http://oreluis.wix.com/orasi

A Partnering Approach to Continuous Improvement in

Healthcare Settings

By Luis E. Ore, J.D. M.A., Consensus Building & Relationship Management Consultant

It is common to hear that the healthcare system is broken in this country; however experts

say that there is no such a thing as a healthcare “system” in United States of America.

Every political party in the world acknowledges that healthcare is a crucial issue for

citizens and constituencies. Today, many healthcare stakeholders, from insurance

companies to organization owners of hospitals and healthcare facilities, from healthcare

management to healthcare professionals, are facing the challenges of improving the

current situation of the popularly called “healthcare system”.

Healthcare professionals at all levels have the challenge of making things better. One way

to do it is to wait for the government to intervene and make things happen in one way or

another, but this alternative might not take into consideration the many views and

perspectives of the healthcare professionals at every level in the complex context of the

healthcare industry. Another alternative is to have many stakeholders working together to

improve current conditions. As a student I have learned, there are diverse altitudes,

lenses, and venues to tackle these healthcare challenges. Considering the interdependent

lenses to look through the horizon of the healthcare industry, professionals deal with

quality, access and costs. It is commonly thought that an increase in quality will imply an

increase in costs and limit access to healthcare. This article challenges this assumption

and develops a framework to set continuous improvement procedures at the institutional

altitude.

The premise is that if the quality increases the cost will increase. The father of the total

quality management movement, W. Edward Deming, emphasized that by adopting

appropriate principles of management, an organization can increase quality and

simultaneously reduce costs. As Deming affirms, “improve constantly and forever every

________________________________________________________________________

* Luis E. Ore is founder of ORASI Consulting Group Inc., a training and development consulting firm specializing in negotiation, consensus building, relationship management, and conflict prevention. Ore assists businesses with cross-cultural and international negotiations, strategic alliances, organizational changes, dispute resolution system design, and foreign direct investment, especially between the United States of America and Latin-American countries. Ore has Masters of Arts degree in conflict management and in organizational communication, a J.D. from the University of Lima (Peru), and extensive training in negotiation and conflict management from CMI International Group, Western Kentucky University, Lipscomb University, and the Program on Negotiation at Harvard Law School. Ore served as Chair of the Association for Conflict Resolution’s International Section and an active associate of the American Bar Association. He can be contacted via email: oreluis@hotmail.com

© 2010 by ORASI Consulting Group, Inc.

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process for planning, production, and service. Search continually for problems in order to

improve every activity in the company, to improve quality and productivity, and thus to

constantly decrease costs”. (W. Edward Deming, 1986).

In this order of ideas, this article argues that developing procedures for continuous

improvement will increase the quality of the health care service and reduce its costs. The

question that arises is how to develop a continuous improvement process that has the

buy-in of its users which facilitates its implementation. This endeavor will imply

potential changes and might affect the way things are currently done. In general,

companies and non-profit organizations constantly seek improvement. The healthcare

industry at the institutional level is not far away from these changes. Consequently,

hospitals and healthcare professionals need to analyze the current situation and seek ways

to improve its services. While healthcare management professionals are in charge of the

hospitals’ administration and finances; medical providers, doctors, nurses and other

professionals are responsible for the direct healthcare services. Many of them hold

different views on different issues.

If the goal is to develop continuous improvement process that has the buy-in of the

healthcare professionals to implement new processes, the healthcare professionals must

have a hand in the creation and development of it. As Fisher and Sharp (1998) affirm “If

a change in our methods is to be effective, everyone on the team needs to understanding

it, and try to make it work. The best way to achieve both of these goals is to have

everyone a hand in shaping the change. Everyone will know why this idea was chosen,

and everyone will feel sufficient ownership of the new practice to want it to succeed”.

(p.25)

It is well-know the phrase “begin with the end in mind”, which means that if someone

wants to get from a current situation to a desired situation, one needs to clearly define

what the desired situation is and what is wanted to be achieved. Therefore, if the

healthcare professionals want to embark on an endeavor to create a continuous

improvement process to improve quality in their institution they need to have a clear

vision. There is abundant literature about planned organizational changes and the

importance of having a vision. An organizational vision is commonly understood as

organizational ideas used to picture its goals. Lewis (2000) argues that a mission

statement should be elaborated to address desirable outcomes. It should also provide a

meaningful vision for organizational members; this will give an image of what the

organization wants to be. Lewis (2000) concludes that a mission statement that makes the

purpose of organizational changes clear and inspires participation from employees could

trigger the organizational change with enthusiastic support and the energy necessary.

