It was more than 10 years ago that I conducted a small survey-based study into the NHS / pharmaceutical industry collaborative working landscape (click here for more information). Since then, I have maintained a close interest in collaboration and collaborative working. More recently, I have explored Collective Intelligence (the Nesta definition of which is, “something that is created when people work together, often with the help of technology, to mobilise a wider range of information, ideas, and insights to address a challenge”) and collaborative working in foresight. You can read articles on both these topics by following the links.
So I was curious about how many of the research conclusions I drew then (on the landscape for collaboration between the NHS and pharma) remain true today across business more generally.
Over many years, much has been written in the health press, by the DoH and ABPI about collaborative working. Most commentary has involved statements of intent or policy and descriptions of a number of collaborative working initiatives that are repeatedly held up as exemplars of collaboration in the health sector. Helpful as these examples are, they focus mainly on the structures, outcomes, and organisational arrangements that support collaborative working.
But how do practitioners of collaborative working—those individuals in industry and the NHS that are currently engaged in joint working initiatives—experience collaboration and how much success do they enjoy? What does the future hold for collaboration and what needs to happen in order for collaborative working to be widely and successfully adopted?
Addressing these questions raises a number of issues that are pertinent to how the industry and NHS will progress the collaborative working agenda.
Collaborative Working Practitioners’ Experience
About half of all respondents reported positive experiences and success from collaborative working, but other experiences are variable with mixed success. It has been said that the NHS has yet to fully grasp the concept of equity and mutuality, sometimes seeing the industry as a source of funding. A lack of understanding about the NHS’ needs and particularly a lack of any clear effort from some industry members to understand it, leads to frustration on the part of their NHS colleagues.
Given this backdrop, it is no real surprise that the attrition rate for converting ideas into implemented projects can be high.
The ability to partner successfully can be situational and a factor of both organisations’ collaborative working culture. Where NHS organisations and pharmaceutical companies are able to jointly work on a patient-focussed issue and its solution is expected to deliver benefits to both parties, experiences become positive and can act as a catalyst for further collaboration.
Competence in collaborative working is critical. But there is broad acceptance that the process of connecting to form relationships, contracting to set clear goals and guidelines, collaborating to deliver the objectives in the agreed manner, and closing to review success and agree next steps is still new but competence is increasing with experience.
Despite the largely positive perspective provided by industry colleagues, some scepticism about the industry’s willingness to fundamentally change its business model remains. Making reference to a number of company re-organisations, a respondent remarked, “we have seen commitment (to collaborative working) via the structures that pharmaceutical companies have put in place but there is still a question-mark whether fundamental change is really happening.”
Hurdles to Collaborative Working
Attitude to collaboration at the organisational level is seen as the most significant hurdle by both industry and NHS colleagues. The overwhelming sense is that collaborations generally succeed because of the commitment of individuals rather than an institutionalised approach to collaborative working by their organisation. "Partnership isn't someone's job it's just part of one”. This leads to a supplementary question: “Is the partnership role main-stream or just a bit-part?" Change has to start at the top: “Senior pharmaceutical folk (directors) have got to get out and meet with their customers," as one industry respondent put it.
A change in priorities—particularly as the industry tries to cut its cloth according to its means—can be disruptive to ongoing collaborative initiatives. NHS or pharma company re-structuring—often an operational fact of life—can lead to colleagues taking on new roles, often in different organisations leaving a particular initiative lacking the required leadership, knowledge, and drive to see the work through to an optimal conclusion.
Some NHS participants still lack an understanding of what the industry is offering. “It is not always clear what pharma has to offer, what they want in return and how they want us to work with them,” said one respondent. As such, assessment and qualification – understanding the potential business value of a collaborative initiative and partner – can be challenging.
In some cases, entrenched views about the “other side” remain. “Some pharma companies are only really interested in selling drugs," remarked one NHS colleague. But then again an industry respondent said: “The NHS still expects to get things for free from pharma.”
Motivation to Collaborate
There are two different perspectives when it comes to the motivation for collaborative working: a business perspective – by working with customers and other stakeholders, benefits will be realised and shared which will help both parties achieve their business objectives; and a strong personal perspective – a desire to add value and invest personally in the relationship and the expected outcomes from collaborative working.
Evidence suggests that when colleagues engage in personal development activities on collaborative working, they quickly build their newly acquired skills into their practice. Individual relationships can be further enhanced by the reputation of the colleague’s company, re-enforcing the importance of a positive corporate attitude.
