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Successful Partners

Feedback from NHS and industry practitioners can inform how collaborative working progresses

A tortoise with a hermit crab on its backIn recent years much has been written in the health press by the Department of Health (DH) and the Association of the British Pharmaceutical Industry (ABPI) about collaborative working. Most commentary has involved statements of intent or policy, and descriptions of a small number of collaborative working initiatives that are repeatedly held up as exemplars in the health sector.

Helpful as these examples are, they focus mainly on the structures, outcomes and organisational arrangements that support collaborative working. But how do practitioners of collaborative working, ie those individuals in industry and the NHS that are actively engaged in joint working initiatives, experience collaboration and how much success do they enjoy? What does the future hold for collaboration and what needs to happen in order for collaborative working to be more widely and successfully adopted?

Addressing these questions raises a number of issues that are pertinent to how the industry and the NHS will progress the collaborative working agenda.

Practitioners experience
About half of all respondents report positive experiences and success from collaborative working, but other experiences are variable and indicate mixed success. It has been said that the NHS is yet to fully grasp the concept of equity and mutuality, sometimes still seeing pharma as no more than a source of funding. A lack of understanding about the NHS' needs and, particularly, a lack of any clear effort from some industry members to understand it, leads to 'frustration' on the part of their NHS colleagues.

Given this backdrop, it is not surprising that the attrition rate for converting ideas into implemented projects is high.

The ability to partner successfully is situational and a factor of both organisations' collaborative working culture. Where NHS organisations and pharma firms are able to jointly work on a patient-focused issue, and when its solution is expected to deliver benefits to both parties, the experience is generally positive and can even act as a catalyst for more collaboration.

Competence is critical. There is broad acceptance of the fact that the process of connecting to form relationships, setting goals and guidelines, collaborating to deliver the objectives in an agreed manner, closing to review success and agreeing to the next step, is still new, but competencies in this regard are increasing with experience.

Some scepticism about the industry's willingness to fundamentally change its business model remains. Making reference to a number of company re-organisations, one respondent remarked: "We have seen 'commitment' [to collaborative working] via the structures that pharmaceutical companies have put in place, but there is still a question mark as to whether fundamental change is really happening."

Hurdles to collaborative working
Attitude towards collaboration at an organisational level is seen as the most significant hurdle by both industry members and their NHS colleagues. The overwhelming sense is that collaborations generally succeed because of the commitment of individuals rather than an institutionalised approach to collaborative working by their organisations. "Partnership isn't someone's job, it's just part of one". This leads to a supplementary question: "Is the partnership role mainstream or just a bit-part?" Change has to start at the top. "Senior pharmaceutical folk [directors] have got to get out and meet with their customers," is how one industry respondent put it.

A change in priorities, particularly as the industry tries to cut its cloth according to its means, can be disruptive to ongoing collaborative initiatives. NHS or pharma company restructuring – a fact of life at the moment – can lead to colleagues taking on new roles, often in different organisations, and leaving a particular initiative without the required ownership, leadership, knowledge and drive to see the work through to an optimal conclusion.

Some NHS participants still lack an understanding of what the industry is offering. "It is not always clear what pharma has to offer, what they want in return and how they want us to work with them," said one respondent. As such, assessment and qualification – understanding the potential business value of a collaborative initiative and partner – can be challenging.

In some cases, entrenched views about the 'other side' remain. "Some pharma companies are only really interested in selling drugs," remarked one NHS colleague, and an industry respondent said: "The NHS still expects to get things for free from pharma."

Motivates to collaborate
There are two different perspectives when it comes to the motivation for collaborative working: a business perspective – by working with customers and other stakeholders, benefits will be realised and shared, which will help both parties achieve their business objectives; and a strong personal perspective – the desire to add value and invest personally in the relationship and expected outcomes of collaborative working. 

Evidence suggests that when colleagues engage in personal development activities in collaborative working, they quickly build their newly acquired skills into their practice. Individual relationships can be further enhanced by the reputation of the colleague's company, re-enforcing the importance of a positive corporate attitude.

Colleagues from both sectors demonstrated their commitment to a collaborative approach. "What would motivate me to collaborate with industry is the ability to procure a package of products and services from a company," was one NHS perspective. "As a partner, the industry can become an inclusive part of the care-delivery process."

There was equal enthusiasm from industry colleagues. "Collaboration can be a very productive way of working, and one that reflects my personal values. This is a proper way of working," said one account manager. "Shared challenges, need and a desire to work together can lead to great collaborations."