There are many ideas about what a vision means, who and how should be developed.

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Collins and Lazier (1992) refer to the Colins-Porras Vision Framework, which states that

a vision is formed by core values and beliefs, purpose and mission. Values and beliefs

translate into a system of guiding principles and the philosophy of business and life. The

purpose refers to the fundamental reason for the organization’s existence and derives

from the core values. A mission has a compelling goal and has a clear finish line with a

specific time frame. Likewise, Fisher and Sharp (1998) recommend to “formulate a

purpose that motivates and guides (…), set a purpose over three points in time: An

inspiring distant vision, a mid-distant goal en route that is a worthy goal itself, some

immediate objectives to start working on at once. Formulate (the) purpose in terms of

result to be achieved”. (P.43-49)

Fisher and Sharp (1998) affirm that “articulating a mission is vital to improving

performance” (p.39). Besides having a clear vision, if healthcare professionals are going

to work together toward developing a continuous improvement process they need to

function as a team. Group dynamics are particularly special when their members are

working together but they lack trust and vision. “There is no incentive to innovate or take

risks. When things go wrong, as they often do, nobody admits failure. Instead the parties

take defensive positions and attack each other’s shortcomings in order to avoid liability”

(Ledger, 2004, p.3). As Lencioni (2005) affirms a team is a group of people “that shares

common goals as well as the rewards and responsibilities for achieving them”. (P.9) This

author affirms that “when it comes to teams, trust is all about vulnerability. Team

members who trust one another learned to be comfortable being open, even exposed, to

one another around their failures, weaknesses, and even fears (…) Vulnerability-based

trust is predicated on the simple –and practical- idea that people who aren’t afraid to

admit the truth about themselves are not going to engage in the kind of political behavior

that wastes everyone’s time and energy, and more important makes the accomplishment

of results an unlikely scenario” (p.14).

Following Fisher and Brown’s (1988) ideas, in order to improve the level of trust in

teams, team members need to improve the reliability of their conduct. The level of trust

among team members depends in part on what the team members do and what the other

team members think about what the team members do. Team members can improve

trustworthiness and be less suspicious by improving their behaviors. The more

trustworthy they are the better off they are, and more likely the teamwork endeavor will

succeed. Fisher and Brown (1988) shares key points to enhance trustworthiness, “be

predictable, be clear, take promise seriously, and be honest.” (p.112). In this order of

ideas, Susskind and Field (1996) recommend to “act in a trustworthy fashion” and affirms

that “(…) to inspire trust one must shape expectations; or, put it as simply as possible, we

must ‘say what we mean and mean what we say’ if we want to hold on to the trust we

have or build more”. (p.40) In this sense, according to the work of Fisher and Brown

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(1988) team members need to be clear and be cautions about using language and

statements that could be interpreted as commitments when they are not intended to be a

commitment. Being clear about what is said and what is meant, reduce the likelihood of

being attributed with misleading statements. Also when making commitments and

promises team members need to be sure to carry them out and fulfill the promises made.

In the same way Susskind and Field (1996) recommend to make commitments that one

intends to keep, and keep them.

According to Fisher and Brown (1988) in order to improve trustworthiness team

members need to be honest and to be honest is to mean what is said when is said. Team

members must be honest about what they disclose. Susskind and Field (1996) go further

and affirms that when facing secrecy and lack of access to information people in general

assume the worst. As the popular expression says “honesty is the best policy.” But even if

team members behave in a trustworthy matter, team members’ partisan perceptions,

personal backgrounds, and how they process and take in information can prevent them to

perceive other team members as trustworthy. In such a case, team members have a

chance to shape the other team members’ expectations and perceptions by engaging all

the team members in direct honest and open talks to address any distrust issue.

As Pettrey (2003) affirms “In healthcare, people work closely together and rely on their

colleagues and other team members when caring for patients and their families. These

team members come from a varying backgrounds and cultures, and hold diverse values.

