Consulting inter-organizational relations in the public sector Symposium Ralph Grossmann, iff

Consulting inter-organizationalrelations in the public sector Symposium Ralph Grossmann, iff Karl Prammer, Iff und C/O/N/E/C/T/A

Management of Collaboration • Managing cooperation is becoming an increasingly important task for managers and consultants. • During the last decades organisations have tried to become successful by specialising and concentrating on core competencies. This process of differentiation and specialisation by organisations and non-profit organisations has increased the strength of organisations and the capability of societies to solve problems. But a lot of issues within society remain unsolved between these specialised organisations. • Due to the increasingly high cost of innovations investments and globalisation, organisations are even looking to cooperate with former competitors.

Management of Collaboration • In the non-profit and public sectors collaboration is playing an even more important role. No single important issue within society can be solved by one organisation alone.

The Context of the Case Study • For the first time the big players in health and social policy within one federal state have decided to work with an OD approach. • The regional government and the general insurance company for workers have jointly initiated this project. The aim of the project is to optimise the processes between all of the organisations in the health and social fields. • The department of Organisational Development and Group Dynamics has a mandate to support the project with scientific work and consulting services. • Introducing the case study we want to clarify some specifics of consulting collaboration. • To characterise trans-organisational management as a specific field of management consulting. • And to show an example of integrating the work of research and consulting.

The Current Situation • In Austria there exists an established social welfare model. This means that the government and social security organisations contract and finance autonomous or relatively independent organisations to deliver health and social services. • The patients and clients have to increasingly contribute to the cost of treatment • In the federal state of Upper Austria more than 30 organisations are involved in this project. • They belong to different sectors in society. They work following their own specific professional traditions and keep in mind their own interests. We see a lot of difference especially between the health and social sectors. There are different political structures, different budgets and different professional concepts and theories in use. They have their own networks and informal meetings. • The project is financed primarily from the health budget.

The iff-Model • The IFF has done a lot of research into networks and has a lot of experience in consulting cooperation. We have identified eleven key factors for successfully managing and consulting collaboration: • Organizing a cooperative effort as an independent system • Focusing on the partners´ performance and capabilities • Taking people and their connections into account • Preparing the business case • Organizing a cooperative control system • Managing the cooperation – running the ‘net server’ • Create the internal requirements for cooperation • Carrying out comprehensive teamwork • Taking into account different ways of thinking between cooperative ventures and politics • Trust as the basis for cooperation • The targeted use of external consultants

Considerations to guide the project design • Initiation of a preparatory project for common commission to the external consultant system in charge of accompaniment by all institutions concerned. • Focus on the overall level of the federal state and the district level on site at same time. • Commitment among relevant players in the individual institutions on an operational level and on a management level as well as commitment within one institution across all hierarchical levels. • Creation of one’s own organizational project vessels for the diagnostic/proposition work to be doneas well asdecision-making/safeguarding work. • Organization of a processin which transfer is from the beginning in parallel to diagnostic and proposition work. • Explicit statement of the specificities of the approach and the differences between this and previous experiences with similar projects and making it amenable to experience by project players from the start.

Considerations to guide the project design • Initiation of a preparatory project for common commission to the external consultant system in charge of accompaniment by all institutions concerned. At the stage of constitution and at sensitive nodes in their development, cooperation systems need omni-partisan third parties. They need “neutral” persons to accompany the structuring of the cooperative work program and facilitate sensitive decision-making processes. To be accepted and able to act, cooperation systems – especially when at the stage of development – need experts and organizational consultants who are committed to the cause – i.e. cooperation – only. They need persons who are not there to just back individual persons or one institution and who have no stakes in the game, i.e. who are not themselves affected by the solutions to be found.

Considerations to guide the project design • Initiation of a preparatory project for common commission to the external consultant system in charge of accompaniment by all institutions concerned. At the stage of constitution and at sensitive nodes in their development, cooperation systems need omni-partisan third parties. They need “neutral” persons to accompany the structuring of the cooperative work program and facilitate sensitive decision-making processes. To be accepted and able to act, cooperation systems – especially when at the stage of development – need experts and organizational consultants who are committed to the cause – i.e. cooperation – only.

