11

 Collaboration

Changes in social, economic, and political structures are evident in every part of our lives. Where expectations and rules were once clear, we now live in a world in which relationships are changing, boundaries are blurring within and between organizations. There are many articles in the literature about team building and working together.

In the past, relationships were characterized by independence and competition. Now, they are characterized by interdependence and collaboration. The reality of the 90's and march into the new millennium of health care mean that collaboration will be increasingly important.

Reasons for Collaborating

Fostering collaboration is all about getting people to work together. The process of collaboration must be nurtured, strengthened, and managed. In the health care arena, collaboration can be fostered by developing collaborative goals, seeking integrated solutions, and building trusting relationships.

Teamwork is essential for a productive organization. Collaboration is needed to develop the commitment and skills of staff members, solve problems, and respond to changing pressures in the workplace. Fostering collaboration is not just a nice idea. It is the key to unlock energies and talents available in organizations.

Shared visions and values also bind staff members together in collaborative pursuits.

Group tasks and shared rewards also play a role. As staff members work together, they need information from each other to be successful and they become convinced that everyone should contribute and collaborate for the good of the group.

Staff members realize that their goals are common when day-to-day organizational norms encourage them to share information, listen to each other's ideas, exchange and share resources, and respond to each other's requests through positive interdependence. Common goals promote people's working together to ensure each other's success. Individual welfare is ensured by the success of the group.

Terrance Bucholz cites three reasons for the growing interest in collaboration.

„ First:

Health care has exhausted the benefits of specialization. Specialists operating independently can no longer be expected to accomplish what needs to be done. Gains in patient satisfaction will be a function of how well staff members and physicians work together to meet the needs of the patients they serve.

As organizations have gained experience working across boundaries, they have achieved a greater understanding of the need for collaboration. Organizations have learned from people in other fields. Subjects such as how to collect, manage, and provide information; how to market effectively; and how to address quality are important for people in every department of the hospital.

There are numerous benefits to cross-training staff members. Assembling staff members from different departments to work on issues and problems that need to be addressed, or arranging training programs so staff members can be brought together rather than keeping them separate according to specialties is the desired approach.

Organization managers are finding they can accomplish more by building stronger relationships across departments within their organizations or by working across boundaries themselves. These relationships require trust. They also mean that individuals must think about what they must do differently and they must be willing to develop new perspectives and additional skills.

„ Second:

The second reason for collaboration among health care members and organizations is the need to address "quality," whether it is called continuous improvement, reengineering, renewal, or any other name. This effort requires staff members to participate in the change process and work collaboratively. Boundaries have to come down, and staff members need to trust each other so they can work together effectively.

„ Third:

Individual organizations, whether they are public, private, or not-for-profit can no longer accomplish their goals by operating independently. Many have found that it is easier and less expensive to develop the capabilities they need through affiliation, collaboration, strategic alliances, or mergers. Hospitals and social service agencies face continuing financial pressure and will be more effective by collaborating rather than pursuing their goals independently.

[Terrance Bucholz. New Ideas from Economists (New York: Plume Publishers Inc., 1989), 19].

Manager's Role in Fostering Collaboration

Managers realize that the key to doing well lies not in competition or in overcoming others, but in gaining their cooperation. It is important to make it a point to provide team members with opportunities to associate and intermingle. This effort will allow them to break down barriers between people by encouraging interactions across disciplines and between departments.

Managers also foster collaboration by searching for integrated solutions. In finding integrated solutions, staff member's thinking is changed from an either/or mentality to a positive perspective on working together. Staff members can be clear about their needs and interests, so the politics and negotiating games can be minimized. A willingness to reciprocate will encourage both parties to recognize that the greatest gain will come from cooperating with one another.

Involvement in planning and problem solving when trying to find integrated solutions does work and is one of the most effective ways to foster collaboration. This process of involvement can take many forms.

Rosabeth Moss Kanter has proposed numerous strategies for managers to utilize in promoting integrated solutions:

ü Select staff members with a working knowledge of the situation and problem solving process, but with the potential of diverse opinions.

ü Seek broad support.

ü Clearly articulate the outcomes and standards to be met.

ü Create a climate of trust.

ü Provide the resources and authority to do the job. This means make available the necessary information, connections, training tools, money, and decision-making power.