This diversity, in addition to the innate stress and urgency in most acute care hospital

settings, makes conflict a common occurrence. If a group does not resolve conflict

effectively over time, a toxic and negative work environment is created”. (p. 21) Proper

conflict management promotes retention, work satisfaction, and quality patient care. In

this sense, Kelly (2006) affirms that in order to provide quality patient care, conflict must

be dealt with in an open manner. Also, Porter-O’Grady (2004) affirms that the best way

to prevent negative effects of conflict is for leaders of organizations to invest in staff

development to improve conflict management skills.

Lencioni (2005) affirms that the five dysfunctions of a team are “absence of trust, fear of

conflict, lack of commitment, avoidance of accountability, and inattention to results”

(p.6) ) The author affirms that people in general are fearful to engage in conflict.

In fact, when facing conflicting situations most people face the dilemma to fight or flight.

Many people when feeling threatened will choose to fight for survival with an either/or

mindset - a win/lose mindset - and the conflict can seriously escalate. The fact is that

these dilemma of choices “to fight or to flight” are not the only ones. Positive and

constructive ways of dealing with conflict tends to build trust as well. Fisher and Brown’s

(1988) framework for building positive working relationships has as an essential strategy

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to be unconditionally constructive; and among the basic elements listed to build a

relationship that can deal well with differences the authors have “Persuasion, not

coercion: Negotiate side by side” (p132) which advices to be open to persuasion and try

to persuade the other party under a collaborative approach to negotiation that tends to

leads to mutually beneficial and satisfactory agreements. Therefore, based on these ideas,

the foundation of successful teams working toward determined goals is having a shared

vision, trust, and negotiation capabilities that enable team members to deal effectively

with conflicting situations.

As Bottrell (2003) affirms, “Quality improvement (QI) is a technique for encouraging

innovation in many fields. In health care, QI projects vary widely with respect to project

size, design, methods, healthcare setting, and resource use, but all have the goal of

improving the healthcare system’s ability to provide high-quality, high-value health care”

(p.3). Some say that to improve the quality of healthcare services is a social obligation

and others say it is a business obligation. There are several diverse concepts regarding

quality, such as “quality assurance”, “quality improvement”, and “continuous quality

improvement”. As Kahan and Goodstandt (1999) assert “The term quality assurance

(QA) is used in some of the health promotion quality literature as an umbrella term which

includes CQI, rather than as an adjunct to CQI. More generally, however, a distinction is

made between the two with QA identified as focusing on outcomes, and COI identified as

focusing on processes as well as outcomes.” (p.84)

If the goal is to develop a continuous improvement process that has the buy-in of the

healthcare professionals working as a team and having a clear vision of what they want to

accomplish, what sort of processes can administrators and healthcare professionals use

to accomplish this task?

The conflict management field has developed many Alternative Dispute Resolution

processes to assist people dealing with differences and difficult moments. A preventive

dispute resolution process used in the construction industry called “partnering” can be

brought into the healthcare industry to help healthcare professionals find ways to create

and develop continuous improvement processes to increase quality and reduce costs of

healthcare services. Partnering is a process broadly used on large construction projects.

The American Arbitration Association’s Guide to Partnering in the Construction Industry

(1995) argues that “No improvement process has caught the imagination of the

construction industry as completely or has been adopted as quickly as partnering”. (p.2)

The American Arbitration Association’s Guide to Partnering in the Construction Industry

(1995) defines partnering as “a voluntary, organized process by which two or more

organizations having shared interests perform as a team to achieve mutually beneficial

goals (…) a collaborative process that focuses on cooperative solving of problems

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participants have in common. Properly applied, it yields reconciliation (win-win) as

opposed to either compromise (los-lose) or concession (win-lose). It is not a social

process that simply promotes courtesy and politeness among participants, but rather good

faith resolution of problems”. (p.3)

Ledger (2003) affirms that, “collaborative working arrangements (which include

Partnering and Alliancing) break down established barriers to success and facilitate the

creation of a culture of trust, open communications, feedback, and a desire for continuous

improvement”. (p.1) This partnering process has been broadly used and implemented in

the construction industry, Ledger (2003) argues that “Several U.K. companies have

obtained continuous improvement thought strategic partnering with a particular

contractor” (p.2)