Recognising value
Critically, value must be delivered to all parties if collaborative working is to be universally successful. There are varied perspectives on what defines value across both sectors; including reputation, commercial and financial success, relationship development and access to information and capabilities. Mismatches in what is perceived as value by the industry and NHS can be particularly damaging when it emerges during a collaboration.

The following key issues emerged when seeking to determine how the value of collaborative working is recognised: planning for partnership – understanding the idea; assessing the investment required and potential outcomes; measuring success – identifying success factors and metrics and risk versus benefit analysis.

The NHS is looking for the tangible benefits of collaboration. The achievement of mutually agreed on targets and shared goals is often linked to efficiency, improving care pathways and eliminating hospitalisation through appropriate drug intervention. Access to, and adoption of, pharma's skills and competencies is seen as critical for the NHS' ongoing development. Collaborative working is seen as an ideal way to acquire these skills and competencies.

For the industry, identifying a shared view with customers on important health challenges that relate directly to its product portfolios is key. The view was also expressed that: "Collaborative working in my organisation is seen as a strategic activity and so we plan for RoI over a longer period."

Evolution of collaborative working
Just under half of all respondents expected to be involved in more collaborative working over the next 12–18 months. A similar number gave a qualified 'maybe' citing their personal capacity to participate or that the supply and demand for collaborative working between companies and local NHS organisations was about right.

It was also felt that a pharma company's ability and willingness to collaborate effectively is a differentiator. Colleagues in both sectors, however, thought that skills, capabilities and attitudes would need to be addressed in their own, as well as their stakeholder's organisations, to improve collaborative working.

A number of NHS colleagues expressed a desire to be involved in more collaborative working and when asked if a company's ability and willingness to collaborate become a differentiator, one NHS colleague said: "Definitely, definitely, definitely yes, but it will require brave leaders on both sides."

Industry respondents felt that competence in collaborative working will or may have a positive impact on how pharmaceutical companies are regarded by NHS organisations. "Our approach to working collaboratively should position the company as first port-of-call for customers when they want above product support," said one account manager.

In describing the actions required to improve collaborative working in their own and their stakeholders' organisations, respondents said the following:

Pharma on pharma
"The customer agenda needs to be imbedded across the organisation. For example, brand marketing needs to appreciate the payer's agenda more than it does now," was one comment. Another said, "Many colleagues in customer facing roles 'get it' and have belief – if not confidence – in their organisations, reflecting the size of the challenge." Investment in improving skills and capabilities in collaborative working is critical and includes the collaboration process, assessment and qualification of collaboration opportunities and consulting skills.

Pharma on the NHS
The industry is changing and some colleagues ask the NHS to trust pharma companies and to put their historically-based pre-conceptions of the industry behind them. A genuine and sustainable commitment to moving away from the traditional business model can only work if both parties engage and experience the benefits of joining forces and sharing skills. Colleagues also ask that consistent messages and demonstrable collaborative behaviours are exhibited by NHS organisations to re-enforce their commitment to collaborative working. Part of this could be more joint communication of successful collaborative working arrangements.

NHS on the NHS
NHS collaboration practitioners are looking for greater accountability and the responsibility to act and implement collaborative initiatives with pharma companies. "We should actively look for opportunities to take 'safe' risks where adding value to both parties is the clear objective," was one view. The NHS must create a culture of "trust in our partners and us to work in partnership with them." This would involve actively seeking to understand the clinical and business priorities of the NHS and pharmaceutical organisations in order to determine collaborative working opportunities; looking to "take safe risks where adding value to both parties is the clear objective."

NHS on pharma
Pharma companies should seek to understand more about their local NHS businesses and how they can play a role in helping the system successfully manage the tension between quality of care, cost of care and patient engagement. Commitment was the watch-word here. "Collaborative working is something that they should genuinely want to get into. It's just so frustrating when they string you along and then pull out," said one NHS colleague.

There is some concern about the level of accountability that some pharma sales and account teams are given by their companies. Inefficient and ineffective internal collaboration between local and head office teams risks delivering a 'slow no' to NHS customers, which can strain or damage any relationship built up to that point.

Perhaps seeking to answer the questions posed through this work will encourage collaborative working practitioners and other colleagues to pose questions to each other and their potential partners that help both parties make informed choices about the relationships they want to have with their stakeholders, and what they need to do to make them successful.

The Author:
Steve Wells is an independent consultant.
For more information, contact steve.wells@informingchoices.com

7th January 2009

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