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An essential resource for students, this bestselling textbook includes the latest research findings and contains more tools, frameworks and international examples of best practice to aid practitioners to more effectively evaluate partnerships.

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This chapter explores a series of tensions around the evaluation of health and social care collaboration in more detail, focusing on some specific areas of debate within the literature, including:

  • How can collaboration be effectively evaluated?

  • What kinds of evidence about integration might we present to different groups?

  • Performing governance: what is the additional work of collaboration?

In Chapter 2 we argued that evaluating collaboration can be a difficult process. Gomez-Bonnet and Thomas (2015, p 28) explain that ‘methods to evaluate partnerships have … proliferated, but tend to focus only on particular aspects of partnerships. None alone provide a comprehensive picture of how a partnership is working.’ In this section we explore some of the different approaches that have been used to evaluate collaborative working, and the appropriateness of these to particular purposes and settings. This section provides background in terms of methodology and philosophy of evaluation to consider the frameworks and tools that will be set out in the following chapter. We start by setting out the methodology adopted in the Sure Start programme that we have already spoken about in the previous two chapters (see Box 3.1). As this illustrates, the Sure Start evaluation was composed of different components, each devised to analyse different issues. For each of these components it was decided what was under investigation and which approach would be most suited to uncovering these factors. As this demonstrates, approaches were formative and summative, quantitative and qualitative, and the various components of the national study were used to reinforce and inform other strands.

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Through a series of themed sections, this chapter explores three current and future key issues in management and leadership in inter-agency collaborations. Given the volume and breadth of literature concerning leadership and management, there are a great many potential issues we might have covered in this chapter, and selecting just a few areas to focus on has been a challenge. We have selected those that we believe are of greatest interest to those actively involved in collaborative working, namely:

• ‘No more heroes’: leadership as a distributed practice

• Boundary objects – a new space for leadership?

• Leadership as sense-making and performance.

As noted at the outset of this book, leadership has traditionally been viewed as a quality of individuals, that is, the charismatic leader, the ‘great man’ tradition (Lowe and Gardner, 2001; Brown and Gioia, 2002; Denis et al, 2012). However, with the growth of cross-boundary working in public sector management and various forms of crosssectoral and cross-organisational collaboration (Rhodes, 1997, 2007), new concepts of leadership have necessarily emerged. Over the last decade or so, particular interest has grown in various forms of ‘plural’ leadership (Denis et al, 2012), which broadly refers to forms of shared leadership. These can range from shared leadership among a central team or elite group (who lead subordinates), to views of leadership as a collective process of interaction (that is, leadership as a collective practice, rather than a position). Shared leadership is thought to be particularly relevant in aiming to solve complex problems where no one individual will be able to provide ‘the’ answer (Osborne, 2006, 2010).

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As suggested earlier, teamworking is a diverse field, and the potential literature that may be drawn on is significant and increasing in both breadth and depth. Space means that we cannot talk in detail about all areas that may be important in the future, such as geographically dispersed teams, self-managed teams and team coaching. Changes in the ways we commission and provide services is creating teams that are geographically dispersed away from the main organisational hub, not just across local borders, but in other parts of the country. This provides a range of challenges regarding the support for these teams and their alignment with the host organisation. Self-managed teams come in and out of fashion, but cuts to management layers, a greater understanding of how people engage with services, the need for people to take responsibility for their actions, and decisions being made as close to service users as possible, are again driving an interest in self-managed teams. There is much written about coaching as an intervention for individuals. The art of real team coaching is about enabling teams to improve performance, functioning, wellbeing and engagement (Hawkins, 2014), and it is being recognised as an intervention that can have a tangible impact and accelerate the learning and development of a team.

In this chapter we have chosen to concentrate on three key areas that are most salient to health and social care teams, and will likely remain central regardless of the rapidly shifting context in which we find ourselves:

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Having explored key concepts and summarised key findings from the research, this chapter examines three key issues concerning IPE in health and social care settings. These hot topics were chosen because they are the ones about which we are asked most:

  • How can we involve service users and carers within the process of IPE? Does this make any difference to outcomes for trainees and, ultimately, for people who use services themselves?

  • How can we‘mainstream’ and sustain IPE in education and training for health and social care?

  • How can IPE programmes be effectively evaluated?