Among the benefits of Partnering, Ledger (2003) highlights “Improved communications

at points where the partners’ interaction leads to cooperation rather than suspicion, joint

discussion of problems, and their roots, and the exploration of solutions. This allows for

more informed decision to be made based on what is best for the project (endeavor), not

just for one stakeholder.” (p.2). In deed, “the stakeholders are encouraged to learn how to

communicate with each other and share information about the project and any problems

that may arise” (Ledgers, 2004, p.3). Once the stakeholders or team members gain the

communication and negotiation skills required, they will be able to analyze the causes

and effects of any problem or challenging situation that might arise, parties engaged will

be able to gather information together, analyze it, draw conclusion together, and jointly

resolve the challenges in a mutually beneficial manner. In sum, stakeholders will be

equipped with the capabilities they need to move away from a finger pointing and blame

game toward a problem solving and joint decision making approach. In addition, Clay,

MacNaughton and Farnan (2004) affirm that “The partnering process creates a proactive

environment in which participants learn the importance of teamwork. For partnering to

have the desired effect, project participants must develop a working relationship based on

mutual respect and trust. The seed of cooperation and collaboration cannot grow when

participants suspect each other’s motives and agendas. (…) The essence of partnering is

promoting a cooperative attitude and the active pursuit of common goals by parties

involved”. (2-3 pp)

Furlong (1995) studied the possibility to use partnering methodology in more generic

project-type work in non-construction related areas. The author worked to determine the

existence of Non-Traditional Partnering. Furlong’s analysis concluded that the process of

partnering applied to “no traditional” situations applied effectively. “(…) it is clear that

what we have termed ‘Non-Traditional Partnering’ can be a useful and effective process

in situations far outside the construction industry. (…) what is clear is that in many

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circumstance, applying the Partnering methodology in non-traditional settings will

deliver great value and benefits to the parties, and assist them in developing better

relationships while working toward joint goals”. (Furlong, 1995, p.12). Clay,

MacNaughton and Farnan (2004) affirm that partnering has a wider application because

its principles are universal: good communication, cooperation, collaboration, common

goals, dispute avoidance and resolution. Ledger (2003) asserts that in U.K. industries

such as oil and gas, aviation, food, retail and water have began to try the partnering

approach for their business.

There is not much written about experiences in the health care industry using Partnership

methodology. How might a Partnering process look like? Furlong’s (1995) work

organized the process of traditional partnering as follows:

1. The Alignment Meeting – this includes:

Educating the organizations

Confirming senior management commitment

Ensuring the right people will be in attendance

Clarifying the intentions of the parties, etc

Organizing the workshop location, facilitator, etc

2. The Partnering Workshop – this includes:

Partnering Charter: Teamwork, aligning goals, objectives and

values

Roles, Challenges and Opportunities on the project

Issues Resolution Process

Legacy Structures: Ongoing support and renewal

3. Following Through processes:

Ensuring the “Partnered” Approach is maintained

Meetings of partnering “Champions”

Facilitation of difficult issues, if needed (Furlong, 1995, p.5)

Also The American Arbitration Association’s Guide to Partnering in the Construction

Industry (1995) describes the essential phases and stages to successfully implement a

partnering process: Phase One: Define the overall long-term strategy; Phase Two: Enlist

project participants; Phase Three: Team formation; Phase Four: On-site implementation;

and Phase Five: Project close-out. This guide recommends the use of a facilitator to

manage this process, and highlight as key components for the partnering implementation:

Project Charter, Team Assessment, and Issue Resolution Process. More recently, Clay,

MacNaughton and Farnan (2004, p.3) have published their eight-step approach to

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partnering to create long term success working relationships and create the conditions to

reduce or avoid disputes. These authors advocate the following Partnering Model:

1. Agree to use partnering

2. Selecting the partnering facilitator

3. Holding a partnering “retreat”

4. Building “group memory”

5. Agreeing to a “problem-escalation” ladder to resolve disputes

6. Developing the partnering “charter”

7. Providing for continuing partnering evaluation

8. Using a We-enabled information sharing system (…)

This article will reframe and adapt the latest versions of the Partnering Process and the

Deming Cycle (Plan-Do-Study-Act) (Kahan and Goodstandt, 1999) to make it applicable

for the use of the healthcare professionals in setting continuous improvement programs or

processes:

The Pre-Partnering Workshop: Alignment Process

Educate organizational leaders on Partnering

Obtain organization’s leadership commitment

Identify stakeholders: The right people on the table

Interests’ clarification for developing topics proposed agenda

Pre-partnering workshop logistic

The Partnering Workshop: Partnering Charter & Strategies

Introductions and trust building

Capabilities building

The partnering charter: Aligning goals, objectives and values

Challenges, Opportunities and Roles

Issues Resolution Process

Support System

Post-Partnering Workshop: Following Through processes

Continuous partnering evaluation.

