Collaboration – delivering the triple aims

Sarah Clark, Senior Manager at Attain explores the power of collaboration

Sarah has led on, and has played a key role in, a number of teams delivering successful collaboration across multiple organisations. Most recently Sarah led the re-procurement of the East of England Home Oxygen Service, a collaboration of 19 CCGs.

We’ve all heard of the phrase “two heads are better than one” – what about three heads, four or five even? Since the Five Year Forward View (5YFV) was published in October 2014, and more recently the creation of Sustainability and Transformation Plan (STP) footprints across the country to enable delivery of the objectives set out in the 5YFV, the spotlight has never been so keenly on collaboration as it is now.

Collaboration will be key to the implementation of sustainability and transformation plans and delivery against the triple aims of bridging the health and wellbeing gap, the care and quality gap and the finance and efficiency gap, once plans are approved in the winter.

Types of collaboration

We see various different types of collaboration amongst organisations on both a macro and micro level forming, including:

  • Strategic collaboration in the form of an Accountable Officers or Chief Executives forums with the aim of sharing ideas and strengthening relationships. These forums are not limited to commissioners but joint strategic forums which include providers;
  • Collaboration between providers to work together to deliver more joined up services, increasing the quality of services for populations, and seeking efficiencies through the back office services;
  • Commissioners working together to procure services collaboratively increasing their buying power, creating economies of scale and in turn the potential for savings; and
  • Health care commissioners and social care commissioners designing pathways and procuring services collaboratively which focus on improving the overall wellbeing of people. The outcomes of which not only make positive impacts on people’s lives but also creates a natural reduction for demand on services which are overstretched.

Collaboration – a definition

Collaboration has been embraced in some areas where benefits have been quickly identified and fast paced transformational changes being made, and the reality is that a looser form of collaboration has been in place in the form of groups such as Executive Forums for quite some time now.

However, perhaps the starting point is understanding what the word ‘collaboration’ actually means. What’s interesting is that when I typed the word into my search engine the first two meanings which appeared were:

  1. The action of working with someone to produce something
  2. Traitorous cooperation with an enemy

The first definition didn’t surprise me, as that’s a given, however the second spiked my interest quite considerably and I spent a long time pondering this. Is that true? Is that how collaboration is viewed by some? How do we ensure that this is not the case?

The power of collaboration

Collaborating with others can bring incredible benefits such as: greater resources; shared knowledge; and efficiencies in service pathways and finances; however, it doesn’t come without its challenges. The key is finding the common ground and having a common desire to work together, collaboration which is being forced upon organisations where the choice to do so is outside of their control can often feel like a more forced relationship. Evidence suggests that collaboration which begins this way is more likely to fail. In addition to this, collaboration between commissioners and providers where relationships have historically been adversarial can also be very difficult to change. When we talk about collaboration in the NHS I often hear the phrase ‘it’s like trying to turn the Titanic’. But is it that difficult? More importantly, does it need to be that difficult?

Barriers to collaboration

There are a plethora of barriers to overcome to ensure successful collaboration, none of which are insignificant, and STP leaders are wrestling with at present.  Some of the key barriers are: differing governance arrangements; disconnects between executive level and operational teams; ingrained behaviours; immature relationships, different payment and contracting mechanisms, and difficulties finding the common ground.

Overcoming barriers to collaboration

Over the years our team members have developed a wealth of experience in working collaboratively across commissioner and provider organisations to support successful collaboration in varying scenarios. It is important to note that no two scenarios are the same, each bringing different challenges and with every project we learn something new. Focusing on outcomes for people and patients, not the needs of organisations should be the driving force for collaboration.

So how do we overcome these barriers to achieve successful collaboration? What are the key enablers which we need to have in place?

(Click image to enlarge)

Overcoming barriers to collaboration diagram


It’s clear that we need to work together to create partnerships both formally and informally. Through the emerging STPs we are seeing examples of system wide collaboration. We need to work in a more joined up fashion if we are to increase the quality of care for the populations which we serve and create sustainable public services. Collaboration is not impossible and collaborating with each other is not only a necessary step but a positive one. Just think about the endless possibilities and at scale opportunities which otherwise may never exist if we didn’t collaborate.


For further information about Attain’s Commercial offer and other services please contact Chris Spark