Health Platform Health Fund Research and Consultancy System iff Preliminary Project Core Team Preliminary Project Extended Body Considerations to guide the project design • Initiation of a preparatory project for common commission to the external consultant system in charge of accompaniment by all institutions concerned. In the framework of the preliminary project, the project commission, including the commission to iff to accompany the project, was jointly worded by all cooperating institutions. As ifffacilitated the process, iff and its consultants and scientists were observed by those concerned and scrutinized for their “omni-partisan” attitude. This way, the institutions to be accompanied were assured that they could trust iff and its players in finding solutions. Authority Social work/Health care Health insurance inst. Preliminary project set up

Doctors in practices Hospitals Sen. citizens‘ / Nursing homes Mobile services Health insurance inst. Authorities Politicians NGOs . . . Considerations to guide the project design The project was to eventually create generally valid guidelines for the entire federal state. In the future all players were to be committed to these guidelines so that each player or person/ nstitution concerned would “operate” in a way that was best harmonized with the other players. • Focus on the overall level of the federal state and the district level on site at same time. Level of federal state At the same time, it had to be possible to render specific services for and to the individual citizen/patientlocally, in the district based on the general guidelines applicable in the entire Land. The wording “possible to render services” should be taken to mean that on site services can only be rendered successfully if they take into account the specific social and organizational circumstances of the district which are the result of “organic growth”. Level of district

Hospitals Doctors in practices Mobile services Sen. citizens‘ / Nursing homes Health insurance inst. Authorities Politicians NGOs . . . Considerations to guide the project design Executives on managerial level Commitment cannot be ordered! To make commitment materialize and ensure that it is there when the project has been completed, processes of social interaction and common work are required on all these levels already during the project. • Commitment amongthe individual institutions as well as commitment within one institution Level of district / Level of state Cooperation / Commitment on level where framework is created and managed for entire state Cooperation /Commitment between levels of federal state and district Employees on operational level Cooperation / Commitment on operational level of doing in districts

Safeguard project / Safeguard results Decision-making / safeguarding body Diagnostic /proposition team Finding alternative and creative solutions Considerations to guide the project design • Creation of one’s own organizational project vesselsfor the diagnostic/proposition work to be done as well as decision-making/safeguarding work. Since the members of the diagnostic/proposition team do not have to take decisions on solutions binding on the organizations, they find it easier to look at alternative and creative solutions. Since the members of the decision-making/safeguarding team are explicitly entrusted with that function, the probability that they will stand by this mandate in their organization will rise. Diagnostic/proposition work and decision-making/safe-guarding work are done in two separate bodies. These bodies are staffed with different groups of persons. So the project organization deliberately reflects the hierarchy of every-day work. Regular organization Project organization

Safeguard project / Safeguard results Decision-making / safeguarding body Diagnostic /proposition team Finding alternative and creative solutions Considerations to guide the project design • Creation of one’s own organizational project vessels for the diagnostic/proposition work to be done as well as decision-making/safeguarding work. Diagnostic/proposition work and decision-making/safe-guarding work are done in two separate bodies. These bodies are staffed with different groups of persons. So the project organization deliberately reflects the hierarchy of every-day work. • As these bodies are staffed with different persons, • there is a clear-cut dividing line between decision-making and proposition, • the solutions found will be supported by more players within the organization who were actively involved in finding the solutions • resources are used in a relatively economical way as regards the time spent working on the project. Regular organization Project organization

Considerations to guide the project design This approach differs explicitly from other projects in the public service because it does not involve experts who develop complete solutions in bodies removed from those concerned. Hence, it is not about developing everything, committing it to paper, having it approved by the top level of the hierarchy and then transporting it to those concerned and implementing it in the institutions. • Organization of a processin which transfer is from the beginning in parallel to diagnostic and proposition work. As solutions are found directly by representative of those concerned with the support of external consultants who accompany them in respect of content and procedure, and as solutions found are directly tested for their practical value in the course of pilot projects, solution transfer is from the start an ongoing parallel process. To use resources as economically as possible, • the actual work on finding solutions only takes place in a few districts brought together in clusters; • operational players and executives of the other districts are hooked up with the process via occasional transfer events.

