the swampy ground research project
a resource about partnership working for managers & educators in health & social care
Case Study - Keeping partners involved
Keeping partners involved: a multi-professional education strategy for a primary care trust
This story is about planning education and development for the whole workforce in a new Primary Care Trust. It highlights strategies used to manage across old/new organisations, and different work groupings, through a time of major transition.
The Training Manager for the old community trust brought together a new broader group, and the first meeting was full of energy. However, everything was changing all around them, and at the next meeting, none of the wider group attended. Different actors had widely different ideas about what was important – from generic roles for staff in the future, and development required for these; to how to 'keep control' while involving a wider group.
The task was to draw up a unified Education and Training strategy and a Workforce Planning document that together would outline the philosophy, aims, process and budget required for the new Primary Care Trust for the following year. The proposal for funding was to go to the Workforce Confederation, which was also a new multi-professional organisation.
We will hear stories about what happened from the Training Manager who thought that this group was to be her key group, and was very disappointed when it fell apart'; from the Director of Human Resources who chaired the group, who was looking ahead to envisage new roles to match new services; from the Assistant Director of Nursing, who was aware of submerged conflict and personal pain in the meetings and looking back would have wanted more transparency and explicitness about roles; and from Maureen, the Primary Care Tutor, who worked with the Training Manager on the strategy, which in the event was only for the 'community' side of the Primary Care Trust. Their stories are about how to cope with ongoing transition and insecurity about roles and jobs, while continuing to get the work done.
Read or download a PDF of all the stories in this case study.researchers' Commentary
Multiple perspectives: who is creating a single story for the partnership effort?
Everyone here is telling a different story, all of which are real for them. The Human Resources Director, reflecting a longer term strategic overview, is looking 5 years ahead to consider how boundaries will change between professions. The Training Manager is coping with her role within a much broader partnership than before: how to 'keep control' in a nebulous new partnership, and how to keep involvement, when everything around is moving. Using the analogy of the orchestra, she commented: ‘When the conductor is unclear, what is the effect on the players?' So the question is posed: is there a conductor in this partnership and who is it? To change the metaphor slightly, all the players are giving their best performance, but do the actors agree what the play is about? No one seems to be saying: 'Let's take a step back? What is the purpose of this?' So the partners retain their personal perspectives about the direction of joint efforts and these are not really shared.
Building ownership of a virtual organisation
The Workforce Confederations are intended to 'take the lead in visioning the future Healthcare Workforce' . More, they have been set up to help provide integrated services for users and patients. But the pressure of immediate targets make it hard for those who hold this vision to communicate it to the other players. How can purposes be made explicit, and shared, given such different perspectives? As well visioning the future workforce, and putting the user at the centre, the Workforce Confederation is also a 'club' for participating member organisations rather than a funding body ‘out there’. The Primary Care Trust is one of these participating members, which should take up its membership actively, and communicate what the Confederation is. The Confederation is an example of a network or a virtual organisation, whose numbers are growing. Building ownership and belonging within a virtual organisation requires thinking through by leaders, so they work with the invisible team as well as the visible members.
Managing quick wins in a long term strategy
This case illustrates clearly the enormous difficulties for leaders of clarifying the long term while completing the short term: the tensions of the interim strategy. The case perhaps indicates the importance of building in at least some information about the future into the plan, to build some commitment to that which hasn’t yet happened. But the plan also must acknowledge that decisions might be undone, and the need to keep the service going in time of transition. Here the need was for interim work to be done to create more of a 'level playing field' between 'primary' and 'community'. This needed to be clear to everyone. These were actions which were important whatever decisions were taken later. This illustrates the idea of the 'trumpet of opportunity: taking actions now that could contribute to a range of different scenarios. The case also highlights ideas of ‘pre-figuring’ change, which means actually enacting the process desired before the decision point itself can be reached.
Who is involved in decision-making?
User involvement is this case was also complex. If the users of the Education strategy are taken to be staff in the Primary Care Trust, can their managers 'represent' their staff’s interests? And what about end-users, the patients? What should or could their involvement in the Education Strategy be. The case also raises questions about how to assess the adequacy of involvement, for example of people from black and ethnic minority groups. Is it that one or two individuals from ethnic minorities at a level above the frontline is sufficient? Or is there an aspiration that decision--making meetings have ethnic representation in proportion to the communities served?
Read or download a PDF of all the stories in this case study.