ü Set up a timetable for planning and problem solving

ü Enable information to flow upward as well as downward.

ü Periodically review progress with the groups.

ü Tie reward to performance and make sure the rewards are balanced by the group's doing work.

ü Become a risk taker when it involves others.

ü Celebrate team accomplishments regularly.

[Roseabeth Moss Kanter. Change Masters (San Francisco, California: Koehler Publishers, 1990), 159].

Often managers realize that there might be more conflict than collaboration in the workplace. The conflict starts to affect the bottom line and hurt productivity. Sometimes it might just be a petty dispute between staff members. So, what can a manager do to turn conflict into collaboration?

Set explicit norms for behavior in the work environment. This effort can be matched by memos, bulletins and meetings. The more specific, the better. Lay out measurable expectations of how staff members are to behave. Then advise the staff that they will be held accountable for living up to the norms.

Establish group-based rewards. This gets staff members looking at each other not as enemies, but as colleagues reaching for the same goals. Even a small bonus rooted in group behavior may be enough to bring more harmony to your business.

Model appropriate behavior. Staff members take many clues from their boss. If the boss is good-humored, direct in dealing with others, and follows the rules set down for everybody, then staff members are sure to follow the example.

Give a final warning. If conflict continues, don't turn a blind eye. Make it clear that their conduct is not acceptable and get their commitment to cease such behavior in the future. Let the staff know that standards are not just for show. Put the burden on the staff members to sort out their problems.

Barriers to Collaboration

For competitive and collaborative relationships to be effective, participants have to trust each other. The more each staff member knows about barriers to trust and ways to manage the relationships, the more effective those arrangements will be.

Organizations and various health care components that have been successful often find it hard to collaborate for the following reasons:

u They underestimate the rapid development of new technology and change theory in applying it to their specific units, departments or sections. They often fall into the same trap by wanting to do it "the way it's always been done" and avoid collaboration because they believe they can continue to be successful by operating independently. They continually resist new ideas and change.

u Another barrier is institutional pride, which makes it difficult, if not impossible, to collaborate effectively. They may rely on size as an asset and feel the need to attract every patient, at the cost of collaborative relationships. Organizations that feel this way and see themselves as above the battle, will face a difficult future.

u Health care facilities that misidentify their competitors and allow themselves to become preoccupied with efficiency, rather than progress, will not become organizations of tomorrow.

Managing collaborative relationships will require a willingness to live with complex relationships in the future. Collaborative relationships require that staff members move beyond their individual structural arrangements and trust each other. In order to manage these relationships effectively, Philip Katz describes several issues to deal with:

n Focusing of people. To be successful, organizations, like individuals, have to be willing to focus on the patients' needs first (the people they serve), then their own.

What is the patient base? How can care be enhanced? What is needed to expand successful services? As for staff members, team-building efforts need to be a priority. It's important to promote the concept of collaboration. If health care organizations forgo collaborative relationships with their patients and staff members, they invariably sacrifice markets, future patients and future loyalty.

n Practical value. A collaborative relationship must have a practical value. It must enable the organization to develop new capabilities, products, and services, or the collaboration has no value and will not work.

n Values and goals. Developing collaborative relationships among departments within an organization or among organizations requires that each partner have a clear understanding of own values and goals as well as the values and goals of colleagues. If values and goals are compatible, almost anything is possible. If they are not compatible, then each problem becomes a seemingly legitimate reason for conflict, dissolving relationships and breaking down teams. A shared sense of values and goals enables staff members and organizations to create something new in which there is no winner or loser.

n Focusing on the total relationship. Managing successful collaborative relationships requires that staff members and organizations focus on the total relationship, rather than individual components. The ability to maintain a win-win perspective with emphasis on the overall goals, values and purposes of the organization is essential.

n Effective communication. Collaborative relationships work when staff members are straightforward about problems and issues that need to be addressed. Ignoring sensitive situations will not make them go away. In order to be effective, sensitive issues need to be dealt with in an honest and trusting manner.

[Philip Katz. Collaboration and Information Comes of Age in Health Care (San Francisco: Westend Publishing Corporation, 1996), 147].