The Pre-Partnering Workshop: Alignment Process

At this stage is important that, “the overarching goals of the parties must be in alignment

for collaboration to take place at all” (Furlong, 1995, p.5). The organizational leader at

the health care facility must be aware of any potential intrapersonal conflict. Does the

leadership really want to develop and implement a continuous improvement process? Part

of the organizational leadership wants to implement it but other part does not. Therefore,

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it is relevant to unveil the issues, interests, and beliefs of the leadership and have the

overarching goals aligned in order to count with the support of the leadership. It is also

important to educate organizational leaders about Partnering, its purpose and benefits. It

is important that the leader inform the rest of employees about this decision. In this sense,

Rigsbee (2003) affirms “In any organization, the culture is driven from the top down –

never the bottom up”. As Furlong (1995, p.6) affirms “This acceptance of the goal of

achieving a collaborative approach on a project must come from the top of the

organization, and must be publicly stated for all to hear, ‘all’ in this case referring to not

only the senior staff (…), but also to the front line employees of their own organization,

so the intention is clear to all.” Once the organization’s leadership is committed to use

partnering, a neutral party or facilitator can start working on identifying stakeholders that

might be wise to invite to the Partnering Workshop stage. The facilitator will identify the

people that might be affected by the decision to be made and assist them voice their

concerns. Perhaps, most important than all of this preparation work is that a neutral party

identifies the stakeholders’ interests, needs, and concerns that might be at stake, with the

new endeavor. This will allow the facilitator developed a proposed agenda based on the

facilitator’s findings. Then, the facilitator will make arrangement about the setting and

logistics to prepare the Partnering Workshop.

The Partnering Workshop: Partnering Charter & Strategies

This is the core of the partnering process, during the workshop the stakeholders learn

to work side by side and agree on project goals and the strategies to reach them.

Introductions and trust building work: At the workshop’s kickoff, is fundamental

to create a physically and emotionally safe environment that enables trust and free

flow of ideas. Also, it is important to build collaboration by learning more from

each other, reducing personal distance and building affiliation (Fisher and

Shapiro, 2005).

Capabilities building: The stakeholders undergo training designed to share the

benefits of teamwork over individual “silo” actions and help them work better

together. The facilitator/trainer can transfer and enhance knowledge and skills to

empower stakeholders to achieve aspirations. Negotiation and working together

skills can be transferred to “transform an adversarial interaction into a cooperative

search for mutual gains” (Shapiro, 2006, p.106) and build a collaborative working

environment that maximize participation and commitment, ensures results and

creates a culture of effective teamwork that leverages creativity and innovation.

The facilitator will assure the stakeholders that he or she will keep record of what

is discussed; this will frees the stakeholders from taking notes and focus on the

tasks. It also helps the facilitator guide the discussion.

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The partnering charter: Aligning goals, objectives and values. Stakeholders work

together to identify common goals and interests ‘below the line’ and behind their

positions, and define the values that will reflect the partnering. The commitment

to the values of partnering must be obtained from the leadership at the very top of

the hierarchy of each stakeholder organization, division, or department, because

without leadership full commitment, the partnering values cannot filter down

through the chain of command to team members on site where they perform their

daily work. “If management is only half hearted (or uninterested) about the

alliancing effort, the collaborative efforts of the people within the alliance will be

undermined” (Ledger, 2003, p.6). The task of aligning goals and objectives is as

important as knowing the port of destination when a ship is at sea. What the

stakeholders want to achieve. What the health care professionals want to

accomplish in their facility or hospital and what for. What product, service or

process is wanted to be improved? What are the benefits of achieving those

objectives? The parties also need to define how they will know that they

accomplish their objective, what is the evidence that they accomplish their

objectives? How they will measure the results, the parties will need to negotiate

some objective criteria to measure the results of their efforts toward their goal.