A key theme of health and social care policy concerns enabling service users (patients/clients) and carers to take a more central and active role in the organisation and delivery of their care. This policy has been extended to education to the extent that the DH (2002b) required social work education to involve service users and carers in the design and delivery of programmes. The General Medical Council (GMC) set out similar requirements in 2009 followed by the Health and Care Professions Council (HCPC) which regulates educational standards for allied health professionals and social care (2014).

There are a variety of ways in which service users may be involved in IPE. The earliest examples in the literature describe service users or carers sharing their experiences with mixed groups of professionals, either through presentations (‘testimonials’) or by allowing themselves to be interviewed by the students. For example, Turner et al (2000) describe a series of palliative care workshops during which medical, nursing, social work and rehabilitation therapy students interviewed the family carers of people with a terminal illness.

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A thorough introduction to IPE in health and social care for students. This second edition includes updates to research and policy contexts and provides an essential set of IPE ‘do’s and don’ts’.

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A robust guide for students to the leadership and management of inter-agency collaborative endeavours. It summarises recent trends in policy and uses international evidence to set out useful frameworks and approaches.

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Drawing on the questions, summaries and frameworks set out in this book, there are a series of practical recommendations and potential warnings that arise, for both policy and practice.

  • Given that collaboration takes so many different forms and is driven by different goals, they cannot be expected to deliver the same outcomes. More research is required to establish what kinds of collaborative arrangements can produce which kinds of outcomes, for which kinds of service users, when, and how?

  • Central government needs to be clearer about what it reasonably expects collaborative working to deliver, and under which circumstances collaborations are appropriate and, importantly, when they are not.

  • Political timescales and evaluation timescales are often incompatible. When commissioning evaluations of collaborative working, this needs to be carefully considered.

  • Service users are not homogeneous groups, and individuals (particularly those with complex or challenging needs) require specific support. More closely involving individuals in determining the nature of their own care may produce positive impacts, in terms of both service effectiveness and efficiency. This can produce different ways of joining up services and empowering individuals to achieve better outcomes, and is worthy of further exploration of its usefulness beyond social care. It can also create new demands for evidence of performance.

Although various structural, legal and technical fixes have aided the formation of health and social care partnerships to a certain extent, what local organisations and front-line services also need is more detail on how they might actually go about producing better collaborative working, and what this would entail.

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It would be to ignore the richness of the preceding discussion to try at this stage to draw out a simple set of lessons – to construct a cookbook after the banquet! As we have noted, there are no easy answers when it comes to the leadership and management of inter-agency collaboration. Therefore many of our recommendations have a distinct flavour: the best way to support leaders and managers is often to allow them to take responsibility for finding ways to work through challenges in a way that is appropriate for that locality. This is not to say that it doesn’t matter if the broader context does not support collaborative working; it patently does, and we can learn from history about the many different initiatives and policies that have ultimately served to make collaborative working an even greater challenge. However, the evidence also suggests that we cannot just bring about high quality collaboration through changes to the macro environment; what happens locally plays an incredibly important part in making this happen.

Ultimately the challenges, summaries and frameworks we have set out in this text do lead us to make a set of practical recommendations and potential warnings, both for policy and for practice.

For policy-makers

• Although effective leadership and management do have a significant impact on the functioning of inter-agency collaborations, it is important that leaders’ roles are not overstated, and that we are realistic about what types of leadership and management can produce what kinds of results in what sets of circumstances.

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Ultimately, the evidence, questions, summaries, learning and frameworks set out in this book lead us to make a series of practical recommendations and potential warnings, both for policy and for practice.

For policy-makers

  • There is a need to consider the implications for existing teams and services when they exhort new teams or style of working. Creating new teams in any area will affect existing teams, their working practices and relationships, and may hinder the development of practice as people struggle to differentiate roles and boundaries.

  • Measures of teams in organisations are sometimes only built around their existence, not around their effectiveness; this perhaps adds to cynicism around rhetoric, as opposed to commitment, to teamworking.

  • Although teamworking may be helpful in a number of ways, it is not a default position that will solve all difficulties. Teams need real tasks and a real need to work together in order to be effective. Simply ordering more of certain types of teams will not overcome the difficulties that health and social care communities face.

  • National policy needs to send out stronger messages about how organisations need to make investments in enhancing and sustaining teamworking, rather than just one-off training.

  • There is a real need to have some stability in the system. Improvement in services is about doing something differently. To do this, people need to take risks and they will not feel safe to do so until there is a climate of mutual trust and respect, which takes time to develop.

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