Organización de Documentos

LL Site is the concept of the CEO of LL and it was set up as an online support network for mental health. It is described by LN as “an online community of people who supported each other”. Users were happy with the support they received and asked for additional professional input. One of the “Wall Guides” was training at a hospital trust at the time, and suggested that LL engage with them. A meeting was arranged with Chief executive of the hospital who was insightful regarding mental healthcare. There is a mutually beneficial relationship expressed extensively by LN and a clear clinical need from the NHS to both improve the model of mental healthcare and increase the online presence of support available. IN expresses that the NHS would never have come up with this format and would also have taken a protracted period of time to develop this. At the same time, LL needed to respond to user demand and also required governance that the NHS trust could lend to the platform.

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This kind of “safe and well-governed” management of individuals in risk was not easy to do without the guidance and backing of an NHS trust, both in clinical provision and governance and regulation. Moreover, the partnership lends weight to LL when on the site there is a banner saying “In partnership with” the hospital, aiding with marketing a trustworthy brand. A joint venture was set up featuring a formal agreement, setting out expectations and responsibilities from both sides.

LL engaged also with the NIC, who funded the development of the ‘product’ and presented the company at several showcase events. However this relationship was not close or collaborative in terms of actually developing the platform, and not discussed in the interviews.

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Table 11: LN Interview Quotations and Thematic Coding

Quotations Themes

The Beginning and Origins of the Project

 “an online community of people who supported each other”

 “LLGuides”

 “very forward looking for a consultant psychiatrist”.

 “He understood and he understands that our current model for delivering mental health services is really a mental illness model and it’s about treating people when they get poorly.”

 “He wanted the hospital trust to have more of an online presence, more of a digital presence. He knew that in the NHS that kind of thing takes forever...would never create this”.

 “In partnership with the <hospital name>”

 “mutually beneficial” NHS Relationship Origins/Drivers Collaborating Partners Interdependence Relationship

The Current Situation

 “it has changed for very legitimate reasons” Change

NHS Relationship

Barriers and Challenges, Successes and Progress  “lots of small things”

 “if the communication is good you get over them”

 “The language that’s used around different ways of accounting and around expectation”

 “I find it fascinating how two organizations with such different cultures and people with different outlooks and pressures on them can come together and work together on a day to day basis and genuinely how constructive...How frustrating and difficult it can be on a day to day basis in terms of the friction and the pressures because the drivers are different but actually how constructive it is”

 “as a small organization if cash flow is an issue we need to have an upfront conversation about that”

 “upfront conversations” Communication Barriers Challenges Culture Flexibility Funding

Set Up and Structure of the Project Working Group

 “it’s a combination of who was available but also who was willing”

 joint trip to Australia and New Zealand, which was considered “very constructive”

 “informal”

Team Members Leadership Communication Relationship

Team Practices and Processes

 “the language used in the NHS is very different from the language used in the independent sector you know right through to

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 “the way any issues get resolved and any relationships get built between people working in very different environments”.

 “communicating at all levels but in an informal way as well as just through structured monthly meetings”

 “making the effort to make sure those sorts of relationships happen”

 “if you’re in different buildings and your only contact with people is through formal meetings yea you miss out”

 “there’s a lot that gets done in an organization around the water cooler just having a conversation”

 have “tough conversations” and being “really honest”

 “very interesting for all involved in that I think working with LL outside of the NHS there was probably a sense of frustration at times at how quickly we wanted to move with things, so the pace is very different”

 “frustration about the consultant psychiatrist or the governance lead putting the brakes on a bit and saying well no … we actually this is going to take a few weeks to put this in place but we need this”

 “can be frustrating … each is good for the other”

 describes “renewing and constantly revisiting expectations and explicitly stating them”

 “I guess kind of reappraisal of why you’re doing what you’re doing and is this still working…. it has changed for very legitimate reasons but let’s talk about where our expectation of that is now”

 “why we’re in this partnership and a sense of keeping the bigger picture and really believing that together we can create something that apart we can’t”

 “especially for a small organization like LL it’s finding the time”

 “LJ is very much a forceful leader…. is somebody who thinks differently and is quite disruptive in her approach….how people want to use it rather than how the NHS tends to think more about it services…”

 “without somebody like LJ creating it who just has a sense of let’s just go do and then kind of mop up anything that needs mopping up afterwards”

 “I guess that LL was the one that created the vision for what this service is LL is the one that is marketing that, selling that, winning contracts, therefore getting revenue in. What the hospital trust I guess what they did is helped with the quality of the product if you like and make it a robust service that was well governed well managed and therefore could be sold if you like.”

