True collaboration and real alliances

It is inevitable that people place their own interpretation on what constitutes an alliance contract. Trouble is, if they use it for a watered down or compromised version, will they miss the point?

It worries me that people are saying they have an alliance contract when they don’t. When one of these DIY versions hits problems then people might say that alliance contracts don’t work.

It’s easy to go to a conference or workshop where someone talks about alliance contracting, then download or copy the slides and think you can do it. I’ve seen my words from as far back as 2011 in people’s documents and presentations.

Now we have the added problem of circulation of an adaptation of alliance contracts, corrupted to fit the NHS model of national standard contracts. You can of course have different permutations of any contract type so I should not be precious about it. Unfortunately, once something is in official publications it becomes the accepted version. I have seen it in NHS England presentations and in a recent publication. The NHS Commissioning Assembly diagram (last page of Commissioning for Outcomes: a narrative from and for clinical commissioners) is a variation on a partnership agreement overlying individual contracts. It is not wrong, just unnecessarily complicated and represents a watered down way of getting the benefit from true alliance contracting.

I feel frustrated for local NHS organisations who are denied the freedom to use a proper alliance contract approach because we have imposed national standard contracts. When I work with councils, justice, community safety, employment services or any other sector I can talk about real alliance contracts. When I talk with NHS organisations, I have to show how you can make it fit the constrained reality of our over prescriptive system.

Even with the right model, following the descriptions and using template documents does not mean you’re actually ready to be part of a true alliance contract. Unless each organisation involved is willing to become genuinely aligned and is ready to work towards a solution that is best for service rather than best for them, things will almost certainly end badly. Time and time again, issues over money, the role of each organisation and changes for their staff cause problems that can derail a promising alliance.

I was recently involved in helping facilitate the financial negotiation part of an alliance contract. The alliance had been up and running for the best part of a year, I was told, and just needed a bit of help on the financials. When we got into the room, it was clear that the various parties hadn’t done the necessary groundwork. There was little alignment, little honesty and trust and too many issues unresolved for any progress to be made.

“True collaboration means you can discuss money constructively and maturely. To do that you need trust.”

True collaboration means you can discuss money constructively and maturely. To do that you need trust. Trust does not just appear. It comes from getting the terms of alignment agreed before work begins. This means more than just agreeing on a worthy but high-level vision like ‘we want better care for patients’. It takes more than writing down a list of principles or values on an away day together.

Alignment is about having deep, challenging and possibly difficult conversations about what the vision really means. In order for genuine alliances to be created, people have to declare what they want to get out of a prospective collaboration and their relationships with others who will be working alongside them. They also need to declare what they bring and, importantly, any constraints on collaboration. This is why developing an alliance-based way of working requires specialist help from facilitation services.

I can see you might think this is a plug for me and yes it is. I sometimes describe what I do as ACAS before the dispute. When you are steeped in the local issues and personalities, it is hard to have the perspective to look at the bigger picture. There is too much baggage and vested interest. It’s essential to get all of the potential issues out in the open and dealt with before the real changes get underway. It may not be pretty but it’ll better in the long run.

It would be a shame if people call their initiative an alliance contract and then just put a few of the pieces together and miss the larger point. When it comes off the rails they will say alliance contracting doesn’t work. This will put others off from going down the alliance route in the future. The potential for extraordinary things that have been achieved in other sectors is so exciting. Let’s be brave. Let’s do it right.

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