Judge Business School Collaboration for Engagement and Impact Routes & Road-Blocks Sandra Dawson CLAHRC SDO NETWORK CLAHRC South Yorkshire 6 October 2010
© Copyright, Sandra Dawson, 2010
© Copyright, Sandra Dawson, 2010
Research from social science & humanities base concerning SDO
Research from the science base
Influences Influences Translational activity Patient experience
Cambridge & Peterborough CLAHRC Service Users Commissioners Service Providers CLAHRC Directorate
Public Health Implementation Theme Service Design, Innovation & Knowledge Implementation Theme
Adapted from Dickerson © Copyright, Sandra Dawson, 2010
Child & Adolescent Research Theme
Adult Research Theme
Old Age Research Theme
Surfacing assumptions behind CLAHRCs Collaboration assumes different groups /organisations working together for common goals which are better (or can only be) achieved through working together than working separately in parallel or in competition Engagement assumes different groups will build relationships with other groups which are positive not hostile or indifferent even though there are historical, budgetary, cultural and identity reasons why distance or hostility may appear more ‘natural’ Impact assumes collaboration has consequences which make a difference to outcomes and advances ‘common goals’ © Copyright, Sandra Dawson, 2010
Routes & Roadblocks None of these assumptions will be realised ’naturally’ They require a managed journey of choices, tradeoffs, costs, learning, innovation and leadership Roadblocks on this journey are many and constructed on firm foundations (which also support other activities we may also want to value) Routes for this journey cannot depend on either mass indiscriminate destruction of what has gone before, or the inclination to turn around and bunker down in the status quo How can we construct routes through a terrain which encourages roadblocks? © Copyright, Sandra Dawson, 2010
Drawing on work with Eivor Oborn on MDTs in cancer care
Oborn E, Dawson S. 2010 'Knowledge and practice in multidisciplinary teams: struggle, accommodation and privilege' Human Relations (published online September 2010, forthcoming in paper form) Oborn E, Dawson S. (forthcoming) 'Learning across multiple communities of practice: an examination of multidisciplinary work', British Journal of Management
© Copyright, Sandra Dawson, 2010
‘the way we are’ in clinical practice is mainly learned within our ‘community of practice’ ‘Clearly the way I think is different from the way a surgeon thinks…I think about cancer all the time, where as these individuals think about all sorts of other urological problems, not just cancer. So their concept of what cancer is about is bound to be different from my concept.’ (Oncologist, his emphasis) ‘We are different tribes of Indians and we have to behave in a tribal fashion to get the job done…and the different tribes are moving along at different rates.’ (Surgeon)
© Copyright, Sandra Dawson, 2010
The surgeon: stereotype or individual reality Temporal Quick (brevity valued), clear boundaries Power ‘These guys have all the power- the surgeons. In particular Surgeon Y. I mean, he runs the show’ (Nurse) Decision making and experience focus ‘Surgeons have a much more pragmatic problem based way of thinking… If I do this, your choice is X, if I do the other thing, [then] your [choice is Y].’ (Surgeon)
© Copyright, Sandra Dawson, 2010
How do you turn this into a virtuous and not a vicious cycle of connections? Individual behaviour and attitudes Stereotypes, priorities
Peers and informal groupings
Institutional customs and practices, structures and cultures Complexity and uncertainty of Work (task, technology, knowledge) Resources and incentives
Inclination to attack, ignore, denigrate, dismiss, embrace those ‘not-on-our-side’
Policy framework and national funding © Copyright, Sandra Dawson, 2010
How do you turn this into a virtuous and not a vicious cycle of connections? Individual behaviour and attitudes Stereotypes, priorities,
Peers and informal groupings
Institutional customs and practices, structures and cultures Complexity and uncertainty of Work (task, technology, knowledge) Resources and incentives
Inclination to engage, listen, trust, learn from others
Policy framework and national funding © Copyright, Sandra Dawson, 2010
The Foundations of Roadblocks Inclination/capacity to understand the others’ Knowledge, notions of evidence & language Power & influence Territory (brand, assets, location, liabilities) Rooted in History, culture and socialisation Nature of task Policy imperatives Organisational, Planning and financial structures © Copyright, Sandra Dawson, 2010
How to get started? • Policy framework will not be sufficient • Nor will funding streams • Nor will individual professional or entrepreneurial leadership-though these and much more is necessary The fundamental starting point for a critical mass of participants is to create, feel and commit to a common purpose which can only be advanced through collaboration a non trivial task requiring detailed engagement (time, intellect, learning, emotion) supported by leadership, incentives and infrastructure © Copyright, Sandra Dawson, 2010
Where to start Why are we prepared to start this perilous journey ? What is our common purpose? How will we know whether our efforts are achieving anything? – What will success look like in 1, 3 & 5 years • Can we measure this or a proxy for it?
