Neil Goodwin on preparing your team for Darzi

Neil Goodwin

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Meeting the expectations of Lord Darzi's review will require leadership, vision and team-building skills.

There is little doubt that the next stage review will emphasise the importance of partnership and collaboration as managerial strategies for developing better, more accessible services. But, for the NHS, developing collaborative working has been something of a stop-start affair, especially in the context of a waxing and waning flirtation with market-based approaches.

Learning when to compete and when to collaborate is testing for even the most experienced and sophisticated managers. So, what are the essentials for developing better partnerships and collaboration?

Start by thinking of leadership. Partnerships and collaborative ventures are created because change is required. The more change there is, the greater the need for leadership.

Leadership is a dynamic interpersonal process. In other words, it is about building empathetic relationships. Someone has to lead any change, so spend time identifying the best person for the job, who may not necessarily be the most obvious person in the hierarchy.

True vision

Vision is the essence of leadership. It provides inspiration and momentum. It is a positive image of what a service or organisation could become and the path towards that aim.

When making changes to local health and social care services, it is not sufficient to use national visions as the basis for motivating local stakeholders. The management research is clear: the reputation of leaders is derived largely from leading change seen as important to local stakeholders.

You won't get a reputation as a great leader by slavishly implementing national policy. Why? Because everyone has to implement national policy, so you are not going to differentiate yourself by following the crowd.

Remember that trust is important. Trust is an action-based concept and we trust people on the basis of what they do rather than on the basis of what they say they are going to do. Trust is inexorably linked with leadership, so choose a leader with a track record of trust. And as I know from my own managerial experience, trust can be undone in a moment and then take months to be re-established, if at all.

Looking at relationships

Assess the quality and sustainability of current relationships. The NHS has a history of underestimating the time required to achieve effective partnership working, particularly with other agencies.

It is common for leaders of organisations to launch into inter-organisational working without first putting in the time to develop relationships. Why would we trust people we don't know or know very little? We need to get to know them first - their values, their track record, their motives and their reliability.

Think about the people. People are the social glue within and between organisations, and it is people, rather than departments and services, who do business with other people.

Given the chance, we work with people we like, trust and respect. If we can get away with it, we limit our contact with those we do not like or trust. So, taking time to select the key players who will work with each other to make the change happen is important to success.

It is also important to choose some people to join a team who have a history of working together. If no team members know each other, or most do not, then they are likely to be reluctant to share information and knowledge. This can slow down the collaborative progress.

Team leaders

Choose team leaders who are both task and relationship orientated. In the early stages of collaboration, they will have to agree on clear objectives and the roles of team members.

As the team develops, relationship issues will inevitably emerge, which will need addressing by the team leader. Above all else, it is relationship issues that impede progress and change, although research also shows that the higher the number of experts on a team the greater the propensity for dysfunction.

Finally, beware the four predictors of relationship break-up when working with others individually or in a team. They are: criticism, defensiveness, stonewalling and contempt. By far the worst behaviour is contempt, which inevitably destroys relationships because it communicates disgust. When this happens, there is little option but to rethink and start again.