable targets.

This is summarised in Exhibit 6 below:

This section provides some tips on how to get these basics in place. It also highlights the importance of having some early successes or 'quick wins'. There are two useful checklists that can be used to assess whether the partnership is well organised. Finally, there is a 'tool' which can be used to examine the stage of development the partnership has reached. This can be used to check out the effectiveness of the partnership arrangement that has been put in place by the senior managers and the partnership board, and by the contributing organisations which have entered into the partnership agreement.

Vision

The vision for the partnership should set out what is hoped to be achieved and give you a clear sense of direction for the service. This should focus on what will be different for service users once the vision has been achieved.

Values and principles

Having a set of shared values and principles which underpin the work can be a useful way of establishing a common culture among partnership members. Involving users and people from the local community can ensure that these values are rooted in what is important to them. However, it is not always necessary to develop your own set of values and principles, as it is reasonable to make use of those developed by others when they are relevant to the work of the partnership.

For example, the guidance on co-ordinated planning for children's services produced jointly by a number of Government departments outlines the following:

All children should:

• Grow up healthily from conception to adulthood
• Gain full advantage of education
• Behave well and keep out of trouble with the law
• Have a strong sense of personal identity and self-esteem
• Be safe from harm
• Acquire essential personal and social skills.

In Wales, the Assembly Government has adopted the UN Convention on the Rights of the Child as the basis of all its work for children and young people. It has translated this into seven Core Aims through which it will work to ensure that all children and young people:

• have a flying start in life;
  
• have a comprehensive range of education and learning opportunities,;
  
• enjoy the best possible health and are free from abuse, victimisation and exploitation;
  
• have access to play, leisure, sporting and cultural activities;
  
• are listened to, treated with respect, and have their race and cultural identity recognised;
  
• have a safe home and a community which support physical and emotional wellbeing;
  
• are not disadvantaged by poverty.

The UN Convention on the Rights of the Child could also be used as the framework for developing a set of values and principles for the Children and Young Person's Strategic/Framework Partnership. Information on the Convention can be found here.

Aims, priorities and objectives

It is important to be clear about the purpose of the partnership and your priorities. The aims and objectives need to be identified in the strategic plans for the partnership, with clarity about the priorities for service development linked to the financial resources which will be available to meet those objectives.

Objectives need to be 'SMART' specific, measurable, achievable, realistic and time bound (Exhibit 7). This will help with monitoring progress and evaluating the success of the partnership.

Source: Joint Reviews

The Portsmouth Partnership provides an example of a partnership which has produced a set of clear and measurable objectives for Children's services after wide consultation with stakeholders. For more information click here.

Targets

The partnership will need to develop a work programme linked to its strategic plan. This will need clear targets for its identified priorities on what will be achieved and the timescales for achievement. Targets should be linked to the key performance indicators mapping the progress which is expected over the lifetime of the plan.

Terms of reference

If the partnership is informal or advisory (see Objectives) then the terms of reference need to reflect such an arrangement. These could include details of the membership of the partnership, what is expected of members, accountability and reporting arrangements, and how decisions are to be made. If the partnership is more formal and has decision-making responsibilities, then you are likely to need a more lengthy document, often called a partnership agreement, which will set out the legal framework for the partnership and governance arrangements. More information on partnership agreements can be found in Partnership agreements.

Develop the first medium - term strategic plan - the importance of quick wins

Once you have agreed the basics it's time to develop a clear medium-term strategic plan, which must be linked to a financial plan for the partnership. Both of these plans need to reflect the medium-term service and financial plans of the host organisations.

It is important to focus on some quick wins as well as longer-term objectives within these plans, concentrating on those areas which are relatively straightforward to tackle within the partnership, but which may have been troublesome for the separate organisations. These are likely to be issues which are of immediate concern to service users. They may be problems that would be well recognised by those working in the new organisation from their past experiences and where the benefits of working together can quickly bear fruit.

For example, some councils have found that working in partnership to find alternatives for service users living in expensive residential placements some way away from the local authority has been a useful starting point. The Good Practice Examples, South Tyneside and Ealing, illustrate this.

Creating Success

Two checklists have been included below to help with the creation of successful partnerships. They are also useful tools to enable progress to be monitored by the host agencies.

Key ingredients for a successful partnership - An Audit Commission checklist

The Audit Commission in its report, 'A Fruitful Partnership' identifies the key ingredients for a successful partnership, see here.

The following key criteria for a successful partnership are identified:

• Clear shared objectives
• A realistic plan and timetable
• A commitment from partners to mainstreaming
• Clear framework of responsibility and accountability
• Trust between partners
• Realistic ways of measuring achievements.

