by Linda Hutchinson |
A frequently asked question to which the simple answer is yes. However if the person asking the question thinks that having an alliance contract written up is all that is needed to bring about integrated, collaborative working, they are mistaken.
When I am asked about sample contracts, I fudge the answer as politely as I can. Of course there are existing contracts that you can use and adapt. The trouble is that doing this will not bring you an alliance way of working.
It is the perennial problem of rolling out a successful initiative in one place to many others. How many times do we see the power of the original diluted and reduced when it is applied elsewhere? A nicely described example is given in the article in last week’s HSJ about adopting the US initiative to reduce central line infections – Why ‘cookie cutter’ change falls short. Those who thought it was about adopting the five point checklist were disappointed. It needed culture change, internal recognition of a problem and collective determination to tackle it. The checklist enabled the change to happen if these elements were in place, but it could not force them to happen. It is the same with an alliance contract. It supports a change in relationships once that change is happening and that is the part that takes time and effort.
As alliance contracting becomes an established term, often used as a possible answer to everything from integrated care to bad behaviours in existing contracts, I guarantee that the words on the page of a legal document are not what will make the difference. People make the difference; people recognising that the current behaviours are not helpful; people recognising that they need to change to enable others to change; people prepared to put the best for people using services ahead of what is best for their organisation and maybe for themselves; people prepared to put time and effort to achieve the collaborate and integration we all seek.
There is no magic bullet. An alliance contract can help seal a new way of working. It will aid the commissioner who is determined to drive collaboration through the way they do business. Yes, a commissioner can offload to a prime contractor the effort and leadership role for creating the co-operative relationships. Many are now doing this. It is understandable when the expectations and duties of a commissioner are many. I would argue though that the very essence of a commissioner is ownership of the leadership role and that they should be involved and continually engaged in how a health economy and its many partners work collaboratively.