This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Effective collaborations between healthcare providers can improve quality of care and resolve staffing issues. New research highlighted the key components of successful collaborations.
Researchers reviewed evidence and interviewed NHS staff and the public about how, why and when collaborations between healthcare providers were effective. They found that successful partnerships are built on trust and shared beliefs. Clear priorities for improvement, roles and responsibilities that are clearly set out in contracts, and similar working cultures in partner organisations, all supported collaboration. Staff appreciated leaders’ enthusiasm for partnerships, especially when they acknowledged the challenge of staff shortages.
The practical advice in this research could help NHS providers, managers, policymakers, and leaders of collaborations to improve partnerships.
The issue: why don't all healthcare collaborations work?
Governments around the world aim to improve patient care by encouraging collaboration between healthcare providers (such as hospitals and care homes). Effective collaboration can help prevent safety issues and enable healthcare providers to serve a wider area. But attempts to improve links between healthcare providers in England have had mixed success. Barriers to collaboration include the physical distance between providers, competing priorities, and different ways of working.
Integrated care systems are partnerships of organisations (including mental health, primary care and local authorities). They plan and deliver joined-up health and care services in a local area. They were introduced by the NHS Long Term Plan, along with primary care networks. The NHS and local authorities are legally obliged to collaborate within integrated care systems.
Researchers explored approaches to collaboration: what works well and for whom, and what impact do behaviours, rules, and structures have? The study aimed to provide insights that could improve partnerships.
What’s new?
A review of previous research included 86 papers on collaborations between healthcare providers (including systematic reviews and non-academic, grey literature).
The review suggested ingredients that lead to a successful collaboration. These include:
- trust — engagement with everyone involved can make a workforce more willing to experiment, innovate, and take risks to try and make the collaboration a success
- belief — when senior leaders believe that a collaboration will work, they can inspire others to get involved in a collaboration
- ambition — clear priorities and milestones, along with the methods to achieve them, need to be agreed to make a collaboration a success
- contracts — formal agreements that confirm the roles and responsibilities of each organisation can help resolve conflicts within a collaboration
- culture — similar working cultures and practices in partner organisations reduce complexity and remove barriers to collaboration.
The research team interviewed 37 NHS staff and held a focus group of 8 patient and public representatives. Participants found mandated collaborations were often unhelpful, when local approaches to collaboration that more clearly aligned with the population's needs were in place. While continuous monitoring and data collection could identify areas for improvement for the organisations involved, it could be hard to get this data upfront and make assessments in real-time.
Staff appreciated leaders who inspired and energised the workforce and made collaborations work. But also those who balanced enthusiasm with recognition of workforce shortages across the NHS. Furthermore, staff and services with overly complex workloads sometimes doubted that collaborations would work. For example, collaboration across multiple organisations meant more paperwork or elaborate changes to processes.
Why is this important?
The review provides evidence about how NHS providers can better work together to improve services. It raises both questions and answers for organisations considering how they can improve their own collaboration.
The researchers concluded that successful collaborations improved allocation of resources, coordination of care, communication and sharing of best practice. Effective partnerships grew out of trust and confidence.
Those leading services raised concerns that legally enforced collaborations (such as in integrated care systems) might harm existing partnerships that are working well. However, the researchers also found that contractual agreements can help develop shared understanding of each partner’s responsibilities.
The analysis considered a wide range of collaborations, so the researchers could not make specific recommendations for different kinds of partnership. Recommendations could be adapted to fit local needs.
What’s next?
The researchers have developed exploratory tools and methods to improve assessments of how collaborations are working in practice.
This study predominantly explored the experiences of service leaders. Further research is needed to understand the perspectives of the general workforce on how new policies are implemented, and the impact of collaboration on patients. Organisations could also consult the public directly on their experience of collaboration.
More research into digital communication and the integration of computer systems is needed.
You may be interested to read
This summary is based on: Millar R, and others. Towards achieving interorganisational collaboration between health-care providers: a realist evidence synthesis. Health and Social Care Delivery Research 2023; 11: 1 – 158.
A YouTube video explaining what an integrated care system is.
A progress report on integrated care systems from the NHS Confederate.
Funding: This study was funded by the NIHR Health and Social Care Delivery Research programme.
Conflicts of Interest: None declared.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
