Hello PPMA members and friends

This weeks’ post is written by President, Sue Evans, who mulls over whether integration is the holy grail for delivering on health and social care, or a hasty marriage based on shaky foundations.

“In maths – never my favourite subject – integration is described as ‘the inverse of differentiation’. I think that is an apt descriptor for what we are trying to achieve in health and social care and it is perhaps there that the solution, or lack of it, lies.

There are some essentials required if integration is to happen and, more importantly, be sustained.
• A focus on common ground;
• An understanding of what will make an integrated approach successful;
• A very clearly articulated vision of what the outcome needs to look like;
• A very clear reason for doing it in the first place;
• A shared understanding and recognition of what’s in it for each party and what each brings into the mix and expects to get from it and;
• A willingness to compromise and share.

So far so what? We know all that. So why isn’t there more progress on this agenda? The starting point is critical and considering the workforce issues early on in the process can make a positive difference to the way people think and feel about integration and the likelihood of success. With people in the mix the focus on similarity – the inversion of difference – becomes a deciding factor. What do we have in common, what is the benefit of coming together and what needs to be left behind to allow for new values, a new culture and a new and different set of relationships?

Time to explore the characteristics, habits, strengths and qualities of each party is time well spent and not doing so will end in tears at bedtime. We would never approach the building of any other relationship the way we sometimes approach integration –just imagine the scene.
Two people who vaguely know each other have just met properly and the conversation goes along the lines of:
A: ‘Shall we get married?’ (Pause for effect….looking hopeful and adding) ‘It seems like a good idea.’
B: ‘Oh, why not? You are in the same place as me and we can probably make some savings by moving in together.’
A: ‘That’s decided then, shall we look at places to live?”’
B: ‘OK, and can we have a blue carpet’.

It’s complete nonsense isn’t it? Yet in the early stages of planning integration the basic courtship required for successful long term relationships is largely overlooked in favour of focusing on systems and practicalities like the colour of the carpet and chairs or shared ICT. It is likely that more time will be spent on the practical issues of accommodation and communications than on the all – important thoughts, feelings, concerns, fears and hopes of the people involved. The ‘soft’ stuff will trip us up time and time again if we don’t pay any attention to it. HR and OD are key to brokering the kind of discussions which can make or break an integration deal.

Allowing time for those people involved to get together to think about the similarities and their common hopes and expectations will pay huge dividends. Let people get to know each other, find out what drives them, understand what their strengths and experience can bring to the enterprise. With a focus on inverting differentiation – reducing differences and building trust and confidence between players should take precedence early on. OD can help to build a shared sense of purpose and a respect for the different players and what they bring. Developing new approaches to working and managing the transition from the present to the future state will involve change and uncertainty. Acknowledging this can help people to leave things behind that don’t fit or work in the new world.

In the end the difference between successful integration and an unhappy marriage of convenience is the extent to which the parties can reach agreement, compromise and build on the similarities. A little patience and a lot of goodwill will go a long way and is more likely to be found where each party has something to gain from continuing the relationship and making it work. Those leading integration will be keen to get on with the work – of course, a great deal of hope and plenty of expectation is riding on it – but a slow and well planned lead-in, a courtship if you will, supported by effective OD and given the time to develop mutual trust and respect is more likely to result in a long and happy marriage than an acrimonious divorce.”

Sue Evans

PPMA President and Head of HR and OD at Warwickshire County Council