'A Fruitful Partnership' includes a checklist for action which will assist in the development of effective partnership working.

Checklist - The Eight 'I's which make Successful 'We's

In an article on 'Collaborative Advantage' published by Harvard Business Review (July-August 1994) Rosabeth Moss-Kanter outlines the Eight 'I's which make Successful 'We's. These were drawn from research on the characteristics which make for successful partnership working.

Developing the relationship

Professional partnerships take time to develop irrespective of whether they evolve or are imposed.

Rosabeth Moss Kanter talks about 'growing' relationships between agencies using personal relationships as an analogy. This is adapted below and is useful for assessing the development of partnerships when a more evolutionary approach is adopted. This would be when partnerships start from a 'loose' more informal approach which becomes more formalised as the partnership matures over time.

Stage 1: Early days

Partners meet, are attracted and discover some compatibility.

Stage 2: 'Going steady'

Partners begin to think about the future and start drawing up plans.

Stage 3: Becoming real partners

Like couples setting up a household, agencies discover they have different ideas about how things should be done.

Stage 4: Settling down

Partners develop mechanisms for bridging differences and develop techniques for getting along.

Stage 5: Growing old together

Each agency discovers it has changed internally as a result of accommodating the ongoing partnership.

This is an appropriate analogy for the more evolutionary approach, and indicates the time it might take for partnerships to mature in this way before they become fully effective. However, if the partnership is formed from a more strategic perspective, effectively imposed from the 'top down', then care must be taken to invest in the development of effective working relationships at operational level which will also take time to develop and mature to create a fully effective partnership.

Measuring success

Terms of reference for partnerships, or the more formal partnership agreements, must identify how both the host organisations and the internal management of the partnership are going to judge the effectiveness of their work.

This section deals with the elements that need to be in place to monitor effectiveness. It refers to three resources that can help with setting a framework to monitor performance.

As with any other organisation, it is necessary to have in place a comprehensive system of performance management which is based upon clear objectives and a strategic plan that identifies how those objectives are to be met. The host organisations must ensure that the partnership agreement specifies the performance management arrangements which need to be put in place to enable them to oversee the performance of the partnership, and ensure that the accountabilities of the partnership to the host organisations are sufficiently robust to support effective governance. This must include financial performance as well as service performance.

The ingredients of a comprehensive performance management system are:

• Effective management information systems are in place that provide accurate and timely finance and service activity data.
• Targets for delivering objectives are set with clear timescales.
• Key performance indicators are in place which reflect the objectives.
• Performance targets are set for all staff with an appraisal system in place which identifies the development needs of staff as well as performance against targets.
• Development needs are linked to a development and training plan for the organisation.
• Publicly accessible quality standards are in place for the service.
• There is regular reporting of performance on budget management and service activity, agreed targets and the key performance indicators and the delivery of service quality standards.
• There are arrangements which promote organisational learning and build upon best practice.
• There is an appropriate system for the management of complaints which meets statutory requirements.

When measuring the success of partnerships remember to think about the 3 Es - Economy, Efficiency and Effectiveness - and about measuring your inputs, outputs and outcomes. The table below shows the relationship between these factors.

To assist with the evaluation of partnerships, three evaluation tools that provide a strategic framework for performance evaluation are included below:

• The Improvement and Development Agency's Partnership Assessment Tool
  
• The Nuffield Institute for Health's Partnership Assessment Tool
• The Building Links project (co-ordinated by the Government Office for the South East) Partnership Working Assessment Tool.

The Improvement and Development Agency has produced a Partnership Assessment Tool. The assessment focuses on five areas which contribute to the effectiveness of partnership working, including a section on efficiency and use of resources. The table below provides information on each of the five areas and summarises questions included in the self-assessment.

If you would like a copy of the assessment in full click here. Then log in, and select 'knowledge', then 'best practice toolkits'. There are then a number of headings which provide information on partnerships including 'health'- 'local strategic partnerships' and 'evaluating partnerships.'

The section on evaluating partnerships includes the Partnership Assessment Tool.

The Nuffield Institute for Health have produced A Partnership Assessment Tool included in the publication 'What Makes a Good Partnership' by Brian Hardy, Bob Hudson & Eileen Waddington. Information on how to order can be found here.

The Assessment takes place over six stages which are clearly outlined and the publication includes all the material you will need.

The Government Office for the South East co-ordinated the Building Links project which produced the Building Links Partnership Working Toolkit which is available here.

The toolkit includes a Partnership Working Assessment Tool and case studies from Oxfordshire, Portsmouth and the Isle of Wight Councils. There is a section containing examples of documents which support partnership working.