the swampy ground research project
a resource about partnership working for managers & educators in health & social care
Key messages from this research
What is significant about this research is that it illuminates what is happening in the 'swampy lowland' see quotation above] in response to the requirements for 'partnership' from the high ground of policy. While the rhetoric may change – ‘joined-up government’ giving way to ‘partnership’, and now to ‘service networks’ - these stories demonstrate that 'the messy confusing problems [that] defy technical solution' in the swampy ground do not change.
There seem to be common themes in these stories from the lowland and we have drawn them together here. This multi-vocal research enables us to hear the real concerns of the different actors, concerns that the pressures of working life often forcefully obscure, and which are not often shared in a transparent way. So this material illuminates what we otherwise cannot access in our own partnerships. We hope that the points below will also encourage you to read the stories and viewpoints - and to feedback to us how far it is useful to you.
The ‘Tamara’ effect
In ‘Tamara’ the longest running play in San Francisco, both actors and audience move around the many rooms of the building following and building their own stories and understandings. This play vividly demonstrates for its audiences what in organisations and in partnerships is a truism: that there are many different perspectives at play. Here in these stories of partnerships the viewpoint of each player is transparent to us all. This is unusual. We are struck nonetheless by the stark differences in how the same situation was viewed. What 'Tamara' helps us to see is not only are there many different perspectives on one reality, but that we do indeed construct different realities.[ Law J. and Urry J. Enacting the Social ] And it is the intensity of these different realities that contain the kernel of what is involved in working collaboratively. This ‘Tamara’ effect underlies all the remaining issues we raise here.
Metaphors of conflict: strong emotions
Beyond differences of view, nearly all these stories also display very strong emotions, especially of hostility towards people in the ‘other camp’. Warfare metaphors dominate how the people involved talk about this work, with references to ‘entrenchment …being in a trench’, ‘ignoring the war’, the ‘seduction of conflict’, having an ‘ally’. Another metaphor was that of a family wedding with the two groups sitting on different sides, or that of ‘bad behaviour’ reminiscent of children within a family. In another story, others were termed ‘the dinosaurs’ and not welcome in the new structure.
The strength of emotion was also striking: for example, ‘I ache with hate’ was left written on an office whiteboard following a ‘partnership’ meeting, leading to extended stereotyping of the ‘others’.
Passionate commitment to the work and involvement were equally strongly felt. People comment on the level of ‘personal investment’ they made. ‘It’s my job’ meant that their whole work identity was bound up in the partnership and so it mattered immensely to the person.
Important choices
In building these difficult partnerships, a number of critical issues emerged, evoking contradictory responses. These illustrate choices to be made according to the context.
Engage the resistors or dilute them by widening the circle
Particular people seen as resisting being involved or making change drew two very different responses in these stories. In some cases it was most helpful to engage with them, by moving towards them, talking with them directly. This produced positive shifts even if they were small ones. In other cases the conflict was effectively diluted through ‘widening the circle’. In one of these, the shift was swift and markedly successful and stopped the ‘bad behaviour’ in the ‘family’; in another the bad behaviour was allowed to continue for months sapping the momentum of the partnership until an event was organised which ‘widened the circle’ and enabled some progress.
Fast action or slow movement and learning
We saw also two contrasting ways to approach partnership which both worked in different settings. We referred above to how swift action, for example in managing conflict, can be successful. In another story, the key partner ‘came to know’ what was important in the work and how to approach it. This took time. Similarly small shifts are important and it sometimes takes a long time to see the benefits.
Ignoring the ‘history’ or dealing with it
The 'history' of coming to the partnership in each case was very influential in what happened. Where there were past conflict and present bad feelings, the leader had to make a choice. S/he could ‘allow people to sound off’, so finding out directly about people's feelings. This 'enabled [the change], rather than [allowing it to] fester'. Alternatively s/he could override the history, ignore the conflict, and require people to be future and user focused. Each approach seemed to work in that context. We conclude that it may be necessary to engage fully and genuinely whichever approach you choose, always recognising that you have a choice.
‘It’s good enough’ : compromise or standing firm on your views
Key issues
There were some other key issues with clear messages: clarity in complexity; maintaining momentum; forging relationships ; and crucially, being aware of others' perceptions of who has power.
Clarity in complexity
Simple rules are one of the clues to self-organisation and adaptability in complex systems. All of these stories are set in highly complex environments made up of many linked complex systems. Where a leader was able to assert a simple rule, for example, the user comes first, this was extremely helpful. This clarity is needed particularly in times of transition, where it is hard to keep partners involved. ‘When the conductor is unclear, what is the effect on the players, when they’ve all got different perspectives?’ Where there is conflict there is also a need for early leadership to clarify purposes and focus. Where this is absent there can be a long period of drift. In another story, in an acute trust, the ongoing role of the leader was to manage complexity through active scanning of the boundaries to understand the key importance of the links with primary care.