Conflicts can arise around the measurement criteria, a joint fact-finding procedure

can help by assisting stakeholders in developing mutually agreed measurement

criteria. In sum, the stakeholder participants need to define the purpose by

formulating the results wanted to be achieved. The stakeholders will agree on the

main objectives and values in a “statement of purpose” or “mission statement”

which needs to be distributed to all stakeholders to all levels of the project or

health care facility. This way, all of the participants in the project and employees

at the healthcare facilities will know the criteria by which their performance and

success will be measured (Legder, 2003). At the end of the workshop the

stakeholders will draft, commit, and sign the Partnering Charter.

Challenges, Opportunities (options/strategies) and Roles (who does what): In a

collaborative environment, without playing finger pointing or blame games, the

stakeholders will joint discussion of problems, define what the current state is and

what the desired state is; what is the challenge? They will define the root causes

of the current situation and identify each stakeholder’s perspectives about the

potential major problems that could arise on the project. What are the things

standing in the way of this being a much better unit, department, division, or

hospital? What is likely to prevent achieving the objectives? What can the

stakeholders predict as potential difficulties to overcome the challenge? Then,

stakeholders will engage in brainstorming to generate as many options and

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strategies they can think of, without judging them, just creating. Once the

stakeholders cannot think of other options and strategies, they will discuss and

agree on what would be the best option or strategies to implement to improve the

current condition, based on criteria that legitimize that option.

Issues Resolution Process: Stakeholders design a procedure to address the

problems they might run into in the course of their performance. Clay,

MacNaughton and Farnan (2004, p.4) called it the “problem-escalation ladder,

which provides the mechanism for resolving disputes that cannot be resolved in

the field.” The resolution process outlines the steps that parties need to take when

a problem arises. Therefore, the first approach to resolve a conflict would be

direct negotiations between the stakeholders at the lowest possible level, if they

cannot resolve it they will bump the problem up to have it approached by a higher

level of authority through direct interest-based negotiations. In general, as Furlong

affirms (1995, p.6) “This is a facilitated design process where the participants

develop and commit to a focused, structures and rapid process for addressing and

resolving problems, with the goal of resolving most problems at the front line,

avoiding the delays that escalation to formal processes often brings.”

Support system: For reinforcing new behaviors and making them last,

organizations have to generate incentives and rewards that create support for their

use; at this point the stakeholders will design and agree on support structures for

the partnering in order to stay focus on collaborative working relationships and

collaborative problem solving approaches. Furlong (1995) recommends naming

Partnering “champions” who will keep the partnering approach on track by

meeting with stakeholders and encouraging collaborative approaches and interest-

based negotiation to resolve problems that might keep working relationships from

joint collaborative efforts. Stakeholder might want to consider designing a reward

system. Constantino and Merchant (1996) affirms that stakeholders need to have

incentives to use a new system. The authors explain diverse incentives and

rewards that motivate organizational stakeholders, “Recognition; Being part of the

team; Creation of new initiatives; Achievement of organizational mission;

Fulfilling personal visions and values; Increased efficiency or effectiveness; and

Economics.” (191-194pp.) In regard to economics, Wood (1998) affirms by

displaying a quote from Rosabeth Moss, a professor at Harvard Business School,

“A reward system should emphasize investment in people and projects rather than

payment for past services, too many support a looking backwards approach that

just reinforces the status quo rather than continuous improvement” (p.93).

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In general, a Partnering workshop provides opportunities for stakeholders to develop:

“effective communication (negotiation and working together) skills, decision making

processes, specific goals and objectives, organizational commitment, and better intra-

organizational lines of communication” (Clay, MacNaughton and Farnan, 2004, p.6).

As Ledger (2003) affirms “the lessons to be learned is that collaborative strategies

should always be ‘life-cycle’-based, so that benefits are obtained before, during and

after the project is completed” (p.2). Up to this point, the Partnering workshop has

involved the “plan” piece of the (plan-do-study-act) Demings Cycle. The next point

will take the “do-study-act” piece of the Demings Cycle.

