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Collaboration Failures: Shift Focus To Behaviours Over Results

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Trevor Gore says collaboration in healthcare, particularly in community pharmacy, is not an option, but a necessity.

I have been very lucky over the past year to have been invited to speak at several international conferences on a variety of topics that are dear to my heart – self-care, behavioural economics, conscious and un-conscious biases, and of course collaboration. It is always the talks on collaboration that generate the most questions and follow up.

At a meta level, the direction of travel for governments, NGOs such as FIP (International Pharmacy Federation), the WHO (World Health organisation) and the NHS all have enshrined collaboration as part of their vision and/or goals. The WHO ‘17 goals to transform our world’ has “developing partnerships to deliver the goals”. FIPs 21 Development goals has goal 8 “Working with others” and within the current CPCF Community Pharmacy Contractual Framework, it states “We expect to see collaboration within PCNs in the delivery of clinical services.” “The advent of PCNs will require contractors to collaborate in a way that they will not have done in the past” “Demonstrate that pharmacies in a PCN area have agreed a collaborative approach to engaging with their PCN.”

But there is a problem at the heart of collaboration. It means different things to different organisations. For clarity, I will be using the term Collaboration as used by ICW ( Institute for collaborative working). In the simplest terms, cooperation is about working with others to achieve your own goals. Collaboration, on the other hand, is about working with others to produce something together and achieve shared goals. My suspicion is that many of the organisations, and there are over 13, that claim to represent pharmacy in the UK are more interested in representing their own ‘faction’ of community pharmacy, rather than the shared goals of the profession. I counted at least six different visions for pharmacy released in 2023, all similar but different. Is this helpful to the profession, let alone the NHS and the government?

The futureNHS website states, “Collaboration is the backbone of Future NHS” and it’s about connection, sharing and learning. Indeed, a quick search of the NHS England website returns 689 ‘hits’ for collaboration and 575 for Pharmacy.

So how do we get better at collaboration, and delivering for our patients, which surely must be the main goal? Surprisingly not many people who embark on a collaborative enterprise are unaware there is an International Organisation for Standardisation (ISO) standard for collaboration, and that ISO44000 “Principles for successful collaborative business relationship management” introduces 12 principles for successful collaboration that give structure to your proposed collaboration. I won’t go into all 12, but the 1st one is ‘Vision and Values’. Do you share the same vision and values as your intended partner? The fact we had more than six visions for Community Pharmacy last year underscores our ‘leaders’ are not really talking collaboration. Other important principles are behaviours (most collaborations fail because of behaviour), value creation and Informationad n Knowledge sharing.

Now I’m not advocating a one size fits all collaboration, indeed the Guide to NHS provider collaboratives states “If you’ve seen one provider collaborative, you’ve seen one provider collaborative”. All collaborations are different, unique to the players involved. But by using best practice and a systematic approach, you are more likely to form a collaborative enterprise that delivers on your joint vision whilst allowing you to live your values.

At the recent Sigma conference, I was joined by Hemant Patel to deliver a talk on “Beyond Dispensing: A Collaborative Blueprint for Clinical Excellence in Pharmacy” where Hemant indicated how collaborative working could deliver for our patients. However, the question I was asked most was “Why are you working with Hemant, you’re so different?” And that’s the point we bring different skills, and different perspectives to the issue, BUT share the same vision of the outcomes we want to see and the same values around pharmacy. You are unlikely to add value to the collaborative enterprise if you’re only talking to people who already think like you.

Earlier I mentioned behaviours as a major reason for failure of collaborations. That is because to change the results of an organisation(s) you need to stop focussing on the results and start focusing on the habits and behaviours that cause the results. And that can be uncomfortable for some. Once your collaborative enterprise has decided on the Vision and the business objective, all parties need to examine their own, and their partners behaviours, and be honest, really honest, about what behaviours are not helping deliver the value you were hoping for and question them. Is it a collaboration you want, or just to get an advantage over another player? If it’s the latter, perhaps you shouldn’t be collaborating at all.

Sound familiar?

Trevor Gore is the founder and director of Maestro Consulting, senior associate at The Consumer Healthcare Training Academy and honorary member of the Royal Pharmaceutical Society (July 2011) for services to Pharmacy education.

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