Momentum
The need to keep momentum comes through in the stories and was noticed by our co-research group – 'a burst of momentum then the drop in energy'. This relates to the need to keep the partnership going through personal investment and energy, to combat ‘the tensions of the interim strategy’, when ‘everything seems nebulous in a time of transition’. The need to prefigure changes and build commitment by 'actually enacting the process desired before the decision point itself is reached' is raised here. When to tell people and involve them was highlighted; in one story arguably some managers were involved too soon when little could be said or done and so stalemate persisted, whereas staff were involved only late in the day, yet getting them involved created some positive energy in a very negative situation. Here too it is a question of leaders making conscious choices about how best to keep momentum, so as to avoid running out of energy (both their own and others') or creating expectations too soon.
Forging relationships not only focusing on new structures
‘Culture eats strategy for breakfast’: these case studies show once again how restructuring is often experienced as unwelcome and disruptive, with questionable benefits, and how it is the forging of relationships that is critical, in new structures as well as in partnerships of all kinds . This takes energy and time. Clearly stating the purpose of the change is also crucial. It helps too to focus on process and on conversations, as well as on tasks, in re-structuring as well as across contract boundaries. 'Then the important thing is the communication skills: clarification, checking, negotiation.' All of these skills will be increasingly important as boundaries become more permeable.
The cases show as well how structure is not just ‘empty boxes’ : people are known and visible, with track records, with previous links and contacts, with all the benefits this brings, as well as potential for exclusion. The continued importance of credibility in your own professional area within partnership working is also demonstrated. This is reinforced by the Mental Health service manager who worried about clinical professionals 'being seen to be working jointly for jointly's sake' and not having their professional judgment recognised. This highlights the importance of not acting out the rhetoric of partnership in a way which loses specific professional input.
The issue here is paying good attention to enabling both managers and professions to see each other's point of view, rather than only seeing issues from their own viewpoint. Conflict between the general manager and the clinical consultant with whom he worked was avoided through an open discussion. The general manager found time genuinely to reflect on the consultant's perspective: 'Coming from a ..collegiate profession.. how difficult it was for him.' The same general manager set up a system of layers of support for managers and for professionals that were both separate and interacting.
Perceptions of power
What is important in perceptions of power is for us to be aware of the 'Tamara' effect: what others experience will not be the same as what we experience ourselves. You may not feel powerful but you may be seen and experienced as powerful [see also models – power/identity and influence ]. The general manager recounted how the new focus on challenging inequalities was strongly blocked by people saying 'they hadn’t encountered any prejudice and so did not believe it existed.' This is a common and dangerous example of the 'Tamara' effect. The general manager worked on this by focusing on service user needs, and in particular by making the needs of different groups explicit.
We also noted that perhaps due to the story-telling methodology we used, there was a familiar silence about issues of power/identity, such as ethnicity and gender, and how these impact on partnerships. Most of the managers we spoke with did not raise this issue unless asked. In our experience this silence on ethnicity is common in organisational settings where white people are in a majority. As in these stories, it leaves perceptions of power imbalance due to 'race' unexamined and un-discussable.
Another issue of power that emerged concerns what resources people brought to the partnership. Here the essential contribution of groups without money was highlighted, such as users or voluntary groups. [see also issues raised Chambers in 'power identity and influence ' ] What was important here was finding ways for this contribution to be seen as more than tokenism. Another example of working effectively with less 'powerful' groups involved managers from the acute team going out to primary care services: 'We go to a meeting where it is their agenda, and where we might just be an item'. This was an important 'low profile' symbol of a new approach. This new approach was an important low profile symbol of organisational culture.
Final questions
Since these stories were researched there have been still further developments in health and social care in terms of what is required in setting up networks, in collaborating outside the usual boundaries, for example in regeneration and ‘skills escalator’ initiatives. In addition there have been major changes in arrangements and requirements for involving ‘the public’ and patients, and for local authorities in a new role for overview and scrutiny of health. The following questions remain for us arising from our research and we believe they are still pertinent:
Who decides?
Who makes decisions about partnership, at what stages and at what level ?
Who was involved at the outset and how did that affect what followed?
Who stands for whom?
In partnerships who stands for whose interests?
What does 'representation' mean in networks and partnerships?
How do key aspects of identity, such as ethnicity, gender or sexuality, interact with power within partnerships?
How can we notice absences and act on this?
How can we understand the extent of rage, conflict and passion?
How did the statement ‘I ache with hate’ come to be felt so strongly?
Where does the language of war stem from?