– – – –
What do we need to start doing NOW What do we need to stop doing now What do we need to do differently What do we have to look out for as unanticipated consequences? – What Tradeoffs are we prepared to make? – Are we realistic and honest with each other about risks? © Copyright, Sandra Dawson, 2010
ROUTES TO: Learning and innovation to be one’s specialist self AND to be enriched by others even when the interaction enables them to share ‘your’ limelight of resources, acknowledgement and territory so that ‘WE’ generate new limelight which is ‘OURS’...and Behold(!) ‘YOURS’ may get brighter in the process, AND you may begin to see limelight differently Learning ‘How to...’ How to create new norms of operation – eg to organise discussions and decision making: create the rules of a new game
© Copyright, Sandra Dawson, 2010
New ways for organising discussions ‘[Before] there was no formal system. People showed up and patients seemed to be discussed more adhocly and you took notes if you pleased.’ (Pathologist) The MDT initially drew on traditional hierarchical relationships between disciplines ‘[T]he MDT is really addressing the front end…it is not truly looking at the whole patient pathway…[you could] set up a completely different meeting. Interestingly it shifts the whole balance away. Because the minute you come into advanced disease then it is no longer a surgical forum, it becomes an oncological forum…and interestingly the MDT turns. … We give the opinion then….’ (His emphasis)
© Copyright, Sandra Dawson, 2010
Valuing and creating ‘boundary objects’ which aid and structure communication (protocols, appointments, agendas, reviews) and can align and coordinate activities in a different way
© Copyright, Sandra Dawson, 2010
How to read, listen & acknowledge other contributions/perspectives so that meaningful conversations are possible (access to the language of ‘others’) •
‘So understanding what the clinical aspects of urology are, is
difficult for people who have been trained in …pathology. And it is difficult for the [surgeons and oncologists] to learn all the niceties of pathology…[Other pathologist, who doesn’t come to the meetings, hasn’t] developed such a good grip or understanding of the clinical requirements from pathology. [Though] she is perfectly able to execute all] of her reporting.’ (Pathologist, her emphasis) • ‘It is important for a pathologist to understand what type of information other disciplines want, because [others] don’t have the same interests and needs as the pathologists themselves. This is key to developing good MDT contentwhen people recognise they are there to support other disciplines not just put out their findings.’ © Copyright, Sandra Dawson, 2010
How to challenge assumptions (yours as well as others), negotiate access to different discourses in which that of evidence is probably the most important
‘There was a beginning- a questioning about the point of the follow up, why were we doing it …. was it for the doctors, was it for the patients, was it for the efficiency…along with the fact there are more and more patients having follow up and really trying to feel how to cope with the numbers.’ (GP) [Research] found anxiety [was] associated with the clinic visit. So people won’t sleep the night before, … They found all this anxiety was produced for no good reason. Because clinic visits don’t prevent recurrence and clinic visits don’t prolong survival. …[Another] thing that came out of the research about follow up, is that actually doctors like it. (GP)
© Copyright, Sandra Dawson, 2010
• How to involve and value ‘boundary spanners’ ‘brokers’ without derogatory labels eg traitors, servants, second class, ‘joiners of the other side’ • How to give legitimacy to entrepreneurial leaders who may not be top of any established hierarchy
© Copyright, Sandra Dawson, 2010
ROUTES TO: Learning and innovation to be a CLAHRCer Learning ‘how to..’ • • • • • •
Organise discussions and make decisions: create the rules of a new game Value and create ‘boundary objects’ which aid and structure communication (protocols, appointments, agendas, reviews) and can align and coordinate Read, listen & acknowledge other contributions/perspectives so that meaningful conversations are possible (access to the language of ‘others’) Challenge assumptions (yours as well as others), negotiate access to different discourses in which that of evidence is probably the most important Involve and value ‘boundary spanners’ ‘brokers’ without derogatory labels eg traitors, servants, second class, ‘joiners of the other side’ Give legitimacy to entrepreneurial leaders who may not be top of any established hierarchy
The path through this learning will be non-linear, partial and contested, but that does not mean you should not plan The journey requires investment, and development of modes of participation, including leadership & trust
© Copyright, Sandra Dawson, 2010
‘The essence of trust … is the confident expectation of benign intentions in another free agent’ Dunn, Interpreting political responsibility, Essays 1981-1989, 1990 p27
© Copyright, Sandra Dawson, 2010
The Anatomy of Trust Trust
=
Credibility
+
Reliability
+
Benevolence ‘other centred’
• No fast way to develop trust • Over time, to instill trust internally, you need to prove that you are someone who: – Delivers on your promises – Behaves consistently – meets the expectations of others, whether internally or externally – Demonstrates that they understand ‘the other’ © Copyright, Sandra Dawson, 2010
Roadmaps for journeys which are hard work, long, repeated yet changeable
Early and sustained investment in developing *sense of common purpose *a common language or at least an understanding of the foundations of different languages, and availability of very skilled interpreters *an agreed structure for interaction: rules of engagement which will lead to new ways of doing things and in time adjustments in structures *sense of knowing for subgroups and for the collective: what success for the collaboration would look like in 3 years and how will we know if we have moved in that direction at all (KPIs) *understanding what each participant is bringing *mentoring and conversation as well as hard measurement *trust and respect
© Copyright, Sandra Dawson, 2010
