'Health alliances are nine networks of primary health care providers and district health boards that are implementing the Government’s ‘Better, Sooner, More Convenient’ care initiatives.
A tagline for the South Island Alliance proclaims 'More Efficient Through Collaboration'. Is there any truth in this? Robin Gould, a Professor in Health Policy certainly thinks so. He has written extensively on the topic, including an interesting article in 20 October 2014 in theconversation.com titled NHS: Lessons from New Zealand on how to integrate care and an article in theguardian.com titled NHS Can Learn Alot From New Zealands Healthcare System. In these articles he reviews the New Zealand Alliancing model as a mechanism to improve Care Integration in the NHS. He argues that:
New Zealand’s nascent alliance model has yet to be fully tested. It does, however, offer a promising alternative for public health system and integrated care governance, which NHS policy makers could consider if they’re serious about finding a fair and workable system.
Do alliance partnerships have a place in the Victorian or Australian health system? In this three part series of articles, I am talking to Anthony Osborne and Sandra Quinlan, from Seeds of Possibility, a Melbourne based management consultancy, about Alliancing and its potential for application in Australian health industry projects and health organisations.
Through their backgrounds in the Energy, Construction and Utilities sectors, Sandra and Anthony both have many years experience in Alliancing, a model of project management that grew, in Australia, out of the construction industry.
Chris: So what is alliancing and why does it have potential for health organisations?
Anthony; Alliancing is a way of managing projects that has been around in Australia for about 10 years or so. One of the key things that alliancing is, is game breaking. How can we not just meet what we want, but how can we exceed it.
In with alliancing model a number of organisations get together to do a piece of work and actually create a new temporary entity that will have an entirely new culture with genuine alignment to values.
Three organisations for example might get together, and the alliancing structure means that the group can be totally focused on the project. This new group can establish new principles, practices and processes that are ideally suited to the project.
You see there is a problem in many organisations where we employ people for their differences then we beat them into submission to think the same. And most organisations are not good at nurturing creative innovation from within the group. Generally the bigger the organisation the more it happens, it is more common to see a ‘don’t rock the boat’ type attitude.
The alliancing model allows for a group of people to make a fresh start, and a combined understanding that ‘we’re all going to work together’.
To date, in Australia alliancing has primarily been implemented in large complex projects where technology is changing quickly. If we were to consider the relevance to hospitals, we can see that technology is ever changing and evolving. For example the technology in an operating theatre is constantly being developed and its fast and its constant.
Sandra: I remember recently talking to a surgeon about the changing environment of a surgery and he was saying that in a few years time there won’t be items positioned around the room, it’ll all be coming from up in the top. The way he started talking made the room sound like a spaceship to me.
Now he wasn’t talking about the happening in the distant future, it was in a few years time. This sort of change can be a quantum leap for people in how they work and think. Many have the attitude that ‘I have been doing my job for 15 years, I’m really comfortable with it and now your bringing that strange machine or technology in!’ If the culture is a blame culture, learning doesn’t thrive in that!
Chris: What are some of the advantages of Alliancing?
Anthony: Alliancing allows creative innovation to flourish. There are times where people have been talking to their managers about doing creative things for a long time unsuccessfully. When I was working in Health and Safety and we were using these principles of pulling the operational workers to find things, if they weren’t asked, they would generally just sit back and wait for things to go wrong. They wouldn’t contribute unless they were convinced that management we’re listening.
We realised that if you want people to give you ideas you need to act on it. People need to see that happening. For me, the important thing is working with a management team to ensure they are committed to the process and are rewarding it. The operational people actually see their ideas becoming reality and buy in, they become more committed to the process.
With an alliance, a new entity is created, that allows for different ways of doing things. Suddenly, people realize that they are being listened to, and this can lead to their engagement!
This element happens right at the beginning of the alliancing process. Right from the beginning, there is an outcome focus, so that everybody has a vested interest in the results. For an alliancing entity, all the key areas of cost, schedule, quality have business as usual Key Performance Indicators (KPIs), but also have ‘game breaking ones’.
Sandra : When I was working with teams on this part of the alliance creation, we would be working on ideas that normally people would see as ‘totally impossible’. If every part of the project was estimated to take 12 months, they group might look at it and set a goal of completing it all in 6 months. They would then work towards making that happen, so that everybody gets actively involved in doing things differently.
What this creates is the possibility for people to go, well what if we could? Its this possibility that peoples minds love to play with. And the group might end up saving millions of dollars on a project by making a few simple but fundamental changes.
Sandra : This new entity also provides the opportunity to change the way the group manages and values conflict. In all organisations there are a mixture of people including some who like conflict and others who do anything to avoid it.
There are often people in the room that try and quiet down conflict and anger. As a facilitator I allow it to come out. People that try to quiet it down need to listen and let it happen.
The alliancing entity provides an opportunity for people to discover and appreciate that there is value in conflict. That doesn’t mean that you’re punching each other in the face, but simply that you are able to acknowledge that on a particular point or issue that I may have a different opinion to you. As long as you are prepared to hear me and we can meet at the boundaries then this is where new ideas can come from.
