Blog: Collaborate has 5 Cs

This is the second in a blog series by Keith Harrison-Broninski FRSA, which explores a new way for cities, towns and rural communities to tackle the effects of austerity. This second instalment provides an overview of the underlying ideas, how they have been taken up in the NHS, and how that work is transitioning into an RSA Catalyst project with a wider vision.

Collaboration planning asks fundamental, challenging questions such as why, what, where and how, rather than conventional, administrative task management questions such as who and when. The theory of human collaborative work that gave rise to what we call "collaboration plans" was first published in my 2005 book Human Interactions, a rather lengthy tome that goes into more detail than most people want or need! There are five fundamental principles of human collaborative work - and you need them all, but that's often all you need. They can be remembered as the five Cs:

• Commit - this is about team building. In concrete terms, a collaboration plan is made up of Roles and Goals. Each Role is assigned to a person (who may represent an organisation) and has an interest in achieving the Goals.
• Contribute - this is about making communication purposeful. We can learn from animals here, most of whose communications have evolved to achieve a specific intended effect as quickly as possible. If we want to also achieve goals in an efficient manner, then we need to send messages that help the team as a whole move towards an agreed goal of the work.
• Compensate – recognise the work people do. In collaborative work, it can be easy to overlook how much time and effort people are putting in, especially when much of the most critical work is intangible - ideas, discussions, introductions, speeches, networking, explanation, reassurance, feedback, reviews, and so on. Compensation does not have to be financial, and often this is not expected, but it is vital at least to let people know that their efforts are valued.
• Calculate - Everyone has too much to do and we cannot assume that we will ever complete all the work assigned to us but the danger is the temptation to cherry-pick the quick and easy activities and leave the high value "Elephant Tasks" for some mythical day when there is enough time to make a start on them. To avoid this trap, we should all manage our time rather than our tasks (as the legendary management consultant Peter Drucker used to advise), and focus on the activities that matter the most - calculating objectively how best to use the limited time we have.
• Change – This is the hardest aspect of collaborative work - dealing with change, not only within the team but also external. Suppose for example that a new charity starts up to address similar aims to ours. It is not sensible to bury our heads in the sand and effectively go into competition - rather, we should engage with them, learn from each other, and explore what opportunities there are for synergy. It is all too easy to carry on working towards goals that have become outdated, and all too hard to be aware of changes in the environment that affect current work (and possibly even render it obsolete).

To illustrate how a collaboration plan allows complex work to be coordinated across multiple organisations, I have looked at transformational change in healthcare. The background to my project, Town Digital Hub, is several years of work in the NHS - in particular, to develop, trial and deploy the NHS GATHER system which provides "collaboration plans" to support the cross-boundary work required to deliver transformational changes in healthcare. A particular focus of NHS GATHER is to capture in an "Innovation Guide" - effectively, a template collaboration plan - how people from multiple organisations in a region worked together to make change happen, so that other regions can do something similar without having to reinvent the wheel.

A good example can be illustrated by patients requiring intensive care. "UK has the second lowest number of beds per person in Europe, report shows, as NHS overcrowding breaches safety limit and raises risk of superbugs," wrote The Telegraph. Bed shortages in the NHS regularly make press headlines, yet solutions are well known to medical professionals. The challenge is that implementing them requires complex collaboration.

One of the successful case studies from NHS GATHER is the work done in Portsmouth Hospitals to deliver care at home for 90% of patients with serious intestinal failure. In simple terms, the project enabled the care of life-threatening conditions to be delivered in patients' own homes, using a combination of training for patients and their relatives, blood tests by community nurses, and regular interaction over the phone with dieticians and nutrition nurses. A key aspect of the transformation was to reduce the dependence on consultants - a radical move that initially attracted criticism.

The results speak for themselves. For the patients, both health outcomes and quality of life improved compared to traditional hospital-based care. For the NHS, savings were considerable since beds used for such patients cost in the region of £2000 per day, and the bed saving of 66 days per complex patient over 3-6 months meant that 12 patients could be treated for the price of 1. The project lead, consultant gastroenterologist Dr Tim Trebble, believes that this model of care ("proactive outreach home management") may be applicable to many recurrently admitted or long-term in-patients with chronic disease.

The improvements required structured engagement by a variety of stakeholders from different departments and organisations - consultants, dietitians, nutrition nurses, various surgical teams, trust executives, community nurses, GPs, and the local Clinical Commissioning Group. 

With such diverse participants, success depended on having clear goals, and clear responsibilities for contributing towards each goal.

These stakeholders may go beyond health and even social care workers. To catch problems at their root, and switch from being reactive and curative to proactive and preventative, it is necessary to create a joined-up effort including public services such as education, policing, justice, housing, transport, and more. For this reason, NHS GATHER is transitioning into a project with a wider vision to support all the needs of community. But where can all the collaboration plans for a community "live"? In other words, where can you find them?

In some cases a community will have a physical hub - a building - where people can go to receive public services, such as in Edgbaston or in Frome, but what is really needed is a "digital hub" - a place in the cloud for the collaboration plan, along with other collaboration plans for the community. And once you build such a digital hub, then it can also be used as a showcase to tell the community what services are available, to let service users provide feedback via social media to help improve the services, and to provide young people with valuable skills by engaging them to help build the infrastructure for their own community. This is the concept behind Town Digital Hub - and in the next post to this series, I'll explain how it works.

I would welcome any feedback on the blogs and the project - we seek to engage with communities both across the UK and internationally, so if you would like a digital hub for your own community (town, city, neighbourhood, district, county, or non-geographical) then please do get in touch directly.

Read the previous blog -  How austerity can result in better public services