From: A model and typology of collaboration between professionals in healthcare organizations
SHARED GOALS AND VISION
This indicator is related to professional values in the form of common goals, with particular reference to the consensual and comprehensive nature of the goals. Identifying and sharing common goals is an essential point of departure for a collaborative undertaking. The data suggest that the goal most likely to rally stakeholders is that of promoting patient-centred care. Providing a response to clients' needs thus becomes a central objective on which everyone can agree. The problem is that this goal entails a radical transformation of values and practices; its achievement would truly be an innovation.
Client-centred orientation vs. other allegiances
There generally exists a complex structure of interests involving a variety of different types of allegiance: to the clientele, to the profession, to the organization, to private interests, etc. The result is thus an asymmetry of interests among partners or a partial convergence of interests. Mutual adjustments are required, making the need to negotiate all the more important. In some cases, negotiation is possible. In others, interests are left largely unexpressed, and there is no negotiating process. When shared goals are not negotiated, the risk is that private interests will emerge, resulting in opportunistic behaviour and a concomitant loss of focus on client-centred collaboration.
The data show that professionals must know each other personally and professionally if they are to develop a sense of belonging to a group and succeed in setting common objectives. Knowing each other personally means knowing each other's values and level of competence. Knowing each other professionally means knowing each other's disciplinary frame of reference, approach to care and scope of practice. The familiarization process occurs at social occasions, training activities and formal and informal information-exchange events. It is necessary to create the social conditions that will foster collaboration, particularly through social interaction.
According to the professionals, collaboration is possible only when they have trust in each other's competencies and ability to assume responsibilities (that is, when goodwill exists). Trust reduces uncertainty. Professionals acknowledge that they do not know each other well, and so must constantly gauge risks and allow themselves to be placed in a vulnerable position. When there is too much uncertainty, the data show, health professionals hold on to responsibility for their clients as long as possible to avoid collaborating. Such actions run counter to the goal of constructing networks. Professionals use the results of collaboration to evaluate each other and build trust.
Centrality refers to the existence of clear and explicit direction that is meant to guide action, in this case, towards collaboration. The data reveal the importance of the involvement of some central authorities in providing clear direction and playing a strategic and political role to further the implementation of collaborative processes and structures. Senior managers can exert significant influence on interorganizational collaboration, particularly through agreements they reach with the managers of other facilities to make the collaboration official.
Local leadership is necessary for the development of interprofessional and interorganizational collaboration. Leadership may take a variety of forms and can be categorized as either emergent or as related to a position. With respect to collaboration, leadership can be exercised either by managers who have been mandated to do so or by professionals who take the initiative themselves. In the latter case, leadership is shared by the different partners and is subject to wide agreement. When leadership is related to a position, power should not be concentrated in the hands of a single partner; all partners must be able to have their opinions heard and to participate in decision making.
Support for innovation
Because collaboration leads to new activities or because it involves dividing responsibilities differently between professionals and between institutions, it necessarily entails changes in clinical practices and in the sharing of responsibilities between partners. These changes represent real innovations that must be developed and implemented. Collaboration cannot take hold without a complementary learning process and without the organization involved drawing on internal or external expertise to support this learning process.
Connectivity refers to the fact that individuals and organizations are interconnected, that there are places for discussion and for constructing bonds between them. Connectivity is the opposite of being cut off, isolated, separate. It solves coordination problems and makes it possible to make adjustments to practices. Connectivity allows for rapid and continuous adjustments in response to problems of coordination. It takes the form of information and feedback systems, committees, etc.
Formalization is an important means of clarifying the various partners' responsibilities and negotiating how responsibilities are shared. There are many types of formalized tools: interorganizational agreements, protocols, information systems, etc. For professionals, it is important to know what is expected of them and what they can expect of others. Earlier findings suggest that collaboration is influenced less by the degree of formalization than by the consensus that emerges around formalization mechanisms and the specific rules that are implemented.
The exchange of information refers to the existence and appropriate use of an information infrastructure to allow for rapid and complete exchanges of information between professionals. The findings suggest that professionals use information systems to reduce uncertainty in their relationships with partners they do not know well. Feedback provides professionals with the information they need to follow up with patients as well as to evaluate their partners on the basis of the quality of the written exchanges and feedback. This is an important aspect of establishing relationships of trust.