Towards a framework for partnering as an intervention for improvement: lessons for NHS providers from a realist synthesis of theoretical, empirical, and stakeholder evidence

Start date: 1 October 2019
End date: 30 September 2021
Funding: National Institute for Health and Care Research
Value: £245,026.61
Primary investigator: Professor Joanne Greenhalgh
External co-investigators: Professor Ross Millar (University of Birmingham) (External PI), Dame Anne Marie Rafferty (King's College London), Professor Russell Mannion (University of Birmingham), Professor Robin Millar (University of Birmingham), Dr Hugh McLeod (University of Bristol), Ms Deborah Faulks
Postgraduate research fellows: Dr Justin Aunger

Variations in the quality and safety of care delivered by NHS provider organisations continue to be a cause of concern. Partnership arrangements and collaborative working between provider organisations has been promoted as a key mechanism for turning around and improving organisational performance. However, up to now there has been no systematic attempt to assess the impact of different partnering approaches or understand the mechanisms through which partnering works in particular contexts. Aims and objectives The aim of our review is to provide a range of useful intelligence regarding how, why and in what circumstances a range of partnering approaches can be used to sustain and improve the performance of NHS provider organisations.

Our review has five inter-related objectives which seek to:

1. Explore the main strands of the literature about partnering and identify the main theoretical and conceptual frameworks that can be used to shed light on the conditions and antecedents for effective partnering across sectors and stakeholders.

2. Assess the empirical evidence with regards to how different partnering practices may (or may not) lead to improved performance and outcomes.

3. Understand and learn from NHS evidence users and other stakeholders about how and where partnering can best be used as a mechanism to support turnaround processes.

4. Develop a typology of partnering that considers different types and scales of collaborative ventures that are appropriate for specific contexts

5. Building on objectives 1-4, to develop evidence informed practical guidance for NHS providers, policy makers and others with responsibility for implementing and assessing partnering arrangements in the NHS.

Methods

Given the complexities, ambiguities, and contextual differences apparent in the literature, the evidence synthesis employs a Realist review approach to capture the diverse theoretical, empirical, and stakeholder evidence associated with partnering. Across four different work packages the review will engage in a process of developing, testing and refining theories about how partnering works. Initial theories will be gleaned from scoping reviews of the literature alongside stakeholder ideas and assumptions about how different partnering approaches are intended to work in practice. These ideas will then be tested across a range of contexts through a review of the empirical literature and a further phase of stakeholder interviews. The eventual synthesis of evidence will be informed by a series of workshops that will look to refine our understanding of how partnering works and the conditions and limitations that influence its success.

Anticipated impact and dissemination

The review provides valuable evidence and learning to inform policy debates regarding different organisational interventions being used to promote and sustain recovery from failure. Furthermore, it will provide practical guidance for NHS policy makers, evidence users, patients and the public about how, when and for whom different partnering approaches can work for NHS provider contexts. The development of a typology showing how different partnering approaches can (or not) lead to the turnaround and improvement of NHS provider performance has the potential to have a wide ranging impact on current NHS policy and practice.

Publications and outputs

Aunger JA, Millar R, Greenhalgh J, Mannion R, Rafferty, AM, McLeod H (2020) Building an initial realist theory of partnering across National Health Service Providers, Journal of Integrated Care, ISSN 1476-9018

Aunger JA, Millar R, Greenhalgh J, Mannion R, Rafferty, AM, McLeod H (2021) Why do some inter-organisational collaborations in healthcare work when others do not? A realist review. Systematic Reviews 10, 82 (2021). https://doi.org/10.1186/s13643-021-01630-8

Aunger, J. A., Millar, R., & Greenhalgh, J. (2021). When trust, confidence, and faith collide: refining a realist theory of how and why inter-organisational collaborations in healthcare work. BMC Health Services Research, 21(1). doi:10.1186/s12913-021-06630-x

Aunger, J.A., Millar, R, Rafferty, A.M., Mannion R. Greenhalgh, J. Faulks, D. (2022). How, when and why do inter-organisational collaborations in healthcare work? A realist evaluation, PLOS One: https://doi.org/10.1371/journal.pone.0266899

Aunger JA, Miller, R, Greenhalgh J (2023) Modelling lifecycles of inter-organizational collaborations in healthcare: a systematic review and best-fit framework synthesis, Journal of Health Organisation and Management, 37(4/5): 409-442. https://doi.org/10.1108/JHOM-01-2022-0025