A version of this article by Keith Fletcher first appeared in "Community Care" 4-10 June 1998 under the title "The Body Compatible".

Working Together

Professional and agency partnerships are a good thing. We are always being told so and there is ample evidence that they produce a bettor result for clients/patients/pupils. If they are such a good thing why are they so difficult to establish and maintain in practice; and what can we do to make them a bit easier?

As you walk in the door of most high street shops you are greeted by, “Good morning sir/madam; how may I help you?”; except in McDonald’s where they say, “Hi! how are you today.” Why the difference? Because McDonald’s, who research everything, have discovered that their formula sells more fries.

There are two important lessons here. First, if you want someone to modify their behaviour to help you to become more effective, your first question is, “How may I help you (to get what you want)?” Secondly McDonald’s are quite clear that they want to sell more fries. You need to be just as clear about what you want from working together.

Teachers want pupils to get a better social work service. GPs want old people to get good support in the community. Social workers want better recognition of the social circumstances of their clients. They should co-operate in enabling these things to happen shouldn’t they? But the two points to note are first, that everyone wants someone else to change, and secondly if people get a crummy social work service it is the social worker who will be held to account, not the teacher or the doctor
Fortunately most professionals recognise that the whole quality of the lives of their patients/clients/pupils is inextricably interwoven. But it is hard in practice to reach effective accommodation with our colleagues. There are systems difficulties concerned with boundaries, organisations and budgets. There are many other problems concerned with personalities, priorities and politics. Few of us have much control over any of these things: they are just there to be circumnavigated.

What we can do is to work out exactly what we want to achieve, for ourselves and our clients.. And we can work hard to find out what the other professionals want to achieve; what makes their lives most difficult; and where they most want to see change. There is almost never a fundamental incompatibility if everybody assumes goodwill and looks to achieve a proper exchange of benefits. They are not always obvious and easy to identify but they are always there. And once an inter-professional group has identified them and agreed what needs to be done it becomes almost unstoppable.

Consider a specific example. The local school excludes a lot of pupils with many negative consequences. You want them to stop doing it or at least reduce the frequency. What do they want? You don’t seriously think they want to exclude children do you? But they do want help to deal with the situation which gives rise to the problem. Perhaps there is something you can offer here. Look at it in terms of definitions. Their problem is disruption in school. Your problem is disruption in the community. The young people’s problem is alienation and exclusion to which they react in the only way they know how. If you can help the school to address their problem (as they define it) you are beginning, simply by doing so, to address it from the other two perspectives at the same time.

It won’t always be the same kind of service of course; but the same two questions, “What do I want?”, “What do they want?” always provide a good starting point.

Keith Fletcher is the author of “Negotiation for Health and Social Services Professionals” published by Jessica Kingsley.

18 July 1998