Promoting partnership working in the NHS

Using an organisational development approach to improve partnership working at East Midlands SPF

About the area

The East Midlands SPF includes regional trade union representatives and HR leads from NHS organisations across the region.  

The forum was productive, developing tools and resources and revising its terms of reference. However, there were some issues relating to how meetings were conducted and difficulties reaching shared solutions.

The challenge

In January 2017, the forum used the partnership behaviours tool to review its effectiveness. The tool asks participants to rate and a comment on issues including: having shared values, walking in each other’s shoes, mutual respect and being solution focussed. Responses were anonymous, which resulted in a full and frank set of results to draw insights.

The average score across all ten questions was 6.02 out of ten compared to an average for other regional SPFs of approximately seven/eight. The lowest scoring questions were do colleagues walk in each other’s shoes with a score of 4.6 out of ten, and do we work from shared values which scored 5.8 out of ten.

The process

After discussion in the forum on what to do about the low scores, partners agreed to bring in two organisational development (OD) facilitators, one from UNISON and an employer representative. In November 2017, the OD facilitators repeated the review process, the areas of focus they identified were:

  • purpose – common purpose with structure, focus on what the group can do, not what the group can’t, clear commitment to goals, develop a shared workplan and the need to see value in terms of outputs
  • involvement – a need to better understand each other’s roles and to connect the work in the forum regionally with work going on locally and nationally
  • trust – for all parties to commit to improving trust and honesty.  

In March 2018, the OD facilitators took the group through an exercise to support walking in each other’s shoes and it became apparent that they wanted the same things but approached them from different perspectives. Partners explored using self as an instrument from the Nancy Kline work, and used the rounds of freshest thinking approach to explore the purpose of the SPF.

From this evolved the concept of jousting on issues, focusing on building trust on easy to agree issues, and jousting on the more challenging topics. Participants agreed how they wanted to joust, to ensure they didn’t repeat the issues outlined in the two reviews. These issues included not listening to each other and rushing to solutions before the issues are clearly understood.


The OD facilitators had been involved in the design of the agenda of the September 2018 meeting but did not attend the meeting. The chairs wanted to use the learning from the OD intervention to self-manage their meetings.

The agenda was structured with each item posed as a question to answer, using group work. Partners enjoyed a joint networking lunch beforehand and seating was cabaret style to support informality and new ways of working.

At the meeting, participants listened to each other to fully understand the issues, before moving to solutions, and agreed to resolve issues in the meetings rather than transferring them to task and finish groups, leading to protracted timescales.

At the meeting, partners were reminded of the forum’s agreed new ways of working, i.e. how do we want to joust?  focussing on three areas.

1.     Involvement – active listening, discussion rounds, posing agenda items as a question.

2.     Trust – developing relationships informally, thinking about individuals not organisations represented, no surprises approach.

3.     Purpose – regionally focussed, collaborative, aiming to reach a solution.

They were accompanied with a commitment to challenge colleagues who were not behaving in line with the new ways of working.

Since working in this new way, the SPF has:

  • agreed its priority work areas for 2019
  • developed principals for running meetings
  • repeated the partnership behaviours audit with average ratings across the 10 questions rising by 2.59 of ten points
  • structured meetings to focus on one main theme, using a workshop style, with a friendly open approach.

The chairs of the forum reflected on this process and made the following comments:

Maz Fosh, Director of Workforce and Transformation and Deputy Chief Executive, Lincolnshire Community Health Services NHS Trust said: ‘It was really great to work together in a different way and everyone was up for trying something different. The OD space which we created enabled us to dispel perceived perceptions and learn where we had commonality and similar views. The sessions were enjoyable and fun, which in turn has helped us build stronger relationships.  Meetings are now much more partnership working and where we have difference of opinion we listen more and now joust in a productive way!’

Sheila Marriot, Regional Director, Royal College of Nursing East Midlands Region said: ‘The best part of going through this process is seeing how the relationships between SPF members has improved. The meetings are fun, productive, engaging and lively. I’ve had colleagues saying to me they wished all regional SPFs could be like the East Midlands. The informal networking over lunch and in the breaks means the group is more comfortable to have challenging conversations, and in our terminology “joust” together in a solution-driven way. The relationships have improved, and the outputs have followed suit.’

Janine Brennan, Director of Workforce and Transformation, Northampton General Hospital NHS Trust said: ‘Having each meeting structured more like a workshop, with group work and clarity about the exam question we’re looking to answer for each item, have all made the meetings more productive and engaging. Asking yourself what we’re aiming to get out of discussing something at a meeting focusses the mind. We also find by having fewer more significant discussions at the meetings, we remain focussed on key priorities and outcomes.’ 

Top tips 

  • Allow time to establish the issues and co-produce a plan for addressing them. The process in the East Midlands SPF took 20 months.
  • Internal reviews may not be enough, so consider bringing in external expertise to support the group through the process and contribute an independent view.
  • Keep focussed on outcomes.
  • Set principals on how the group will work, encourage colleagues to hold each other to account on behaviours.
  • Small simple issues such as seating in the room and lunch affect how relationships are built, so consider these too.
  • Keeping agenda items focussed on the question you’re trying to address can ensure discussion is focussed and achieves an outcome.
  • Task and finish groups can be helpful but can sometimes be unnecessary, slowing down decision making.
  • Developing relationships is key to the improvements seen with this approach. Networking and getting to know you time at meetings are key.
  • The review and discussion of the Mersey Care NHS Foundation Trust’s work on developing a just and learning culture had a huge impact on the group’s approach, demonstrating effective ways of managing employee relations cases in a more person-centred way, and in turn how that impacts on the organisation’s culture.

Further information 






See also...