Reflections about a collaborative improvement project between Health Visiting and Speech and Language Therapy in NHS Lanarkshire
Ready to Act (Scottish Government 2016) and other national and local drivers tell us that collaboration is vital if we are to improve the wellbeing needs of children and young people. But how does that translate into practice and what makes it work well?
I recently began a collaborative improvement project working with Health Visitors to develop early intervention and prevention resources to work with children identified as having Speech, Language and Communication Needs (SLCN). The aim was to ensure timely intervention for everyone, including those whose needs could be met by the Health Visitors and those who may need access to specialist SLT services.
Here is what I learned about working collaboratively………
- Solve a complex problem together
Starting with the problem rather than the solution allowed for the team to come together in a combined effort. We worked together to ask questions, develop ideas for action, what steps were to be taken and how we would know the impact of this. Fundamental to this was having mutually beneficial outcomes and a shared responsibility for achieving this. Collaboration is often viewed as a ‘mutually beneficial relationship’ and therefore we had to explore the benefits of this partnership for all parties involved
2. Understand each other’s roles
In the early stages we spent a lot of time trying to understand each other’s roles. Some misconceptions, stereotypes and misinformation were under-covered on both sites. Having a deep understanding about working conditions, policies, training and background of the profession you are working with was so valuable. Ultimately, I had to continually question whether what I was expecting someone else to do was reasonable, achievable, applicable and acceptable to them.
Sometimes we had to accept there were fundamental differences in ethos between universal resources (which are available to all) and specialist resources which are targeted at those in need. But we also had many shared views and values which brought us together as a team. Ultimately, we both wanted a better experience for children and families and a way of them getting the help they needed as early as possible.
3. Manage the balance of power
As AHP’s we are encouraged to ‘empower’ others in order to ensure that we can transfer some of our skill and expertise to others. Empowering means ‘giving power to others to make them stronger and more confident.’ The notion of empowering others often presumes that one party has all the power and generously gives some of this power to someone else who is powerless. However, this can be at odds with the true meaning of collaborative working which relies on ‘co-equal interactions with common goals and shared values’ (Hartas, 2004)
I found that maintaining equal status was vital to the success of the project. No one party possessed more or less power or skill than the other. We had to ‘pool’ our knowledge together to try and think of the best solution. I had to be willing to listen to how I could also change, adapt, and learn from the Health Visitors I was working with. Central to this is the notion of compromise and being willing to change and adapt yourself.
4. Remove barriers as you go
It is important to continually ask about the barriers and find ways around them. Sometimes the barriers were obvious such as time, skill/competence and access to resources. However sometimes the barriers were hidden and less obvious eg dissemination of information.
Admittedly, some barriers are hard to remove such as embedded working practices and culture of assessment and referral. Understanding elements which will influence people’s decisions such as motivation, attitude and buy in from senior management were all important in trying to remove these barriers.
5. Understand the Blurring of roles (existence of professional boundaries)
There is no doubt professionals feel happier when they perform what they are trained to do within their own familiar professional boundaries. The notion of challenging this or extending someone’s view of their own role could be daunting. However in true collaborative and interdisciplinary working there can be blurring of roles and being open about this was important.
Throughout the project this could be seen as a negotiation of understanding what early intervention approaches Health Visitors would accept and see as fundamental to their role and what elements they would not. Mapping this out and spending time considering this was important to the acceptability and practicality of the early intervention procedures and resources.
6. Nurture relationships- find allies and spend time focussing on relationships
Collaboration is not a quick fix and the relationships will grow over time. If you can find allies, nurture these relationships and value them. There were times in the project I was faced with criticism, rejection or failure. At these times I had allies on my side who would support me, challenge others and build me back up.
So, does it actually work? – Collaborative working is not a quick fix and rather a long-term commitment and change in practice which can take time to translate into improved outcomes for children. We were able to show in the project that families were receiving advice and support earlier. Parents were happier with the advice and support they were getting and that there were clear routes to accessing specialist services.
How do we know we are moving in the right direction? I found that looking at individual changes in thinking, practitioner and family stories gave me the confidence that the project was achieving positive outcomes.
Collaborative working is not always easy but can ensure that children’s needs are met and that the support is delivered at the right time to meet individual family needs and ultimately improve wellbeing outcomes for children.
With thanks to the Health Visitors in NHS Lanarkshire
For more information about this project contact Joanne at Joanne.Gibson@lanarkshire.scot.nhs.uk
Hartas D. Teacher and speech-language therapist collaboration: being equal and achieving a common goal? Child Language Teaching and Therapy. 2004;20(1):33-54