 “beneficial to both parties”

 “when you add them together what you get is so much greater than just the sum of those individual parts”.

 “can be frustrating but each is good for the other”.

Shared Vision and Objectives Communication Relationship Leadership Boundedness Reflexivity Change

The Future of the Project

 “it has changed for very legitimate reasons” Change

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There was buy-in from the NHS champion and the type of person and his agenda worked well at the time LL approached the trust. Additionally LL was already established and demonstrated their success and approach, demonstrating the value and need for the product. LL is the driver and LJ is a “forceful leader” and this is all the reason that the project has been driven forward at such speed. There was some funding provided by the NIC but this involvement was very minimal beyond this. LN attributes the success of the project to the fact the proposal to the hospital was mutually beneficial and the importance of articulating these mutual benefits i.e. “what’s in it for both parties”. In describing the driver behind the success of the partnership LN states “why we’re in this partnership and a sense of keeping the bigger picture and really believing that together we can create something that apart we can’t”. Clearly, this is a key feature; the idea of referring back to the bigger picture and reinforcing the mutually beneficial reasons for the partnership to exist in the first place.

In addition, it is an interesting point that the two leaders from the two organizations developed an excellent relationship by attending an important meeting in New Zealand together, thus building a very strong bond and ensuring that this relationship goes beyond formal levels. This is an approach that has trickled down the rest of the project team, as LN has also chosen to travel to meetings with a representative from the other organization and arranged to have dinner afterwards, purposefully to develop a more full working relationship. LN articulates that this makes up for the “water cooler” conversations that are missing when individuals do not work in the same building and only attend meetings occasionally together. This sense of ensuring that informal communication is engaged in is taken for granted within the organizational boundary but inherently is lost when working across organizational boundaries.

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LN takes this idea one step further suggesting that it is only during these informal discussions that you can really get to understand the language of the other organization, in order to communicate more effectively and on a similar level of understanding of what the other means in the formal meetings. LN believes that the “way any issues get resolved and any relationships get built between people working in very different environments is the more informal stuff”. The “language used in the NHS is very different….right through to finances”.

LN demonstrates clear respect for the leader and the leadership style used, and marks LL prior to the partnership as already successful. She does acknowledge that sometimes LJ needs to hold back a bit and that she had to accept that LL needed some input from elsewhere. However, there is acceptance that the NHS involvement was important for Governance and clinical guidance. The prestige of “in partnership with the <hospital trust>” is also seen as

important from a marketing perspective.

There were clear boundaries and involvement established formally through a legal joint venture agreement, ensuring that expected deliverables were articulated. There is a clear sense of boundedness articulated and formalised.

Organizational culture was a salient topic within which, pace and communication differences were most obvious. There was often a sense of frustration with the difference in pace between LL and the hospital trust, however LN states this could have been mutually frustrating and also accepts that sometimes “we need this”. LN states “each is good for the other” which reflects much of the collaboration and team definitions. Additionally there is a clear sense of reflexivity, having “upfront” conversations about the expectations that have and have not yet been delivered, reviewing the agreements made and revisiting the vision regularly. The idea of explicitly stating the expectations in the agreement and then the difficulty of finding time to revisit these at appropriate times is a challenge but one that she feels has been key to the success of the joint venture.

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Additionally, LN identifies the flexibility, honesty and ability to communicate at all different levels as most important for the success of the project. The difficulties have been resolving inherent cultural differences, but that acknowledging that the “sum of the parts being greater than the individual parts” not only reflect the definition of a team but also demonstrates

that the partnership has been highly mutually beneficial.