In my previous blog, I argued that, while successful collaboration certainly requires a 'common language', there are in fact several kinds of common language, requiring different degrees of effort to develop, and supporting collaborations of varying kinds and levels of complexity.
In this blog, I will discuss the most basic forms of collaboration. These pay no attention at all to their own cultural and behavioural aspects and deliberately restrict the flow of information between partners.
I have called the common language used by such collaborations 'gesture', by analogy with the non-verbal, gesture-based exchanges used by people who share no spoken language of any kind. Pointing, grimacing, miming - in such situations we can rely on nothing more than our common humanity to get our message across, and on nothing much more than luck and patience to avoid misunderstanding.
At Kaleidoscope, we believe that richer, more capable collaboration is the first and best hope for the health and social care system. Collaboration is the key to more valuable interactions between professionals and the people they serve. But collaboration must be wisely used. Here, I want to sound two rather un-Kaleidoscopian cheers for consciously limited collaboration, for gesture as a valid if limited kind of common language.
Gesture collaboration remains the default state. Just ask any A&E or out of hours doctor about the information they can access about their patients. At system level, providers often co-exist without any explicit shared vision for the population they serve. The commonality starts and finishes with the NHS brand and with the shared relationship with the GP. The product of the collaboration is patient experience and outcomes, and in the records that build up at the GP surgery.
Collaborations based on gesture are bound to be limited; but they are not for that reason to be dismissed. In some situations, they may be appropriate. In many situations they will be better than botched attempts at more sophisticated forms of collaboration.
Because they are the default state, they also represent the 'do nothing' option in a business case. Proposals for richer collaborations need to show that they will not only bring benefits but also justify the cost and complexity of developing a more sophisticated common language.
Viewed in this way, as a positive option, gesture has certain distinctive benefits.
"There's no good alternative to investing in a proper collaborative culture, and in the common language that enables it."
First, it is the lowest cost form of collaboration. It relies on adaptability and goodwill rather than process, governance and organisational design, and thus minimises overhead.
Second, it simplifies clinical governance. Gesture views care not as continuous patient experience but as a series of discrete episodes. Each episode begins with an assessment that does not rely on any externally created information, and ends with a review that focuses solely on the interventions offered during that episode. Accountability is bounded by the episode. Wider interactions and longer-term consequences are explicitly excluded. For acute illness this model is appropriate. For long term conditions it is less so. But there is no point insisting on shared decision-making, unless you have also sorted out shared governance. If clinicians are asked to rely on the assessments of others, they need to know that they will not be punished if those assessments turn out to be wrong.
Thirdly, they allow the peaceful co-existence of different service models and cultures. For example, people move from NHS to local authority social care, they move from a free-at-the-point-of-use model to an eligibility-based and means-tested model. These very different models have driven the creation of different processes and cultures. Gesture shields staff from the complexity of the "other side's" process. Meanwhile, cultural tensions can be ignored.
A collaboration I worked on some years ago failed to consider that, in asking nurses and social workers to collaborate more closely, they were also asking them to acknowledge and accept each other's working practices, rather than politely ignoring them. In the event, nurses were unable to accept social work assessments that would later be used to determine eligibility, and repeated them rather than using them. The attempt to move beyond gesture destroyed, rather than enhanced, the existing collaboration.
Gesture works well enough when risks are localised – to one place, time or body part. To invest in collaborative culture, to build a common language, when the risk share is minimal, is a waste of resource.
But when risk cannot be meaningfully apportioned to discrete episodes, in long term conditions, or in population health, for example, then gesture quickly creates more problems than it solves. In these situations, there's no good alternative to investing in a proper collaborative culture, and in the common language that enables it.
Kaleidoscope can help you correctly calibrate your investment in collaborative culture and make precisely targeted interventions to get the best from your partnerships. For a chat, contact firstname.lastname@example.org