Often it’s not the first workshop that people really open up, but the second one. I have found that when I am working really closely with a team, and they are all really passionate and vocal in their opinions.
People Taking Responsibility
Anthony : There is a really big difference between accountability and responsibility and when I run alliancing workshops we do a whole lot of work around this difference. You see a responsibility is what somebody actually chooses to take on. A person can be held accountable but I can’t force you to be responsible if you choose otherwise.
Sandra : In the workshops I work with the group on owning the responsibility. When you are part of the design of something and have input into something you are usually more willing to take more responsibility for it. It highlights a really important concept held within those alliancing principles, which is ‘awareness of the choices and decisions that you are making’.
In business, a lot of times, when questioned about decisions people will say that they didn’t have a choice. In reality they did. They may not have liked the consequences of the choices that they were making but they do have the choice. Gaining awareness of this and appreciating how this affects a persons own behavior, particularly in conflict situations is important. Even if you are the angriest person in the world, how I respond to you is going to either increase or decrease it. I can’t take responsibility for you, but I can take responsibility for how I react to any situation.
Anthony : An interesting advantage of this model is that it leads to personal growth. In the alliance projects we were involved in we called it personal development.
Sandra : My aim is always that if somebody has worked with me, they’ve learnt something about themselves that they didn’t know before they started the process. I had a manager once who trusted me so much, and I didn’t think I was really worthy of that trust, but he taught me something. But I really started to live up to that trust that he gave me. I learnt something about myself, because I upped my standard because he trusted me. There was an expectation that there wasn’t much I couldn’t do. This is what Alliancing does, it lifts the bar and everybody starts to rise up to that place.
I would say that when people go through that process in the most successful projects, everybody’s taken a personal career risk of some description. For example the quiet people in team who never contribute, might actually start contributing.
Anthony: Another example is the principle of not taking things personally. It sounds easy, but in practice as soon as somebody gets into a sensitive spot and pokes us we react rather than respond.. Another one is to not make assumptions. With all these ideas its not about whether our understanding is right or wrong, its about raising our awareness to it.
Most organisations that don’t have alliancing capability, will bring a consultant in to fix the problem. The problem doesn’t get fixed, so they sack the consultant and get anther one in. In reality, its not the consultants job to fix these types of problems its the consultants job to facilitate a process so that the organisation can heal and grow.
Chris : Alliancing in the Health Industry – why hasn’t it taken off and what is needed?
Sandra – I simple don’t think that anybody has pushed for it. Alliancing took off in the construction world in Australia, in around 2004, and I think consultants simply got very comfortable in construction.
There was big money in construction and people didn’t have to move to different industries. There was no major incentive or demand to move into health and for a consultant to go this way you would have to promote it heavily to gain acceptance.
I remember being in an engineering conference. We were there to talk about what we were going to do with this first alliance in Victoria. There were managers in there saying this is never going to work and other people even laughing at us. Gaining acceptance for a new concept takes hard work!
I have a colleague who has gone on to do a lot of work on alliancing in the New Zealand health industry with District Health Boards, but at that time one thing led to another but Australia didn’t end up doing anything at the time.
I was reading about the vision for the Royal Women’s Hospital from the new CEO. I am majorly impressed with her. What she wants for her patients, clearly comes from her experiences because she talks about treating people with dignity and care. It was clearly coming from a deep emotional place that was a fundamental driver for her. I thought, that is somebody who would be an ideal candidate who has the vision to take on a new concept like alliancing.
When you bring in any new concept you get a lot of push back. I know for me, that she would be a really great ally because she would want it to work. She would be able to see the concept on how that would work. As a facilitator, she would be able to guide me through her vision. Her vision is strong and it’s the best one I have ever seen.
Chris : Is Australia ready for Alliancing in the health industry?
Sandra: I Iook at the hospital system in Australia now and I think that there is a readiness that wasn’t there before. There is a level of discontent with what is happening the health system and people need a level of dissatisfaction to be able to try new things. Also people will be aware of what has happened in New Zealand. They will have been sitting on the fence and will have gathered the evidence that they need to be happy to make a decision.
Health Industry Manager
INTRODUCTION TO SEEDS OF POSSIBILITY
Seeds of Possibility are a business performance consultancy. They bring a wealth of experience in alliancing across different industries and Sandra has also worked closely with a Key consultant to a New Zealand District Health Board, who pioneered Alliancing within the New Zealand Health system. What Seeds of Possibility do differently is that they work with clients to improve systems and engage people both at the same time.
As Anthony highlights ‘ I saw a recent Gallup poll that revealed over 70% of people in the workplace are not engaged with the work they do which astounded me. ‘But it’s no use engaging with your people if your systems are no good, because if your systems are no good, the people disengage”.
When you get those elements right and include how you align everybody – the alliancing component - the organisation becomes powerful and strong and make a difference and get great results. Their contact details are:
Mobile +61 413663360
Mobile +61 413663360