managing partnerships for improving health & wellbeing
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Managing Partnerships for Improving Health & Wellbeing. Learning from a “brave new world” Jane Mackinnon, Moira Fischbacher & Judy Pate Department of Management. Community Health Partnerships in Scotland. Inter-agency partnerships for health improvement - PowerPoint PPT PresentationTRANSCRIPT
Managing Partnerships for Improving Health & Wellbeing
Learning from a “brave new world”
Jane Mackinnon, Moira Fischbacher & Judy Pate
Department of Management
Community Health Partnerships in Scotland
Inter-agency partnerships for health improvement
NHS-led in partnership with Local Authority
“It is intended that CHPs will create better results for the communities they serve by being
aligned with local authority counterparts and by playing an effective role in planning and
delivering local services.” Partnerships for Care (2003).
The Glasgow City Integrated Model
5 Community Health & Care Partnerships (CHCPs):
Single integrated management structure for local community health and social work services
Retains clear lines of accountability for statutory functions, resources and employment issues to ‘parents’
The ‘Parents’…
NHS COMMUNITY SERVICES
SOCIAL WORK SERVICES
GLASGOW CITY COUNCIL
INTEGRATED COMMUNITY HEALTH & CARE PARTNERSHIPS
Working across boundaries
Political drive for partnerships & integration but…
What are the realities of managing this process?
Managing change is difficult enough within one organisation…
Different starting points…
Different organisational processes etc…
The experience of East Glasgow CHCP?
Setting the scene for East Glasgow
Deep rooted social & health inequalities e.g.:
Over 41% of population live in the most deprived neighbourhoods in Scotland
Only 68% of 15 year old boys survive to 65(12% below Scottish average)
33% children in workless households (80% above Scottish average)
Hospital admissions for heart disease 38% above Scottish average (2000-02)
East Glasgow CHCP – the organisation
Approximately 1500 CHCP staff:
Around 300 professionals are ‘Independent Contractors’ to NHS (GPs, Pharmacists, Optomotrists & Dentists)
Around 1250 directly employed in the CHCP by the ‘parent’ organisations (NHS & Social Work)
Different pay & conditions of employment!NHS – nurses, health care assistants, physiotherapists, psychologists, health visitorsSocial Work – team leaders, social workers, social care workers, social care assistants
e.g. The ‘matrix’ of CHCP management
Head of service:NHS
Operations Manager:NHS
Operations Manager:Social Work
Team Leader:Social Work
Team Leader:NHS
Nurse
Nurse Assistant
Social Worker
Social Worker
Social Care Assistant
Nurse
The theoretical base
Measures of success
Nature & Development of Trust
Health outcomes(e.g. Mitchell & Shortell, 2000; Roussos & Fawcett, 2000)
Partnership process &outcomes (e.g. Hudson et al, 2000; Dowling et al, 2004)
Partnership Theory
Partnership, professional (e.g. Huxham & Beech, 2003; Glendinning, 2003)
Professional, personal, institutional…(e.g. Mishra and Morrisey, 1990; Jones et al, 1997)
CollaborativeAdvantage, collaborative inertia, prerequisites (e.g. Hudson & Hardy, 2002; Huxham & Vangen, 2005)
Identity theory
The research - ‘Phase I’
Funded by Glasgow Centre for Population Health
Staff survey (response rate 31%, N=389)
Interviews with Managers and Professional representatives (36)
‘Case studies’ in four service areas:
Represent variety of stages of ‘integration’
Interviews with health and social care staff (73)
Developing the CHCP
Staff resilient and highly committed to service users
NHS and social work – common values but very different organisations & cultures
Lack of capacity across ‘boundaries’ = frustration
Trust
High among day-to-day colleagues
Trust in management ‘undecided’ – role of team leaders crucial to ‘build bridges’
More disconnected more anxious and undervalued
Areas of uncertainties lead to anxiety and ‘mistrust’, e.g. consultation and feedback loop; changing roles?
Professional Identity
Universally strong sense of professional identity, particularly in more ‘integrated’ services - strengthens where perceived ‘threat’
Teams of health & social work staff in same office (co-location) largely positive but…
Level of ‘integration’ causing concern – e.g. ‘Care Management’, blurring professional boundaries?
Impact of management matrix & changing professional structures
Managing the challenges across boundaries…
Working to build and maintain trust:
Managing fears of a ‘takeover’
Communicating positive and negative elements of organisational change
Developing staff capacity for change
Creating a sense of interdependence
Co-location or ‘integration’ – who, why and how far?
Perceived ‘erosion’ of professional identity could create a barrier to integration
Managing the challenges across boundaries…
Developing coordination & consistency across boundaries
Can the CHCP tackle organisational barriers – practical & cultural?
Need to shift the focus of integration from structures to the patient/service user
Measuring success (Hudson & Hardy; Dowling et el) – and what are CHCP staff looking for (patients, service level, organisation)?
And finally…
Thanks to East Glasgow CHCP for their open response to the research.
The full report is available from http://www.gcph.co.uk/content/view/124/119/
For any more details please contact Jane on:
Email: [email protected]
Tel: (+)44 – (0)141 330 5479