Colleagues from both sectors demonstrated their commitment to a collaborative approach. “What would motivate me to collaborate with industry is the ability to procure a package of products and services from a company,” was one NHS perspective. “As a partner, the industry can become an inclusive part of the care delivery process.”
There was equal enthusiasm from industry colleagues. “Collaboration can be a very productive way of working, and one that reflects my personal values. This is a proper way of working,” said one account manager. “Shared challenges, need and a desire to work together can lead to great collaborations.”
Critically, value must be delivered to all parties if collaborative working is to be universally successful. There are varied perspectives of what defines value across both sectors; including reputation, commercial and financial success, relationship development, and access to information and capabilities. Mismatches in what is perceived as value by the industry and NHS can be particularly damaging when emerging during collaboration.
The following key themes emerge when seeking to determine how the value of collaborative working is recognised:
- Planning for partnership – understanding the idea, assessing the investment required, and the desired outcomes;
- Measuring success – identifying success factors and metrics; and
- Risk / benefit analysis.
The NHS is looking for the tangible benefits of collaboration. The achievement of mutually agreed targets and shared goals are often linked to efficiency, improving care pathways, and eliminating hospitalisation through appropriate drug intervention. Access to and adoption of pharma’s skills and competencies are seen as critical for the NHS’ ongoing development. Collaborative working is seen as an ideal way to acquire these skills and competencies.
For the industry, "Identifying a shared view with our customers on important health challenges that relate directly to our product portfolio,” is critical. The view was also expressed that, "Collaborative working in my organisation is seen as a strategic activity and so we plan for RoI over a longer period.”
Evolution of Collaborative Working Practice
Just under half of all respondents expected to be involved in more collaborative working over the following 12 to 18 months. A similar number gave a qualified “maybe” citing their personal capacity to participate or that supply and demand for collaborative working between companies and local NHS organisations was already about right.
It was also felt that a pharmaceutical company’s ability and willingness to collaborate effectively would increasingly be a differentiator. Colleagues in both sectors, however, thought that skills, capabilities, and attitudes need to be addressed in their own as well as their stakeholder’s organisations, to improve collaborative working.
A number of NHS colleagues expressed a desire to be involved in more collaborative working and when asked if a company’s ability and willingness to collaborate would become a differentiator, one NHS colleague said, “Definitely, definitely, definitely yes." But it will require, "brave leaders on both sides," he added.
Industry respondents feel that competence in collaborative working will or may have a positive impact on how pharmaceutical companies are regarded by NHS organisations. “Our approach to working collaboratively should position the company as first port of call for customers when they want above-product support,” said one account manager.
What Needs to Happen to Improve Collaborative Working Practice?
In describing the actions required to improve collaborative working in their own and their stakeholders’ organisations, three themes emerged in respondents’ feedback: corporate attitude to collaborative working; communication to promote collaborative working and capability development in collaborative working.
There is work to do to ensure that colleagues across the organisation—not just in the client/customer/partner facing roles—have a greater understanding of the collaborative working process, the aims and objective of collaborating, and an appreciation of the partner’s agenda. Investment in improving skills and capabilities in collaborative working is critical and includes the collaboration process, assessment and qualification of collaboration opportunities and consulting skills.
As the external environment changes, organisation across sectors are required to review business models and approaches to remain successful and valid. This might require historically based pre-conceptions of partnering sectors behind them. A genuine and sustainable commitment to moving away from the traditional business model can only work if both parties engage and experience the benefit of joining forces and sharing skills. Building trust is a crucial element here and will require consistent messages and demonstrable collaborative behaviours are exhibited to re-enforce commitment to collaborative working.
A commitment to the resourcing required, an understanding of both parties (in any given partnership), and clarity about wants and offers are a critical component of the contracting to partner as well as components of developing trust. Deep frustration can emerge when the division of resources applied varies from what was agreed. Partnership is not a quick fix, so the parties need to be aware of, and be able to demonstrate their long-term commitment to achieving the desired outcomes.
A Final Thought
Perhaps seeking to answer the questions posed through this work will encourage collaborative working practitioners and other colleagues to pose questions to each other and their potential partners. It is only through a process of ongoing dialogue that both parties will be able to make informed choices about the relationships they want to have with their stakeholders, and what they need to do to make them successful.
- How pertinent are these observations about the collaboration between the NHS and pharma sectors to your business environment in 2020?
- How have your perspectives on collaboration and collaborative working changed or not in the current covid-19 pandemic?
- What role might collaboration play in re-energising your enterprise post-pandemic?
- Given the increasing uncertainty we face through the pandemic, how might collaborative working support the development and implementation of sustainable business strategy?
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