Horizontal Teamwork in a Vertical World: Exploring interagency collaboration and people empowerment
By Peter Limbrick.
Published by Interconnections in 2012.
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From back cover:
We have constant reminders of how hospitals, schools, care homes, GPs, social services, etc damage service users by failing to work together. People who run commercial organisations take collaboration in their stride and do it well but many managers of public services wrongly assume it is impossible.
As UK public services are downgraded by the coalition government in favour of social enterprises and private bodies, a formula for joint working becomes ever more essential.
Peter Limbrick takes up the challenge, contrasting vertical organisations, characterised by top-down power, with the horizontal landscapes that must be cultivated between them. Here skilled leadership replaces hierarchical authority and space is created for the user’s voice to be heard loud and clear.
This essay explores why agencies do not collaborate and offers a guide to managers for creating coherent support for the multitude of people who need help from two or more agencies at the same time.
Chapter headings and summaries
Some people who need support from public services experience problems of fragmentation and disorganisation when they are helped by more than one agency at the same time or in the same period of time. The agreed antidote is interagency collaboration or, to use another term, multiagency co-ordination in which separate agencies find a way of working together to minimise or eradicate the problems often caused to the service user by a number of separate, concurrent or consecutive interventions. This essay is primarily concerned with service users who are shared between two or more agencies and it is written to promote and support efforts to create improved provision in any country
In this chapter, clear distinctions are drawn between vertical organisations and horizontal structures and horizontality is offered as the necessary structure for interagency collaboration between service providers at both senior management and practitioner levels. The TAC model is described as an example of horizontality which can inform service development for all categories of service users that require support from two or more agencies. The chapter explores aspects of interagency collaboration and the need for it to be properly established as part of the strategic design and direction of local support services. Horizontality is presented as a great challenge to service providers now and, perhaps, increasingly in the next few years.
Power in horizontality
This chapter explores service user power in vertical organisations and horizontal structures and suggests that all agencies should, before addressing how they might empower users, be watchful for any existing culture of disempowerment. While service users have a right and a responsibility to be fully involved in decisions about what support they will receive and how it will be provided, the argument here is that an equal voice is not possible. Negotiation is offered as an essential element of partnership and empowerment and necessary conditions are offered for a culture of empowerment in any agency or agency collective. Horizontality provides new opportunities for agencies that want to enhance their users’ empowerment and for service users who want to be proactive in getting their voice heard.
Where service user and horizontal structure meet
In this chapter I suggest that interagency collaboration, as a collective effort by two or more agencies, requires new professional roles at the interface between service user and the agency collective. The multiagency keyworker and individualised TACs are the roles that have been developed for this interface. To help highlight some important issues about both of these roles, a brief account is given of how the TAC model evolved out of a voluntary organisation called One Hundred Hours – an organisation that pioneered keyworker-based support for families with a disabled baby or young child. A critique is offered of why keyworking has not become a popular role and why very many keyworking projects have failed in England during the last decade or so. Both keyworking and TAC are described as highly successful approaches that empower service users and are greatly valued by them.
The workforce in the horizontal landscape
In this chapter we look at interagency collaboration from the perspective, first of practitioners in support services and then of their managers. Horizontal teamwork, with the TAC model as an example, is described in terms of the significant advantages it brings to workers while acknowledging that not every worker is suited to it. There are apprehensions and real risks involved when practitioners step outside their vertical organisation to work in the horizontal landscape and this chapter offers suggestions for reducing and managing those risks for the protection of workers. Interagency collaboration requires an investment of time and effort at all levels in the agency collective to get new work patterns established and then to support service users in their particular integrated pathways. This effort is offered here as changed work patterns rather than additional tasks.
Planning the service user’s journey
Providing support to a person in need can be thought of as accompanying them on a journey between two places. The journey created by an agency collective must be essentially different from that within a single agency. This chapter describes five phases that must be built into the journey or ‘integrated pathway’ and describes how the shared process of designing it can begin. I suggest that before any group of people can embark on building something together, they must first create a shared vision of what it is intended to look like and agree the values it must embrace and reflect. It is the same when designing a new integrated pathway. This service redesign provides an opportunity to set higher standards for service user empowerment and professional performance. Managers from the separate public services have a lead role in this service redesign and in securing the necessary funds to set it up and sustain it in the long term. Nine stages are offered for this management task.
High standards in interagency collaboration
The way support is provided to people in need in England is changing dramatically – as it is in some other countries. We are in a state of flux not yet knowing how, for example, education and health services will be structured by the end of our coalition government’s (first?) five years in office. As service provision is increasingly opened up to new social enterprises and private agencies, there is valid concern about how standards will be set, to what extent service providers will be regulated and whether interagency collaboration will become even harder to achieve. International air travel is offered as an example of effective interagency collaboration (but not of horizontality) from which we could learn valuable lessons. I offer some optimistic speculations and suggestions for establishing standards and promoting joint working in the horizontal landscape and then refer to the field of therapy for disabled infants, firstly to highlight the potential for an unregulated free-for-all in support for all service users and then to offer a helpful approach to achieve and maintain competency in interventions.