Partnership under Pressure 

The session was chaired by Christina McAnea, UNISON National Secretary for Health and staff side chair on the national SPF. Christina stressed the importance that partners attach to the SPF as it enables them to engage and influence health policy at a national level which in turn links in to experiences on the ground.

Christina highlighted the work going on in the HR Transition Partnership Forum (HRTPF). This is a subgroup of the SPF which is helping to ensure a smooth transition process for staff and employers in the NHS as result of the proposed health and social care reforms. A summary of the SPF’s work and its current priorities was set out in a conference handout.

Keynote speakers Rosemary Exton and Peter Totterdill of the UK Work Organisation Network (UKWON)  drew on examples from their own research and experience to emphasise the importance of partnership working in improving the quality of patient care. Their central message was that partnership must be embedded in an organisation. It has to shape working lives and have a demonstrable impact on patient care if it is to survive.

Peter's and Rosemary's presentation identified key issues in partnership working:

• There are differing views between and within organisations on what partnership means
• Partnership agendas can be ‘stuck’ in the HR arena  rather the whole agenda of the organisation
• Partnership is often bypassed by other priorities
• Partnership has little meaning to clinicians/managers
• Unions and HR rarely understand what the drivers for improvement and innovation are
• There is can be a dis-integration in governance structures between partnership forums and clinical governance
• There is often reliance on key individuals to pioneer partnership working and initiatives tend to end if  they move on
• Partnership can be limited to senior managers and senior trade union officials and as a result there can be a disconnect between those on the shop floor who may feel their issues are not being addressed. 

Direct participation

According to UKWON, partnership working must be embedded within an organisation if it is to be sustainable and structural barriers broken down so that partnership committees can feed directly into clinical governance committees. Their research showed that, where partnership committees act as guardians of direct staff involvement in improvement and innovation this correlates highly with improved performance and is more effective than management led staff engagement. 

Partnership as a driver for service improvement and innovation

In their experience of working with healthcare organisations in the UK and abroad, UKWON found four ways in which effective partnership working can make a sustainable impact on healthcare organisations, their patients and staff:

1. Partnership as a driver for direct staff involvement
2. Partnership approaches to service integration
3. Partnership as the context for local innovation
4. Partnership for sustainable change

Case Studies

Peter and Rosemary highlighted a number of case studies that demonstrated effective partnership working under each of these categories.  Full case studies are available here. These case studies included:

• Guastalla Hospital (Italy) - an open and inclusive partnership forum where staff at all levels in the organisation feel free to express their views
• Hospital of the Future Project (Ireland) - partnership committee representatives engaging with front line staff and capturing stories which led to improved service provision and patient care
• Nottingham City Hospital - work to ensure the 16 trade unions spoke with one voice in partnership discussions
• Kaiser Permanente - use of partnership working to drive cost savings and improve services
• The Orjan Network (Sweden) - non clinical staff spending time on a ward to get a better understanding of patient experiences
• Aker University Hospital (Norway) - management working with staff to reduce the unnecessary use of physical restraints on patients.

Views of Delegates

Delegates were asked to consider the state of partnership working in their own organisations, through a brief self assessment questionnaire. The results showed that, although most delegates believed their organisation to have good standards of partnership working, they didn’t believe the same response would be given if the questions were asked elsewhere in their organisations.

The discussion that followed drew out some interesting observations and useful sharing of experiences from delegates:

• Partnership working must not just be a ‘tick box’ exercise
• Patient care should be a standard agenda item and agendas should include topical issues
• Staff involvement should not just be used for ‘low risk’ decisions
• There should be one committee representing all staff and medical staff shouldn't be separate
• Investment must be made in staff representation process
• It “pays dividends” to have strong staff side organisations
• There has to be a genuine interest from all parties and an agreed set of values
• Staff need to have evidence that partnership works
• A strong staff voice is important, not just union reps
• Partnership must be embedded in an organisation’s processes
• It would be useful for non clinical staff, to shadow clinical staff in their organisation and vice versa so there is a greater awareness of other roles and the impact of organisational policies
• Measures need to be put in place to ensure partnership committees don’t rely on key individuals and are sustainable.