Collaboration. Working together. Partnership. Joined-up care.

Many people working in health and care will be familiar with these words. They feature heavily in policy documents, signalling clear intent for places and communities to work together to deliver services and improve health outcomes. For people delivering care, these words might mean working increasingly in multi-disciplinary teams, forming collaborations with patients or building relationships with community and voluntary organisations.

We have long recognised the benefits of collaboration:1 more joined-up care for patients, less duplication of services, a more holistic and strategic approach to improving the health of local populations. In the context of COVID-19, we have seen teams work in completely different ways – demonstrating how effective collaboration across services and roles can help the health service respond to unprecedented challenges. We’ve seen teams work with a renewed sense of shared purpose, build new relationships2 and together navigate huge uncertainty to enable change at scale and pace. As health care services continue to work through the crisis and beyond, we need to keep this focus on collaborative change – investing in the skills and capabilities that will enable teams to improve the care that people receive, now and in the future.

This essay introduces Skills for collaborative change: a map and user guide – an accessible and practical tool that sets out the skills and attitudes needed for collaborative and creative problem solving to support teams to get better at adopting and developing them.

Download Skills for collaborative change

If the direction of travel is for more – and potentially more advanced forms of – collaboration, then people, teams and organisations are going to have to keep getting better at it. This is easy to say but hard to do. The range of skills needed for collaboration to thrive are vital – but have been poorly understood and invested in.3 More needs to be done to name and prioritise the skills and attitudes needed for collaborative change, as well as thinking about the organisational cultures, processes and environments that enable and support this. 4 5

Skills for collaborative change has been developed in partnership with Nesta. It draws on Q’s experience of large-scale collaborative approaches,6 7 the Health Foundation’s quality improvement expertise,8 and Nesta’s extensive experience of government innovation. It is accompanied by a user guide which includes tasks and activities you can use with your team.

You can download the guide and start using it straight away in your teams. If you’re interested in learning more, this essay covers:

The guidance was developed pre-COVID-19 to be used in person, however, these exercises can be run virtually. Check out Q’s tips for designing and running virtual meetings for more information.

What is the skills map?

About the map

Think about a time that you have successfully worked with others to address a problem. What were the skills and attitudes within the team that contributed to its success? Have you tried to use those same skills when starting new projects or partnerships?

The skills and attitudes required to lead change with and through others are wide-ranging. They require attention and practice to develop and embed them. The skills map helps make explicit which skills and attitudes are needed to foster collaboration and supports people to take a team and organisational approach to developing them.

Shifting to this mode of thinking is not without challenges. Behaviour is influenced by a range of factors – cultural, environmental, political – and teams working under pressure need an enabling environment and leaders who genuinely value this way of working. During COVID-19, we’ve heard how trusting and enabling leadership has given teams permission and agency to act quickly and creatively. This, alongside clarity and renewed shared purpose, have fostered collaboration, not competition, breaking down long-entrenched silos.9 10 The scale of change shows what is possible, and provides a useful platform to consider the skills and attitudes that could embed positive changes long term.

Where did it come from?

Q is a long-term initiative connecting people who are working to improve health and care across the UK and Ireland. The Q Improvement Lab is part of Q and convenes diverse groups of organisations and individuals to work on shared health and care challenges.

Through the Lab’s work, we have supported teams and individuals to work across professional and organisational silos. Those participating showed great energy and capability to work across these boundaries, but it was also a learning curve.

To start to break down those barriers and bring them together was quite a big hurdle to jump… (and to understand) how do you bring patients and volunteers on the journey with you.11 ”

Innovation Unit

2019

The Q Lab’s independent evaluation highlights the need to be explicit about the skills needed for collaborative and creative problem solving.12 Without this clarity, people’s ability to intentionally develop these skills and translate them into action is reduced.

Nesta had done similar work on the skills needed for public sector innovation.13 We worked together to develop a framework for people working to improve health and care, bringing in the experience and insight of practitioners to create Skills for collaborative change.

Key features of the skills map

The map is a tool for reflection which supports teams to better understand and explore the blend of skills required for collaborative working. Key features include:

  1. Focus on teams
    Skills for collaborative change invites people to move away from solely thinking about their individual role, to thinking about their contribution in a team and the skills that their colleagues and peers bring. This map isn’t about heroic individuals, nor is it a checklist. No one person has every skill and attitude – this is about creating balanced teams.
  2. Informed by evidence and experience
    The skills and attitudes highlighted in the map are based on a combination of research and evidence from Nesta’s programme on public sector innovation:14 improvement experts including building on the Health Foundation’s Habits of an Improver15 and Q’s practical learning.
  3. Practical
    Skills for collaborative change includes suggested activities for how teams can better understand their strengths as well as identify where the potential gaps might be. This may be particularly helpful for multi-disciplinary teams working in health and care.

The map and user guide were developed with a range of people, including health and care professionals, researchers and patients. Our intention is that people working in and with the health and care sector will use the map and guide to improve the way they work together.

Using Skills for collaborative change: Hints and tips

Developing Skills for collaborative change with people from across health and care also meant that the group had plenty of ideas and suggestions for how the tool can be used in practice. These include:

  • Use it at the start of a project: Teams are understandably often keen to get started on the task in hand, but investing time at the start of a project to identify what you do well as a team and what areas you might need to work on, can reap long-term rewards.
  • Ask others what they see in you: Sometimes it’s difficult to name the skills that you bring to a piece of work and how they contribute to what your team is trying to achieve. Using the skills map, begin by asking what others see in you and reflect on whether you see yourself in this way.
  • Use it to bring patients and health care professionals together: The tool has been designed with patients and health care professionals and can help you to have conversations beyond professional roles about what both parties can bring and contribute to teams and projects.
  • Revisit it over time: As you get to know people and their skills, use the map to reflect on what happened in practice. Did people’s skills play out in the way(s) you expected? Could you start to explore what behaviours you would like to see?

How the map can support improvement

Bringing together different teams within one organisation is challenging enough. Increasingly people also need to work with different health care organisations, as well as with organisations and individuals outside of the health and care sector to improve health outcomes.

Collaboration involves navigating new spaces, structures and people and there will be systemic, organisational and individual barriers to doing this well. The skills required to lead and participate in this type of work are wide-reaching and require attention and practice.

Skills for collaborative change is a starting point to understanding these skills and having meaningful conversations about how to use them in practice. As suggested in this essay, it can be particularly useful in the early stages of an improvement project when you’re convening a group.

A broader conversation about collaboration in health and care

While Skills for collaborative change is a tool for teams and individuals, we think that a broader conversation is needed about the role of the system and organisations to create the conditions to support and enable people to collaborate.

There remains a gap between policy intent and the context many people are working within, made even more pressing by the current and future impacts of COVID-19. A report by NHS Employers in 2017 states that a ‘bias towards developing functional expertise leaves organisations lacking collaborative capability’16 and it sets out a range of recommendations to enable trustworthy strategic collaboration to thrive over time.

However, in recent months we have heard that people felt they were given license to exercise their leadership and collaborate in new ways, irrespective of their job title. The NHS People plan recognises the enormous potential within this more distributed style of leadership and states that ‘all leaders in the NHS, particularly those who hold formal management and leadership positions, are expected to act with kindness, prioritise collaboration, and foster creativity in the people they work with.’17

There is real appetite for new-found collaborations to continue as teams look to the future and we hope that Skills for collaborative change helps support people to make this a reality.

Next steps

We hope Skills for collaborative change inspires action. Download it. Share it with colleagues. And if you come up with new ways to use the map, please share your reflections by getting in touch with the Q Lab team so we can improve and develop it.