In 2014, Simon Stevens (CEO, NHS England), published the Five Year Forward View (5YFV) for the NHS. The 39 page document outlined a radical vision for the NHS. Packing a punch, this document signalled a paradigm shift in how the NHS will deliver services in the future. This vision is now in the process of being implemented, with the intention that everything the NHS does delivers one outcome: improving patient care.
However, according to a report by the Kings Fund, workforce shortages and other critical pressures within the NHS workforce could jeopardise plans to deliver new models of care as set out in the 5YFV. It is, therefore, imperative that the NHS harnesses the value of partnership working with staff and colleagues across local government and other public, private and third sector bodies.
As major stakeholders in delivering the 5YFV, it is essential for staff to understand how their behaviours, transactions and relationships impact on patient outcomes. Creating an environment which encourages and supports staff to work collaboratively across organisational boundaries and with citizens in the delivery of care will become a business critical feature in the success of delivering the 5YFV. Additionally, evidence from NHS research has shown staff engagement is closely linked to the safety, effectiveness and patient experience of care. Therefore, maximising resources, encouraging innovation, and driving up the quality of care will also be achieved through increased levels of employee engagement.
That said, it cannot be assumed the conditions to work effectively in partnership already prevail. Often, staff are willing to work collaboratively with colleagues however external factors such as extensive and complex geographical footprints, differing priorities, diverse funding arrangements and incompatible IT systems, challenge the most willing.
Another area which tests the successful delivery of resourceful, innovative and heart centred driven care is that of people not feeling free to be authentic and empowered to act. Whilst working within a historically hierarchical system, the challenges faced by some staff can leave them feeling disempowered asking questions such as: “Will I be allowed to do this?” “What will my manager say?”
Thankfully, the journey towards healthier workplaces should result in the culture of authoritarian leadership styles being replaced by more inclusive and devolved approaches. An inclusive approach to leadership provides staff with space, scope and permission to be the architects of high quality care provision.
The Health Foundation report 'Fit for Purpose: Workforce Policy in the English NHS' states, "... to recruit, retain and engage people, it (the NHS) needs to make them feel much more valued and supported than they do at present, while at the same time engaging them with an unprecedented period of change"
Employee engagement and employee voice are intrinsic motivators that the NHS cannot afford to ignore if the FYFV is to deliver care that is coordinated around what people need and want.
A new model designed to foster improved working relationships across sectors and support the delivery of seamless high quality care, is the Permissions and Partnership Model.
The Permission and Partnership Model©
The Permission and Partnership Model (P&P Model) provides a framework in which the essential elements required for a successful collaborative approach towards better patient led care, is predicated upon capturing and combining the power of integrated thinking, aligned with diverse views, to produce commonality in goals and purpose.
Illustrated below is an example of how the model can be utilised. How the model works
The starting position for use of the model is Permission - this lies at its heart.
When groups of staff (or partners) give themselves permission to work in partnership, the diversity in the relationship fosters inquiry, trust, and developmental relationship(s). Permission also encourages creativity and innovation whilst driving down silos and professional duplication. The depth of the interactions often result in, focused, diverse, flexible and strategic intentions as well as discussions. Moreover, permission empowers staff to seek opportunities for change and try new approaches. This is reinforced by the Nuffield Trust in its Reshaping the Workforce report which recommends, senior leaders "Create a culture of support for experimentation and change".
When staff feel confident about receiving or taking permission to act, the model considers who should staff partner with to design care. In the example above three key disciplines have been represented but this is not set in stone and the partnership can be changed or increased. What is important, is the diversification of thought in the discussions.
Taking permission and working in partnership leads to multiple outcomes which is the section on the illustration which affords staff a feeling of accomplishment. The desire to work differently leads to a number of outcomes:
Inclusivity - Collaborating in line with common purpose;
Strengthens compassion - Exploring and learning to understand the employee/colleagues and patient experiences;
Innovation - Inspiring creative and more effective ways of working
Better patient driven care - Creation of an environment and culture for patients to shape and drive the care they want, having enhanced experiences in line with vision for a 21st century NHS.
Binding the principles of the model and strengthening the process are the foundational pillars.
Foundational pillars exist to ensure partners, through dialogue and expression, consider key issues when designing care provision. These pillars promote empathy, respect and trust, providing a healthy space to innovate, think and offer alternative perspectives.
Communication: What, how and why?
Erasing Barriers: Working together to reduce gaps in staff experience
Compelling story & Inquiry: Why is this important?
Transparent & Accountable: Open-minded and answerable
Quality & Value: Strong leadership, and a caring culture
This simple yet powerful model, is a tool designed to harness the elements necessary to cultivate inclusive partnerships. It permits staff to recognise and adopt the behaviours, mindset and inquiry necessary to support transformational change capable of responding to modern demands, through engaged partnerships. These strategic partnerships can collectively and cumulatively maximise resources, reshape care delivery, and ultimately improve outcomes; for staff and patients.
About Nesta Williams MSc, BSc RGN
Described as ‘a dynamic driver for inclusive leadership’ by a number of senior figures across the health care economy. Nesta Williams a transformative leader is currently Associate Director of Staff Engagement for North East Foundation Trust. She is a clinical expert in primary care and has worked across a number of specialisms and environments including prisons. Nesta is a specialist advisor in workforce planning. Nesta’s research interests are focussed on systems leadership and whole systems change. She has developed a new model which examines ways to maximise the benefits of collaborative working across professional and multi-disciplinary boundaries.
 Workforce planning in the NHS, Rachael Addicott, David Maguire, Matthew Honeyman, Joni Jabbal (April 2015) http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Workforce-planning-NHS-Kings-Fund-Apr-15.pdf
 West M, Dawson J, Admasachew L, Topakas A. NHS Staff Management and Health Service Quality: Results from the NHS Staff Survey and Related Data. Lancaster University Management School, The Work Foundation and Aston Business School; August 2011. Available from: www.gov.uk/government/uploads/system/uploads/ attachment_data/file/215455/dh_129656.pdf [accessed 29 March 2016].
 Fit for purpose? Workforce policy in the English NHS, Health Foundation (March 2016)
 Nuffield Trust Research Report: Reshaping the workforce to deliver the care patients need. Candace Imison, Sophie Castle-Clarke and Robert Watson (May 2016)