NHS Education for Scotland Defining A Quality Improvement Framework For A Coordinated Service Model Workshop 27 th May 2003 Dr Ann Wales NHS Scotland Library Service Development Coordinator

Aim of strategic planning Provision of information and learning support for all stages of the patient journey, including support for the well- being of the patient and the population

Service vision “NHS Scotland Library and Knowledge Services transformed in the light of new technology, operating as a network of proactive, skilled information practitioners and managers, empowered to deliver centrally funded resources to point of need on an equitable, integrated, nation-wide basis”.

Organizational Challenges Hierarchies Markets Networks

The Hierarchy Rule-driven design and direction Tiered structure: superordination and subordination Control through scrutiny, rule- making, standard-setting, directives Top-down command; pyramid matrix Conceptually linked to machine age and Industrial Revolution

The Market Competition among dispersed, autonomous economic agents No co-ordinating centre Decisions based on prices and contractual arrangements Order is created out of supply- demand chain Conceptually linked to Adam Smith’s Wealth of Nations 1776

Networks A set of relationships that exist at different levels within and across organisations Mirrors the structure of our primary technology – the integrated network. Involves both formal and informal channels. Will change over time Interdependency Involves and combines elements of the other systems No single model

Definition The term “network” describes the several interdependent actors involved in delivering services. These networks are made up of organizations which need to exchange resources (for example, money, authority, information, expertise) to: Achieve their objectives Maximise their influence over outcomes Avoid becoming dependent on other players in the game”. Rhodes, 1997

Current ways of working among NHS Scotland Library Services Incorporates elements of all 3 systems: Hierarchies – Within services, Boards, National Markets – Individual autonomy; SLA s Networks – Longstanding informal networks. Emerging networks: unified Board level and beyond Consider how our behaviour strengthens different ways of working

Why develop the network approach? Inherent in public sector management: “Public management is getting things done through other organisations” – Metcalfe and Richards, 1990 Inherent in information management: Electronic (and other) information systems create open channels of communication that cut across the organisation. Militates against ”chain of command” management.

Questions about networks: 1.) Why enter into relationships? Government requirement - unitary boards, regional and national responsibilities, Joint Futures, Workforce Development Action Plan, etc…. Need for assistance: finance, resources, skills Support for common values and purpose

2.) What resources are available? Expertise Information Human resources Material resources Time 3.) What are network currencies? Information Trust Shared values, shared purpose

4.) What is to be gained by joining the network? Groups and individuals join the network to gain some benefit in the short or longer term. What does a group give up in order to benefit from network participation? May be some loss of autonomy (market model) but perceived long-term advantages outweigh short-term considerations: –Organisational legitimacy –Reduction of uncertainty eg over funding

Managing network relationships Framework of interorganisational relationships Mutual behavioural adjustment Balancing goals of individual organisation and the network as a whole Different stakeholder interests – common interests need to be perceived as more important than conflicting interests. Implementation – organisation, planning, services delivery – need a common base

Problem solving in Networks Identifying similarities and common concerns Open exchange of information Searching for alternatives that will achieve “the greatest good for the greatest number” Negotiation and mutual accommodation Avoidance of mutually damaging behaviour Solve problems at salient level Long term vision necessary to enable both parties to reach agreement.

Characteristics of Networks Webs build from centre out Building the network is a never-ending process Periphery and centre are inter-dependent Structure is flexible Operate by communication across levels Redistribution of power to point of service delivery Shared responsibility and mutual need

Learning from experience Griffiths Report 1988: Community Care based on joint working Local Authorities / Health Service / Voluntary and Private Sectors Wistow (1992) Learning Points: Process and results rather than structure Project-based working Developing the skill- base Integrated, multi- disciplinary working

Framework for Successful Strategic Alliances Collaboration is about creating new value together rather than mere exchange Kantner 1994

Eight “I” s that create successful “We’s” Individual excellence Importance Interdependence Investment Information Integration Institutionalisation Integrity

Summary How to fulfil the service vision? Hierarchies, Markets, Networks Definition of Networks: Interdependency to Achieve Objectives Why develop the network approach? Problem-solving in network management Inter-dependence of periphery and centre Process and results rather than structure Collaboration is about creating new value together rather than mere exchange

Aim of strategic planning Provision of information and learning support for all stages of the patient journey, including support for the well-being of the patient and the population

Service vision “NHS Scotland Library and Knowledge Services transformed in the light of new technology, operating as a network of proactive, skilled information practitioners and managers, empowered to deliver centrally funded resources to point of need on an equitable, integrated, nation-wide basis”.

Further reading Kantner, RM (1994): Collaborative advantage: the art of alliances. Harvard Business Review July-August: Wistow, G (1992) Working together in a new policy concept. Health Services Management February: Ferlie, E. and Pettigrew, A. (1996) Managing through networks: some issues and implications for the NHS. British Journal of Management 7 (Supp): s81-s99 Helgesen, S. (1995) The web of inclusion. New York: Currency / Doubleday Publishing