Collaboration: The Winning Skill

There's no doubt about it: when you collaborate with others, creativity is on the rise and ideas come together quicker. Teamwork and collaboration are the name of the game in the health care arena. Collaboration will be increasingly important as a skill throughout the balance of this decade and into the next millennium. The question is how gracefully and effectively organizations, health care executives and staff members can acquire the perspective and skills to make it work.

Take the following quiz and identify your collaborative skills. There are 10 questions; read each one and determine which answer is most appropriate. The scoring will be at the end of the session.

Collaboration Quiz

1. Teamwork and collaboration should lead to synergy, which means

    a) making the whole (productivity of the organization) greater than the sum of its parts (individual productivity).

    b) getting along with each other to accomplish tasks.

    c) Keeping energy levels high.

2. Teamwork and collaboration are not only necessary for an organization's productivity, but also for

    a) demonstrating an organization's ability to empower staff members.

    b) individual fulfillment.

    c) holding regular and frequent staff meetings.

3. An effective team that collaborates consists of

    a) individual contributors working on pieces of a project.

    b) homogeneous groups with like minds.

    c) diverse groups in which conflict is aired and openly resolved.

4. The best and most effective collaborative technique when staff members and managers are involved in a meeting is

    a) throw out ideas and vote for the best one.

    b) have the manager run the meeting.

    c) divide the time allotted and set up clear objectives.

5. Collaboration and cooperation in a group can be defined as

    a) problem solving and mutual enhancement of the others' power as well as one's own.

    b) getting along well to create a positive atmosphere.

    c) having an attitude of sharing information for the mutual benefit of the whole group.

6. To collaborate successfully, you must

    a) carefully weigh your ideas before offering them.

    b) drop stereotypes and consider ideas on merit, regardless of their source.

    c) take notes on ideas so that you can review them.

7. In an effort to collaborate and to handle team conflict, you should

    a) keep the issues specific and within working boundaries.

    b) have enough time to discuss conflicting perspectives.

    c) table the discussions until the conflict is handled.

8. To promote collaborative systems, you should

    a) select an equal number of men and women for the team.

    b) ask to be a team member.

    c) allow all staff members to engage in active participation.

9. Negative competition is

    a) debating an issue during a meeting without considering the other perspectives.

    b) influencing through coercion.

    c) doing things for one's own gain at someone else's expense.

10. Positive competition is

    a) matching abilities and trying to win without malice or dishonesty.

    b) sharing all you know for the mutual benefit of the whole.

    c) being willing to take a risk without gain.

Answers and explanations

1. (a) Teamwork in your organization probably involves a number of people, each with different skills, contributing toward a common goal. The productivity of the organization is greater than the productivity of the individual and provides synergy.

2. (b) Almost everyone likes being part of a team. The ability to count on other people, and being able to share feelings of challenge, victory and even defeat contributes to individual fulfillment.

3. (c) Teams take advantage of the diverse cultures, talents, and skills. But don't be surprised if conflict arises just be sure that it is resolved in ways that result in better solutions.

4. (c) Setting objectives provides a framework for brainstorming, discussing, prioritizing, and reaching consensus.

5. (c) Collaboration means giving your team members as much information as you can and identifying what benefits are available to all members through cooperation.

6. (b) Innovative ideas often come from those you might discount because they are outside your department, don't have numerous years of experience, or haven't been in the organization long enough to really "know" the culture. When team members forget stereotypes and become open to everyone's suggestions, the whole team benefits.

7. (a) It's important to maintain issue control. In conflict situations, keeping issues specific gives the parties better management potential.

8. (c) When staff members within a group are not allowed to emerge, the entire system loses. Whether staff members are more nurturing or competitive, each one can bring value.

9. (b) Threat, punishment, and limiting the options of others are the hallmark of negative competition. In the process of negative competition, staff members communicate not to clarify an issue, but to mislead others.

10. (a) This type of competition is like sportsmanship; it fosters progress, new ideas, and more creative ways of doing things.

Scoring

Give yourself 10 points for each correct answer.

Your score:

80-100 You know the difference between simply cooperating and collaborating within a team. Continue to practice the higher form of a working relation - ship, one of collaboration.

60-80 Perhaps you've never noticed or been a part of a smooth-running, productive work team. You may want to consider the assistance of a role model or mediator to assist you and your team in collaborating and effective communication techniques.