If you like challenge, then healthcare is the place to be. Pressures brought about by the Affordable Care Act are nothing short of transformative. Hospitals have recognized the need to change and are looking for more effective ways to deliver care. Ultimately, people are being asked to do things differently.

Most of the pressures for change come from the government’s efforts to improve healthcare quality and reduce costs: tenets of the value-based care model. In part, this means that the government will no longer pay hospitals based on the number of procedures, but rather on specific quality and outcome measures. Naturally, hospitals have had to reassess and change the way they conduct their business in order to reduce cost, and to improve quality of care and clinical outcomes.

Examples of hospital responses to healthcare reform abound. Among them are the following:

More than 450 Accountable Care Organizations have been created. These are networks of healthcare providers, such as hospitals and physicians, who come together to better manage care and reduce costs.

Twenty-five hospitals in New Jersey, New York, and Pennsylvania recently created an alliance to share ideas and research on how to improve care and reduce costs.

Blue Cross Blue Shield of Michigan and Trinity Health-Michigan created a first-of-a-kind private reimbursement model based on performance outcomes following the value-based model the government espouses.

A modest number of hospital mergers and acquisitions are taking place.

Hospital leaders, staff, and physicians are working together to find more effective and efficient ways to deliver care.

Impact

What is interesting is that these changes have important things in common: People are being asked to work together to accomplish difficult goals and usually, these partnerships fall beyond people’s common circle of influence. Forming effective relationships and working well together are crucial requisites, but they are certainly not easy to achieve and challenges are likely ahead.

In fact, the subject of collaboration has garnered a lot of attention in healthcare circles. This is a challenge that may be recognized in many healthcare organizations across the nation, but may not be appropriately addressed.

Defining Collaboration

Given the to the sheer number of definitions for collaboration, a group of researchers at the University of Central Florida recently attempted to create one clear description. They defined it as “an evolving process whereby two or more social entities actively and reciprocally engage in joint activities aimed at achieving at least one shared goal.” A concept that certainly reflects the current demands our healthcare leaders and staff are experiencing.

 The authors made further important clarifications:

–          Collaboration is not teamwork: Collaboration could happen between various entities (teams and individuals; organizations and teams, etc.) Teamwork, on the other hand, usually refers to cooperative efforts among individuals who form a distinct team.

 –          Collaboration is a process, not the outcome: Collaboration is based on relationships and is therefore dynamic. The process of collaboration can in turn lead to desired results.

 Collaboration could be a very elusive concept. At the end of day, it is about people working together to make things happen. This is important any day, but more so when stakes are high and people are required to come together to improve processes. Simply put, healthcare organizations that can effectively foster collaboration will more likely have an advantage over others that fail to do so.

So, how do we foster collaboration? What is needed for people to work well together?

There are many studies that outline the many factors that affect collaboration and creating a summary here could be a dissertation in itself. However, common factors such as trust and shared goals emerge as fundamental ingredients for collaboration to blossom.

 The Harvard Business Review recently published an interesting blog post that provides a great model to help healthcare organizations strengthen relationships which in turn, produces better outcomes. This model is centered on the concept of Social Capital, which is shown to be related to better coordination of care, staff commitment, and improved patient outcomes.

 Basically, social networks are made up of people you know. The strongest these relationships are, the more positive impact these networks can have on certain outcomes. However, this only happens if trust, reciprocity, shared values and norms, and openness exist. 

 In “Building Social Capital to Improve Healthcare Performance” (link to PDF file found on the HBR post mentioned above), the authors describe ways to foster each of these elements. Here is a brief summary:

 Trust:

• Practice honest communication.
• Empower people to do the work.
• Follow through on commitments.
• Create opportunities for people to interact with each other.

 Reciprocity:

• Create statements of responsibility and reciprocity.
• Invest in staff’s development.
• Reward and recognize collaborative behaviors.

 Shared Values:

• Make priorities clear.
• Enlist staff in developing statements of shared values.
• Model shared values.
• Use powerful stories that demonstrate these values.

 Shared Norms:

• Create consistency in processes (include shared language and consistent performance measures).
• Develop standardized procedures.

 Openness:

• Address mistakes with “appropriate forgiveness” rather than a “punitive approach”.

 The authors recognize that the above suggestions are foundational leadership practices; however, they challenge leaders to honestly assess whether these tactics are fully in place. This is a good question to ask, especially when new social networks are expanding and thus, people may need to work more diligently in nurturing these elements and leverage relationships to impact key performance outcomes.

Healthcare leaders and human resource professionals are well positioned to help organizations improve collaboration. However, we can sometimes get caught up with the day-to-day stuff and the immediacy of goal attainment. We must understand new pressures in the industry, continually assess the impact on our people, and figure out how we can leverage our skills and resources to help develop important people and organizational capabilities.

Have you experienced challenges with collaboration? What other challenges are healthcare organizations currently struggling with? How can we help?

 I look forward to hearing from you!