In the first article, we reviewed how Alliances have become a significant form of contract partnership and management within the New Zealand health industry yet do not play a major role in Australian health management.
Chris: What is the most important part of the Alliancing Model?
Anthony: The essence of alliancing is the principles, rather than the legal documents. It’s about the underlying philosophy. We could go into a hospital right now and say that we’re going to create the whole concept of an alliance. The legal structure is an upfront cost to an outstanding result, but will still have the vision of creating something with you and for you. This is a structure and a process that we would be able to do, without the big set-ups that have built in New Zealand.
Some of the example principles that were held within Alliance I have been involved in include Equality, ‘best for project’ decision making, integration, open and honest conversation, a culture of ‘no-blame’ but accountability for action, trust, respect and integrity, proactive pursuit of innovation, mutual support and collective responsibility.
Anthony: Most organisations that don’t have an alliancing capability will bring a consultant in to fix the problem. The problem doesn’t get fixed, so they sack the consultant and get anther one in. In reality, its not the consultants job to fix these types of problems its the consultants job to facilitate a process so that the organisation can heal and grow.
Chris: Do Alliance members ever come into alliancing groups with pre-conceived notions of how problems should be solved?
Sandra: Of course! Yes, everybody comes in with his or her beliefs and what they usually ask those around them is ‘what’s this got to do with [expletive] anything!’
People come in thinking that this meeting is going to be like every other meeting they have attended. That is will be structured in a particular way and immediately focused on the project or on brainstorming ideas or whatever the usual format that is followed in the business. When this doesn’t happen, people can get annoyed. They can ask that we stop this nonsense and get down to business. All sorts of stuff like this.
A good example of this was with an alliancing project for a huge multinational oil company. It was a safety project for the tanker drivers and high crash incidences. In the group they talked about family issues and home life and all sorts of seemingly unrelated topics. But it worked. In the end their safety issues were cleaned up because all sorts of ‘supposedly’ unrelated systems were improved like roster scheduling for example.
You see the problem in this situation was not the obvious one of ‘wearing hardhats or boots or having driver training’. The real, underlying issues was ‘why are the tanker drivers angry and therefore not concentrating and losing control of their vehicles’. Well it turned out that they were angry because the schedules were poor and nobody had ever listened to them. They were being sent into peak hour traffic at 8am in the morning with an excessive number of runs to do.
But until we have the opportunity to really explore these issues to get to the bottom of them, people will ask on the surface ‘what has this got to do with safety?
This is why I always ask upfront ‘what is it what would get in the way of people speaking openly and honestly today’. Sometimes, this is enough to open the dialogue and get productive conversations started.
Chris: Are there health organisations that are not ready for alliancing?
Sandra: Yes, there probably are. Lets consider those organizations, whose leader is very autocratic and who has only one way of doing things. I would doubt that this leader would even want to talk about alliancing. I know that there are plenty of those managers out there.
But there will be somebody who is a leader in the industry who is prepared to take a risk, because an alliance is a risk. But there will be somebody out there who is a leader who wants to do something really different. But once that happens, as it happened with a Victorian Government Transport Authority that took a leap of faith and trialed it for the first time all those years ago, is that everybody watches it and they see the success and they become curious.
Anthony: The leader needs to be open to new ways of being and doing things. They might not know what alliancing is, but they are open to new ways of doing things.
Sandra – As an example, one of the pioneers of alliancing in Australia had been a manager at this Victorian Government Transport organisation for years. He’d always had a dream that work could be done a particular way and he just happened to be talking to someone about alliancing, and it fitted with his dream.
He didn’t know how you could get people working together and working for something bigger than them but he knew intuitively that this was his goal. So he just needed to come across somebody who was able to introduce him to alliancing. Now the risk to him, and I remember him saying it, was that it would define his career. He said ‘I am either going to go out as a hero or my reputation will be gone’.
Anthony: You see the normal model is that you contract out the job to somebody, and they’re an independent person doing the job for this government department so you immediately have conflict and an adversarial relationship, underpinned by an official contractual relationship. So if anything goes wrong, people immediately point to the contractual relationship. The different with alliancing, is that the partners come into the group and become an intimately connected part of it and what it does.
Most people don’t want to go to work to argue and fight. There are some, but I believe that they are few and far between. I believe most people want to work together to be productive and do something great. People who go into the health sector generally go into the industry because the want to help and have an underlying commitment. If you look at an A&E department in a hospital, when things go wrong people take it very seriously because they are so committed.
If you just give them the opportunity to work together they will want to make it work. And importantly, they will know how to do it. You think about how innovative you have to be when you have to make split second decisions.
Further, if you look at the highly demanding health and safety minefield that healthcare workers have to work within. Working constantly under the threat of being sued, while also focusing on saving a persons life managing an ailment. Health and safety rules, when done poorly, can be the biggest block to innovation and creative thinking that there is. And yet managers sometimes impose health and safety systems without consulting the workers.
What is it about the alliance model and process that allows projects to succeed where they haven’t in the past?
Firstly, it’s about bringing the people together. If you have systems that cross over three different departments in a hospital, its about bringing the people in those departments together to ask how can we design a new system that works for all of us. It may be re-working the
If I think back to the alliances I have been involved in, one might involve three different companies but they will work together to decide what is the best system for this situation.
It’s got nothing to do with the division or department that the individuals may have come from. Divisional power struggles are not allowed. What has to happen is for people to talk about what is best for project irrespective of what is best for their department?
It’s the way that they come together that is key in how they work together. The success largely relates to how this process is facilitated. From our experiences both facilitating and working in alliance groups, people need to come in with an attitude that ‘we’re going to find a solution to a problem.
Every alliance requires a neutral facilitator because otherwise some participants wont speak up. A facilitator has to be able to help people see what they are not currently aware of because they are caught up in the process of it. A facilitator therefore needs to have a neutral perspective. They need to be able to stay ‘outside’ of the process.
If a facilitator is not neutral, they also become part of the process because of their background. This affects their ability to stay outside. Participants will think that the facilitator has some bias. For example, that they are aligned with the Doctors group or the Nurses group or have some bias towards the administrative component. A good way of describing it is like coaching in a group setting.
INTRODUCTION TO SEEDS OF POSSIBILITY
Seeds of Possibility are a business performance consultancy. They bring a wealth of experience in alliancing across different industries and Sandra has also worked closely with a Key consultant to a New Zealand District Health Board, who pioneered Alliancing within the New Zealand Health system. What Seeds of Possibility do differently is that they work with clients to improve systems and engage people both at the same time.
As Anthony highlights ‘ I saw a recent Gallup poll that revealed over 70% of people in the workplace are not engaged with the work they do which astounded me. ‘But it’s no use engaging with your people if your systems are no good, because if your systems are no good, the people disengage”.
When you get those elements right and include how you align everybody – the alliancing component - the organisation becomes powerful and strong and make a difference and get great results. Their contact details are:
Mobile +61 413663360