Building a strong partnership between doctors and managers turned a stumbling mental health service into a capable, competent organisation in just two years

In 2005, mental health services in East Sussex had been in difficulty for several years, resulting in a series of management re-organisations. Sussex Partnership trust was born in April 2006 with East Sussex as one of its three localities and a new executive board determined to provide high quality, well managed services.

To develop the new organisation, a set of meaningful values and a clear vision, underpinned by structural re-organisation and development of managerial skills, had to be formulated. East Sussex locality, with its history of managerial, financial and workforce problems, needed special attention and so the partnership model in medical management was put to the test.

Mistrust

Mental health services in East Sussex had been operating for years in a milieu of mistrust and disillusionment, with medics and managers prone to autonomous working.

To help turn this around, management consultancy Oxford Executive Coaching was commissioned and together we developed the partnership model. The model aims to promote co-ordinated and complementary working between senior service managers and lead consultants.

A programme of development was agreed, incorporating concepts from coaching as well as social capital theory, which explores the importance of social networks.

Taking stock

The main elements of the programme were a stock take of the current situation. Participants' responses were analysed and results were fed back to them.

This was followed by personality profiling of all participants using the Myers-Briggs type indicator, away days, and individual coaching for the lead psychiatrists and associate service directors.

The development programme took place over 12 months. Afterwards, in December 2007, the stock take was repeated and a final away day was held in February 2008.

An essential element of the programme was the active sponsorship, role modelling and participation of both the executive director and the associate medical director of East Sussex locality. They had undergone a similar development programme during which they had developed an effective, collaborative and trusting working relationship.

Group culture

Understanding the culture of a group is essential to changing behaviour to improve performance. The stock take used techniques developed in social anthropology to elicit views from all participants. The outcome was a balanced and objective assessment, giving a clear picture of the strengths of the group and areas for development.

Feedback from the Myers-Briggs test, coaching and workshops all played their part in the development programme. The Myers-Briggs test gave the participants a common language for exploring personality differences that may have hindered good relationships and communication. The away days were organised as workshops in which the doctors and managers were able to talk frankly about the issues facing them and work together in establishing solutions.

Individual coaching

The individual coaching sessions were invaluable in providing an arena in which the lead psychiatrists and associate directors could explore and develop their motivations, their leadership and their management skills in a safe setting with an appropriate level of challenge.

Each participant had four sessions of individual coaching. The issues dealt with in the sessions varied enormously. However, in all cases time was spent on developing influencing, communication, finance and strategic planning skills. The associate medical director was pivotal in establishing team members' development needs, supporting them through the process and reviewing progress with the coach.

Away days

The away days had several objectives. These included helping the team to get to know each other better, establishing a common mission and understanding of their roles, providing an extended opportunity to work together free of the pressures of daily activities, and providing an opportunity for doctor-manager pairs to observe how other pairs were dealing with the challenges of their roles.

Social capital theory techniques such as bonding, bridging and linking, as well as understandings gained from the Myers-Briggs test and the stock take, were used.

Motivation

Organisations, like societies, are made up of people who are connected through social structures.

The partnership model seeks to motivate people to work together and excel by helping them to understand individual and collective expectations and behaviours and by developing meaningful mutual goals.

Best practice

New practices and standards were developed, including holding more effective meetings, getting to know each other as people, being honest and open in communication, treating each other with respect while appreciating the importance of appropriate challenge, and developing a "can do" culture.

The success of the programme was apparent in the repeat stock take conducted in December 2007, which revealed significant improvement in communication and relationships between the partners. More overtly, the success of the model was apparent in improvements in the service in terms of its creditability, capacity, performance outcomes and financial stability and the award of foundation and teaching trust status to Sussex Partnership in August 2008.