Post-Partnering Workshop: Follow Through processes

Continuous partnering evaluation: This is an ongoing evaluation process agreed

at the Partnering Workshop to learn how the partnering is working and what

needs to be done to keep the collaborative working relationship. The support

system will be implemented, follow through regular meetings will be held and

chair by the Partnering “champions” named at the workshop who will

administrate surveys, focus groups or stakeholder meetings to help the

stakeholder determine whether the parties are meeting their expectation and

commitments and understand how partnering is working on the front line. The

purpose also is learn from the experience, the Partnering Workshop constitutes the

planning part, then stakeholders will act and implement the strategies developed

during the workshop, but as Fisher and Sharp (1998) refers, stakeholders need to

integrate thinking and doing, thoughts and actions; they recommend follow short

cycles of Prepare – Act – Review. This cycle has similarities with the Demings’s

Cycle PDSA (Plan - Do - Study - Act). It seems there is a clear correlation

between Prepare (Plan), Act (Do), and Review (Study). In this sense, after the

planning stage during the Partnering Workshop (Prepare), and implementing the

strategies developed at the workshop (Act), stakeholders need to check and study

(Review) in order to learn from the experience. Fisher and Sharp (1998, p.122)

suggest a short check list for review: “What seems to have Worked Well? What

might I want to Do Differently? What guidelines does this suggest? For work in

progress? For future work?” The authors affirm that “when we do stop to review a

project we are likely to focus our attention on the substantive work. We are less

likely to review the way in which we have been working together, or work on

improving cooperation (…) If there are problems with our methods of working

together, then finding better substantive approaches will not keep us from

repeating mistakes next time” (Fisher and Sharp, 1998, p.122). Therefore,

stakeholders in healthcare facilities need to review how they are working together

on a task in order to learn how they might get that substantive task accomplished

more efficiently. Healthcare professionals need to ask themselves what guidelines

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might help them improve their working together and how well they are reviewing

together. In addition, cross-functional task teams can be named to address the

problems that stakeholders at lower levels can not timely resolve. A neutral party

can be brought in to facilitate or mediate difficult issues. Technology can also be

used to share pertinent information timely and accessible to all the stakeholders.

There is not very much literature about experience with the use of collaborative

approaches to resolve differences. Nor is there very much literature creating strategic

partnerships in the health care industry. McKersie, Eaton, Kochan (2004) recount the

Kaiser Permanent experience using interest-based negotiations to craft a new collective

bargain agreement while building a new labor-management partnership. Professor

Melese’s (2006) experience with the private sector and academic settings led her to write

about building corporate alliances in Academic Medical Centers which highlighted the

importance and opportunities of partnerships and corporate alliances, and Melese’s

(2006) remarks that “it is clear that all stakeholders in the health care industry will need

to work together to successfully navigate the new area of ‘personalized’ medicine or

pharmacogenomics” (p.3). Also, Ziegeslbauer and Fraquhar (2004) share the experience

in managing the research collaboration between Millennum Pharmaceutical and Bayer

Heathcare AG, a pharma/biotech alliance. The Health Coverage Coalition for the

Uninsured (2008) reached an unprecedented alliance of health care leaders and

announced a historic consensus-based agreement to help reduce the number of America’s

uninsured and expand health coverage.

This article tries to bring to the spot light one potential use of a partnering framework to

the healthcare industry to bring about collaboration and productive approaches to deal

with heath care issues and help healthcare professionals craft their future, beyond and

regardless of governmental intervention. Bridgesmith (2008) says that “a continuous

improvement process implies a process and a culture that says we are free and

encouraged, admitting that we have made mistakes, from which we can learn; but, this is

contrary to the health care culture because mistakes are forbidden. We need to change the

culture, create a culture that acknowledges and accepts that mistakes will happen and that

we will have a continuous improvement process as we go.” As Ledger (2003) affirms

“finding solutions when it is easier to retreat behind the barricades and driving for

continuous improvement are hard work” (p.6) but achievable. This article has tried to

contribute to that end, this author believes that the way we do things (the process we use)

impact the results. The use of Partnering in healthcare settings will ultimately lead to the

shift of paradigm and generate changes on the healthcare professional culture. The use of

this partnering approach to develop continuous improvement processes can shape a new

collaborative culture in the industry, and in turn, increase quality, reduce the costs and

broader access to health care services.

www.orasicg.com

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