About the map

The skills and attitudes required to lead change with and through others are wide-ranging. They require attention and practice to develop and embed them. The skills map helps make explicit which skills and attitudes are needed to foster collaboration and supports people to take a team and organisational approach to developing them.

Shifting to this mode of thinking is not without challenges. Behaviour is influenced by a range of factors – cultural, environmental, political – and teams working under pressure need an enabling environment and leaders who genuinely value this way of working. During COVID-19, we’ve heard how trusting and enabling leadership has given teams permission and agency to act quickly and creatively. This, alongside clarity and renewed shared purpose, have fostered collaboration, not competition, breaking down long-entrenched silos. The scale of change shows what is possible, and provides a useful platform to consider the skills and attitudes that could embed positive changes long term.

Where did it come from?

Q is a long-term initiative connecting people who are working to improve health and care across the UK and Ireland. The Q Improvement Lab is part of Q and convenes diverse groups of organisations and individuals to work on shared health and care challenges.

Through the Lab’s work we have supported teams and individuals to work across professional and organisational silos. Those participating showed great energy and capability to work across these boundaries, but it was also a learning curve.

The Q Lab’s independent evaluation highlights the need to be explicit about the skills needed for collaborative and creative problem solving. Without this clarity, people’s ability to intentionally develop these skills and translate them into action is reduced.

Nesta had done similar work on the skills needed for public sector innovation. We worked together to develop a framework for people working to improve health and care, bringing in the experience and insight of practitioners to create Skills for collaborative change.

The map is a tool for reflection which supports teams to better understand and explore the blend of skills required for collaborative working. Key features include:

• Focus on teams

Skills for collaborative change invites people to move away from solely thinking about their individual role, to thinking about their contribution in a team and the skills that their colleagues and peers bring. This map isn’t about heroic individuals, nor is it a checklist. No one person has every skill and attitude – this is about creating balanced teams.

• Informed by evidence and experience

The skills and attitudes highlighted in the map are based on a combination of research and evidence from Nesta’s programme on public sector innovation, improvement experts including building on the Health Foundation’s Habits of an Improver and Q’s practical learning.

• Practical

Skills for collaborative change includes suggested activities for how teams can better understand their strengths as well as identify where the potential gaps might be. This may be particularly helpful for multi-disciplinary teams working in health and care.

The map and user guide were developed with a range of people, including health and care professionals, researchers and patients. Our intention is that people working in and with the health and care sector will use the map and guide to improve the way they work together.

Developing Skills for collaborative change with people from across health and care also meant that the group had plenty of ideas and suggestions for how the tool can be used in practice. These include:

• Use it at the start of a project: Teams are understandably often keen to get started on the task in hand, but investing time at the start of a project to identify what you do well as a team and what areas you might need to work on, can reap long-term rewards.
• Ask others what they see in you: Sometimes it’s difficult to name the skills that you bring to a piece of work and how they contribute to what your team is trying to achieve. Using the skills map, begin by asking what others see in you and reflect on whether you see yourself in this way.
• Use it to bring patients and health care professionals together: The tool has been designed with patients and health care professionals and can help you to have conversations beyond professional roles about what both parties can bring and contribute to teams and projects.
• Revisit it over time: As you get to know people and their skills, use the map to reflect on what happened in practice. Did people’s skills play out in the way(s) you expected? Could you start to explore what behaviours you would like to see?

Bringing together different teams within one organisation is challenging enough. Increasingly people also need to work with different health care organisations, as well as with organisations and individuals outside of the health and care sector to improve health outcomes.

Collaboration involves navigating new spaces, structures and people and there will be systemic, organisational and individual barriers to doing this well. The skills required to lead and participate in this type of work are wide-reaching and require attention and practice.

Skills for collaborative change is a starting point to understanding these skills and having meaningful conversations about how to use them in practice. As suggested here, it can be particularly useful in the early stages of an improvement project when you’re convening a group.

While Skills for collaborative change is a tool for teams and individuals, we think that a broader conversation is needed about the role of the system and organisations to create the conditions to support and enable people to collaborate.

There remains a gap between policy intent and the context many people are working within, made even more pressing by the current and future impacts of COVID-19. A report by NHS Employers in 2017 states that a ‘bias towards developing functional expertise leaves organisations lacking collaborative capability’ and it sets out a range of recommendations to enable trustworthy strategic collaboration to thrive over time.

However, in recent months we have heard that people felt they were given license to exercise their leadership and collaborate in new ways, irrespective of their job title. The NHS People plan recognises the enormous potential within this more distributed style of leadership and states that ‘all leaders in the NHS, particularly those who hold formal management and leadership positions, are expected to act with kindness, prioritise collaboration, and foster creativity in the people they work with.’

There is real appetite for new-found collaborations to continue as teams look to the future and we hope that Skills for collaborative change helps support people to make this a reality.