When partnerships turn sour: Why leaders need to go back to basics and build relationships from the bottom up

Penny Pereira profile picture

23 May 2022

Penny Pereira
Managing Director
Q (Health Foundation)

'To partner or not to partner?' Is it even a question these days? In a world of integrated systems and transforming care across pathways, partnership working is part of most organisations' strategy and key to meeting improvement goals.

Yet, while the benefits of partnership seem self-evident on paper, the reality can feel a long way from that. It's easy to find yourself focused more on how you'll work together than what brought you together in the first place. You can end up spending more time on the rituals and processes than the work itself.

In Q, we are driven by enabling collaboration and improvement in practice. We do this through partnerships across the UK and Ireland, and our approach is grounded in years of experience as well as the academic research.

We recently published Leading Successful Partnerships, a guide to support health and care leaders in a variety of different situations. This focuses on getting the essentials right in four areas:  

  1. Clear and common goals

  2. Transparent and equitable power distribution

  3. Adequate resourcing

  4. Positive culture and strong relationships.

Time and again, our experience and the research show that partnerships tend to fall down when one of these four areas lacks the attention it deserves. So if you find yourself in a partnership which feels more pain than gain, I'd recommend going back to basics and asking yourself some foundational questions.

Question 1: Is this a true partnership?

Often, we use the language of partnership for organisational relationships which don't really reflect the requisite principles. This may be because that's the terminology defined for us. Yet evidence tells us that partnerships are about working together to achieve a shared vision and goal. They include joint ownership and shared responsibility for the success of the work. True partnerships should be underpinned by equity of contribution from partners, whether that's through sharing resources, decision-making responsibilities and/or risk bearing.

So take a step back and ask yourself whether the aspirations and reality of your relationship fits this description. Maybe the language of partnership is actually getting in the way? Perhaps your relationship is really more of a client/supplier agreement? Is one party acting in more of an advisory capacity? You can still have successful collaborative working without feeling the need to apply the partnership label. A conversation about definitions might even help to prompt direct conversations about your expectations.

Question 2: What are your common goals?

This may sound obvious, but it can be easy to gloss over difficult conversations about your goals and regret it later. To justify the effort of working together there should be a clear shared vision for the work, and agreement about how to achieve it. The reasons for partnering in healthcare are often multi-faceted and you can guarantee that the context will keep evolving. So be prepared to revisit this shared vision often, especially if your aspirations relate to learning and improvement.

Question 3: Where is the trust?

At its heart, every partnership relies on the people involved. Good leadership and formal senior relationships are important of course. But if your partnership goals are about delivering services or change at scale, then staff at different levels need to connect and work well together.

The vague language of leadership can sometimes disguise the subtle and hard work needed, in the same way that the language of partnership can sometimes feel warm but a bit abstract. What's key here is enabling a positive culture. This should establish mutual respect, trust and shared ownership, with open relationships where people can constructively challenge each other. The transparent and equitable distribution of power is critical to shaping success and leaders need to navigate power differentials and value the different contributions of partners.

A set of ground rules and good process can help keep the partnership honest. But if your partnership is characterised by bureaucracy, then ask yourself if it's all necessary. It might be that lots of process is an attempt to compensate for a gap in the relationships.

Question 4: Who is doing the work? 

Partnerships need sufficient staff capacity, continuity of leadership and a range of relevant resources to succeed. These can be fatal gaps in a health sector under extreme pressure. Sometimes there's an assumption that partnerships will simply expand the resources available, but this often isn't the reality. Partners need to​ have open and sophisticated conversations around operational pressures and capacity before they commit resources to establish and run the partnership​, as well as and recognise that 'rewards' may not be quick.

Support to help partnerships stay on track

Partnership working can be challenging, but there is help available. The Q guide is a great place to start. We have other free resources too, drawn from and for the Q community. These can help to foster connections between the organisations you're looking to work with, and to ground your partnership work in achieving practical impact.

In my experience, investing in the essentials of partnership can help keep your joint working on track, and enable you to reap rewards further down the line.

About the author

Penny Pereira profile picture

Penny Pereira
Managing Director

Penny is the managing director of Q at the Health Foundation. She joined in 2011, leading work on improvement capability building, patient safety and improving flow, among other things. She has led the Q initiative since its inception.

Q is a community of thousands of people across the UK and Ireland, collaborating to improve the safety and quality of health and care.

Before joining the Health Foundation, Penny was the director of strategy and service improvement at a trust in east London. Penny has spent her career leading improvement work at local and national level in the NHS, with particular expertise in process and system redesign, leading strategic change across organisations, developing networks to support improvement and collaborative design.