Collaborative patient/healthcare professional pairs

In the second episode of our series "Hospital by Patients" we head to the United Kingdom to explore the "Collaborative Pairs" program launched by the King's Fund foundation. In this program, patients and healthcare professionals work in pairs to improve the organization of care.

A vision for the future of the healthcare system

Co-constructing the healthcare system of tomorrow with patients? The King's Fund foundation (United Kingdom) believes in this perspective and, through its "Collaborative Pairs" program, launched in 2015, seeks to explore and make it more tangible.

In this program, pairs composed of healthcare professionals and patients work together on projects to improve the organization of care: optimizing care pathways, access to care for disadvantaged populations, improving patient satisfaction, etc. "Our foundation is committed to patient participation in the design and organization of care pathways," says Mark Doughty, one of the program's managers and facilitators. "But how can this work concretely? We want to help our healthcare system think about how to work differently with patients and communities".

Fostering a new type of relationship between healthcare professionals and patients

The Collaborative Pairs program arose from a realization: collaboration with patients is necessary to evolve the healthcare system, but it requires a profound change in mindset, both for healthcare professionals and patients themselves. This change in mindset, and the methods for implementing it, are the focus of the program, whose first edition started in September 2015. The King's Fund invited patients, healthcare professionals, and local stakeholders to come together in pairs to explore the construction of a collaborative relationship with patients and then the development of a collaborative culture within their own organization.

What exactly is meant by a collaborative relationship? According to the King's Fund definition, "healthcare professionals and patients move from a 'us/them' relationship, where power is held by the healthcare professional, to a new relationship in which power is shared. The main characteristic of a collaborative relationship is that everything is shared: goals, leadership, responsibilities."

For the first edition, 12 pairs were formed and supported over a period of approximately 6 months. During this time, each pair engaged, through a concrete project conducted at the local level (a hospital, a territory, etc.), in the construction of a collaborative relationship.

The pairs also met 5 times for day-long workshops, led by King's Fund facilitators. During these workshops, they worked on developing their interpersonal skills, leadership, and the ability to rally other stakeholders around their project.

Between one workshop and the next, the facilitators followed up with the pairs, helping them assess the evolution of their relationship and how to deal with any obstacles they encountered.

Investing in relationship skills and leadership

According to Mr. Doughty, to change mindsets and create conditions for new forms of collaboration with patients, the healthcare system must invest in developing relationship skills for both professionals operating within the system and patients, users, and caregivers.

For patient collaboration to take shape, it is necessary to develop capacities related to emotional intelligence, such as self-awareness, the ability to identify and explore one's own beliefs and biases as well as those of others, the skills and confidence to self-lead, the ability to influence different stakeholders, and to work within a framework of diverse modes of thinking and behavior.

"In the UK healthcare system, this focus on relational skills and leadership goes against the grain," explains Mr. Doughty, "as the system tends to prioritize 'hard' elements such as structures, procedures, tasks, goals, and indicators".

Conditions for changing mindsets

For the pairs participating in the program, the path to building a collaborative relationship is not without obstacles. "When pairs join the program," Mr. Doughty explains, "they tend to focus on the tasks to be accomplished to advance their project. In other words, they focus more on the 'what to do' than on the 'how to do it,' which can quickly lead them to forget that the project is only a means to the real goal, which is to learn to work within a collaborative partnership."

Another obstacle: as soon as a pair is faced with difficulty or a stressful situation, traditional power dynamics tend to reappear, and participants revert to their usual behavioral patterns. "The healthcare professional reassumes their expert stance and tries to assert their authority. As for the patient, they no longer dare to challenge the healthcare professional, or they react in a childish manner, as if they were in a parent/child relationship with the healthcare professional."

According to Mr. Doughty, "the challenge for participants in the program is to learn to be equal partners in a system that does not share this collaborative approach." The collective workshops offered as part of the program are an opportunity for each pair to step back and refocus on the collaborative relationship. Through exchange with facilitators and other pairs, participants see collaborative relationships take shape, and they can experiment with new approaches and behaviors in a safe environment.

Following the first two editions, the team that designed and led the program identified 5 key success factors for building a collaborative relationship between healthcare professionals and patients:

1. Finding the right partner for a collaborative pair

2. Identifying a partner motivated to work collaboratively. Identifying a project that addresses real issues. Defining shared working principles. Finding support and funding for the project.

3. Investing in the development of leadership and collaborative relationships

4. Supporting stakeholders - patients, professionals, users - in their journey to develop the capacity to work collaboratively, which involves investments in terms of time, energy, and commitment.

5. Taking time to draw lessons and share them around

6. Regularly scheduling time to reflect and review, individually and in pairs, what has been learned. Charting this learning and sharing it within one's organization.

7. Acting "under the radar"

8. Collaborative work can run counter to established mindsets and practices within an organization (hospital or otherwise). It is preferable for Collaborative Pairs to try to achieve concrete results before seeking legitimization of the collaborative approach from the hierarchy.

9. Integrating the collaborative approach at the governance level

In conclusion, how could the initiative evolve in the coming years? According to Mr. Doughty, the King's Fund's priority is to find solutions so that the collaborative approach can fuel cultural change on a larger scale within the British healthcare system. In this spirit, program leaders are considering the possibility of launching several pairs within a single organization, such as a hospital (this approach is currently being piloted within the Barts Health hospital group).

Another area under consideration is to create spaces and formats for the Collaborative Pairs experience to be led by actors other than the King's Fund itself. Why not in France too?