What could a mental health and community services trust in London learn from a fully integrated social care trust in Northern Ireland and vice versa? IHI spoke to Hugh McCaughey and Kevin Cleary to find out. As members of IHI’s Health Improvement Alliance Europe, they brokered a collaborative relationship between their two disparate organizations. Dr. Kevin Cleary is Chief Medical Officer at East London NHS Foundation Trust in London, England. Hugh McCaughey is Chief Executive of South Eastern Health & Social Care Trust is Belfast, Northern Ireland.
How did you form a collaborative relationship between your trusts and what role did IHI’s Health Improvement Alliance Europe (HIAE) play in the formation of that relationship?
Kevin Cleary (KC): Being quite separate trusts in different countries within the United Kingdom, we wouldn’t normally have any interaction at all. It was through our relationship with IHI and the HIAE that we heard about the work happening at South Eastern.
Hugh McCaughey (HM): When you are on an island, like we are, it is easy to become isolated from new initiatives and developments. If you don’t stay connected with the broader international community, you risk getting left behind. The HIAE provides us an opportunity to come together with other European partners, which has been beneficial and stimulating.
KC: To start, a small group from South Eastern Trust came and visited us in London to see what we were doing in relation to quality improvement (QI). After that, our executive group went to South Eastern to look at their innovation center. That was the start. Over about six to nine months we built some context for our relationship and had a more formal meeting between the two groups.
What have been some of the best results of your collaboration so far?
KC: The first thing we have worked on is how to develop QI capability within an organization. At East London, we have done a lot of work around building skills in our staff so they understand QI methodology how to improve care for our patients. We developed a staff training program called “Pocket QI” and shared our curriculum with South Eastern.
HM: We have also been building our QI capability over the last six years through an internally developed and delivered nine-month programme called SQE. However, we liked and applied the idea of Pocket QI within our world resulting in a program called SQE Light. We have also connected our performance improvement information teams. We are looking at how we present data and reports and how we both evaluate success. Working with another organization at a similar point in the journey has really helped us and I think that is reciprocated.
Why is collaboration between organizations typically so hard in health care?
KC: Fundamentally, health care organizations do not have collaboration built into their normal way of functioning. Other organizations are seen as competition, particularly if you are geographically close. I think there is a real fundamental problem with the culture in health care around how you collaborate with other people. We don’t know how to share, and we don’t have a good model for doing so if we do want to share.
HM: The big challenge is how to share things locally within our own regions. People tend to look farther afield for the best ways of doing things and are a bit reluctant to learn in their own region or neighborhood. Something we have committed to, as a result of working with East London, is being better at sharing good practice within our own geographic region. HIAE has helped to bring together a forum to support that thinking and commitment.
KC: Another thing that makes it difficult to collaborate in health care is that organizations have different models for improvement. If you don’t share an improvement methodology — say, the Model for Improvement — then you don’t share the same language. When you have two organizations with the same language around how to change and improve that does make it easier.
You’ve shared organizational performance reports with each other. Is there any data that you absolutely won’t share?
HM: There are things that we have not shared but primarily because it hasn’t been relevant to what we are doing or sharing. If that information or data was sought out by ELFT, I don’t see any reason why we wouldn’t share.
KC: From my point of view, there is nothing we won’t share. If you truly want to improve quality, you should share as much as you can.
What advice do you have for organizations that may consider collaborating with others?
KC: See it as an opportunity rather than a threat. Try and be as open as possible with the other organization. If you can get to a relationship working well at the top of the organization, it is much easier lower in the organization. Accept that it is good to be challenged. It is a positive thing to have your model for how you do things challenged.
HM: Do it — just do it. We are all under increasing pressure and when we are not receptive to taking things that work from elsewhere, we are denying our staff and our patients the benefits they could otherwise receive.
Note: This conversation was edited for length and clarity.
You may also be interested in:
IHI Health Improvement Alliance Europe
Building a Culture of Improvement at East London NHS Foundation Trust