Second Opinion: Do people understand what makes a partnership work?

Partnership working has been in the news lately with politicians talking about partnership government which we are, unfortunately, not going to get. Do they understand what partnership means in practice?

Partnerships are not easy and, whether formed by partners from the public, private or civil society sectors, have an up to 70 per cent failure rate. This is because the vast majority of people haven’t a clue what is involved.

I am possibly one of the few people in Ireland qualified to write about partnership working having done a PhD on the subject in 2008. Later this year the journal Global Health Promotion will publish a fourth peer-reviewed paper, Factors influencing trust and mistrust in health promotion partnerships, which shows the inextricable links between trust and power.

Although this research was based on partnerships between health and other sectors, the findings are relevant to all partnerships, including those between political parties.

We have known about the importance of trust in human relationships for many years. In 1891 John Stewart Mill noted "the advantage that it is to mankind to be able to trust one another, penetrates into every crevice and cranny of human life".

Trust is the most important ingredient of effective partnership and no amount of effort from partners will make up for its absence. Without trust, partnerships are doomed to fail.

Building trust involves all the partners keeping the promises they make to the partnership, being supportive of each other, and behaving in ways that benefit the partnership as a whole.

Despite its importance trust is a poorly understood and an often taken-for-granted phenomenon. It is hard won and easily lost, so the maintenance of trust is an endless and reciprocal task.

Sharing

Shared power is another essential ingredient of effective partnerships. Behaviours that show that power in partnerships is fairly distributed include sharing the credit when things go right, and sharing the responsibility when things go wrong.

Power abuses create mistrust which is a huge barrier to partnership working, leading to a vicious circle of suspicion, time-wasting, and more distrust.

Partner behaviours that make mistrust inevitable include, plotting in unofficial groups with a view to undermining the main partnership agenda and withholding information of relevance to the partnership. Examples of power abuses are when decisions are made by a minority of partners outside of the main partnership meetings and when partners withhold their expertise or apply it arrogantly.

As can be easily imagined, power abuses are common in health partnerships.

Partnership working is particularly important between health and other sectors. It is the key to addressing the social determinants of health such as poverty, educational attainment, employment and housing.

Healthy Ireland: A Framework for Improved Health and Wellbeing 2013-2025 has 70 references to partnership working. It envisages partnerships between health and local authorities, the private sector, social protection, transport, justice and equality, and education, to name just a few sectors.

Healthy Ireland points out that it is impossible to improve population health without partnerships. “The achievement of the goals set out in the Framework depends on . . . partnerships and cross-sectoral involvement”.

The World Health Organisation's Health in All Policies: Framework for Country Action 2014 (HiAP) also calls for partnership approaches: "Health authorities at all levels . . . should actively seek opportunities to collaborate with and influence other sectors".

In fact, the idea of partnerships for health goes back to at least 1977, almost 40 years ago, with the WHO’s “Health for All by the year 2000” movement.

Sadly, this has not been achieved. Part of the problem is that the training of health professionals does not equip them for partnership working. Rather, they tend to draw their own patch to the detriment of partnerships with other professions and the community.

An April 2016 report from the National Academy of Sciences, A Framework for Educating Health Professionals to Address the Social Determinants of Health, argues that most health workers are oriented to health systems that emphasise "disease- based, curative models of care" and that "the social determinants of health can and should be integral to all health professional education and training".

Unless this happens, health for all will remain an unachievable, if desirable goal. The constant obsession with waiting lists does not help either. We need to keep people out of hospital by focusing on the social determinants. Until our political leaders understand what creates effective partnerships, this will not happen.

Copies of the peer-reviewed papers and the trust and power scales are available free of charge by writing to the email address below.

drjackyjones@gmail.com

Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.