Cross-professional partnering to improve outcomes
A physical therapy professor asks herself: "How will the newly-announced mandatory budget reduction affect my department’s request in comparison to the request made by two other departments?” The professor added: "I must prepare to fight fiercely for my department.” This scenario is unfortunately being repeated across the nation due to the current financially-strained environment we live in. This environment requires that healthcare professionals consider partnering with each other, instead of competing against each other, so that limited resources may be maximized. Comprehensive cross-professional partnering can ensure that sustainable initiatives are imaginative, coherent and integrated enough to impact seemingly intractable problems in healthcare.
Single health profession approaches are often short-sighted and disappointing. Working separately, different healthcare professions tend to develop activities in isolation. This results in negative competition and/or duplicating effort with accompanying waste of valuable resources. Working separately often leads to the development of a "blame culture” in which chaos or neglect is reflexively regarded as someone else’s fault. Cross-partnering provides a new opportunity for health professions to attain impressive goals synergistically with numerous benefits.
Finding innovative approaches to the challenges of sustainable changes is one of the benefits of partnering. Another benefit of partnering is that there is a range of mechanisms that enables each profession to share its own specific competencies and capacities in order to achieve both common and complementary goals more effectively. A third benefit of partnering is that there is access to more resources by drawing on the full range of technical, human, knowledge, physical and financial resources found within all professions. Dynamic new networks are established through cross-professional partnering, offering each profession better channels of engagement with the wider community and a greater capacity to influence the state and federal policy agenda. Another benefit of cross-professional partnering is that greater understanding of the values and attributes of each profession emerges through partnering, thereby building a more integrated and a more stable healthcare environment.
Successful cross-professional partnering recognizes the qualities and competencies of partner professions and finds new ways of harnessing these for the common good. Tennyson in the publication The Partnering Toolbook (2003) offers three Golden Rules that facilitate the recognition of the qualities and competencies of partner professions. The first Golden Rule is to build on shared values. This is importance because a hallmark of successful partnerships is that they are values-driven. The second Golden Rule is to be creative. Every partnership is unique and brings unlimited opportunities for creative recommendations to complex problem. The third Golden Rule is to be courageous. All partnerships involve risk. The three Golden Rules can be followed in a systematic manner through the partnering model that Tennyson (2003) offers. The partnering model consists of the following twelve phases:
- Sustaining or terminating.
Tennyson (2003) describes the elements of each of the twelve phases in the model. The scoping phase involves understanding challenges, gathering information, consulting with stakeholders and with potential external resource providers, and building a vision for the partnership. The identifying phase consists of identifying potential partners and, if suitable, securing their involvement, motivating them, and encouraging them to work together. The building phase involves having partners build their working relationship by establishing common goals, objectives and core principles that will underpin their partnership. The planning phase involves having partners plan the program of activities and begin to outline a coherent project. The managing phase involves having partners explore the structure and management of their partnership from medium to long-term. The resourcing phase involves having partners, and other supporters, identify and mobilize financial and non-financial resources.
The implementation phase consists of working to a pre-agreed timetable and specific deliverables. The measuring phase focuses on evaluating the effectiveness of the pre-determined goals, outputs and outcomes. The reviewing phase allows partners to ask themselves the following questions: 1) What is the impact of the partnership on partner organizations? and 2) Is it time for some partners to leave and / or new partners to join? The revising phase involves the modification of programs or projects in the light of the experience. The institutionalizing phase of the partnership involves building appropriate structures and mechanisms for the partnership to ensure longer-term commitment and continuity. The sustaining or terminating phase involves building sustainability or agreeing to an appropriate conclusion. One of the most important phases of the twelve phases in the model is the identifying phase because it is in this phase that has been associated by Tennyson (2003) with the strongest partnership relationships and outcomes.
Identifying or selecting an appropriate partner is a critical phase of Tennyson’s (2003) model in relation to ensuring success of the partnership. It is worthwhile to take time and locate as much information as possible about the potential partner in order to arrive at an appropriate decision, including undertaking research to confirm the potential partner’s track record. This can be done by reading the potential partner’s web-site, undertaking a "fact-finding” visit and / or asking others who know of the partner’s history for their views. There may also be some value in special activities such as workshops, site visits, and exchanges between several members of the potential partner’s organization. These activities will allow the exploration of the idea of partnering more fully and collaboratively before any firm commitments are agreed. Furthermore, it is a good idea to allocate some follow-up work to assess the potential partner’s capacity to actually turn a verbal commitment into action.
In some instances there may be little or no choice about partners. It is important to be realistic about what the partnership is likely to be able to achieve in this case, and to be open about the challenges involved. No partner, including you and your profession, is perfect. What needs to be identified, is a partner that will provide as good a match as possible to enable the partnership to achieve its objectives. Essentially, the objective is to identify a potential partner that has many of the appropriate attributes and the clear potential to grow more fully into the role of partner over time.
Successful partnerships that are built by using the Tennyson’s model, can be guided by principles to hold them together. These principles should be worked out as part of the partnership-building process and agreed upon by all partners. The principles provide the foundation upon which the partnership is built, and over time, they continue to provide the "cement” that holds the partnership together over time. Each profession will have its own priorities and may struggle to accept the different priorities of others, but a robust discussion explaining why a particular principle matters to one or another partner may go a long way to reconciling apparent differences and to achieving compromise.
Dealing with obstacles to partnering and ensuring that agreed principles are continuously respected, constitute some of the major leadership challenges in a partnership. Other challenges are related to the day-to-day management tasks of the partnership’s project and activities. Above all, the individuals operating in a partnership need to think about each other and ask themselves: "Do they feel connected to a common purpose?” They may also ask themselves how they feel about the partnership. "Do they share a commitment to working together?” "Is it of paramount importance?” Partnering requires the right attitude and strong commitment just as much as the right structures, skills and actions.
Cross-professional partnerships take a lot of effort from all of those involved. Everyone must take a considerable investment of time to build a quality working relationships that underpins effective collaboration. The risk is that sometimes this can lead to a focus on the partnership for its own sake rather than for its capacity to deliver outcomes effectively. Partnering is a mechanism for sustainable achievements; however, it is not an end in itself. There are some obstacles to partnering that need to be considered.
Partnerships offer a real alternative approach to sustainable initiatives by substituting collaboration for competition. No partnership is ever easy, comfortable, secure, safe, quick or cheap. However, with a lot of good management, some good will and a little determination, cross-professional partnerships can work well and may achieve a great deal more than a single profession approach to the same issue. Above all, never forget that however tough things get, as Nigerian author, Ben Okri stated: "Human beings are blessed with the necessity of transformation”. A cross-professional partnership has the potential to be an excellent mechanism for sustainable transformation in healthcare.
Tennyson, R. (2003). The Partnering Toolbook. Accessed September 26, 2010 at: http://www.undp.org/partners/business/partneringtoolbook%5B1%5D.pdf
Lujan J. Cross-professional partnering to improve outcomes. The Internet Journal of Allied Health Sciences and Practice. 2010 Oct 01;8(4), Article 4.