Steering Committee of the Fed.State Focus on level of land Project Team of the Fed.State Transfer Body Cluster Steering CommitteeB Cluster Steering Committee A ElectronicKnow-how Platform ClusterProjectTeam B Focus on level of district ClusterProjectTeam A Districts Cluster B Districts Cluster A Other districts Considerations to guide the project design To use resources as economically as possible, • the actual work on finding solutions only takes place in a few districts brought together in clusters; Consultancy system iff Scientific system iff • operational players and executives of the other districts are hooked up with the process via occasional transfer events.

Considerations to guide the project design • Explicit statement of the specificities of the approachand the differences between this and previous experiences with similar projects and making it amenable to experienceby project players from the start. Many project players are after all unfamiliar with the following: • the fact that members of a decision-making/safeguarding body really have to make binding statements for the institutions they represent, which the project team members can later on refer to in their work; • the fact that the mandate “develop propositions and test them for their viability in pilot projects” means that members of a diagnostic/proposition team will themselves be responsible for handling a real-life pilot project; • the fact that non-compliance by representatives of higher hierarchical levels with jointly agreed rules of the game (in respect of attendance, decision-making etc) will be addressed by the external consultants and compliance will publicly be called for.

Considerations to guide the project design • Explicit statement of the specificities of the approachand the differences between this and previous experiences with similar projects and making it amenable to experienceby project players from the start. Such “resocialization” toward adherence to functional rules of the game and behavior in cooperation systems is an explicit project task to be fulfilled in parallel with the other tasks. In the protected and facilitator-supported space of the project, future cooperation is tested within newly created cooperation structures and guidelines. This makes it more probable that players will in the future act in accordance with the solutions found and considered purposeful.

Snapshots of project aspects relevant to success The Split Between Social Affairs and Health Affairs • We had to work harder than expected on the differences between health and social policy. • It would have been important to involve social policy as a founding partner of the project. • Also the civil servants of both departments could have started their work at the same time.

Snapshots of project aspects relevant to success Managing Conflicting Loyalties • Participants in a cooperation system have divided loyalties: To their organisation they belong to and to the cooperation system. • They need mandate and support from their organisation and at the same time they need space for their own development and decision making. • They need autonomy to collaborate and a strong link to the management behind them.

Snapshots of project aspects relevant to success Split between Development and Implementation • The top management of the organisation involved have viewed the development of the project and its implementation separately. • The employees have had the chance to work in the project relatively independently. Now the project is starting to implement the results, top management are beginning to realise the consequences.

Snapshots of project aspects relevant to success • Cooperation systems need “omni-partisan” third parties to accompany the structuring of the cooperative work program and facilitate sensitive decision-making processes. They need experts and organizational consultants who are committed to the cause only, and not to individual persons or organizations. However, be careful: What really counts here is not the fact that the facilitators consider themselves to be omni-partisan but the fact that they are perceivedas “omni-partisan” by the project players they accompany. The researcher/consultant system is “omni-partisan” • This means that the persons concerned need to be sensitized to the necessity of being omni-partisan or understanding for the fact that key players must not instrumentalize external consultants as secret agents. • For this reason, cooperation processes between external consultants and project-team members are required so that consultants are seen as “omni-partisan” before “hot potatoes” are touched. • To make sure that this is also filled with life, it is necessary that the external consultants “invite” the project-team members to give activefeedback. They have to be asked explicitly to address any suspicion that the principle of being “omni-partisan” has been violated when it arises and to work this out subsequently.

Snapshots of project aspects relevant to success • To attain solutions in an effective way, it has turned out useful for the external consultants to support the work in teams and bodies by compiling documentation. Active documentation work in this context is more than just transcribing flip charts and comments, it also includes coordinating, structuring and graphical processing of material. Moreover, it covers the identification of outstanding issues or contradictory statements. Documentation ensured by scientific accompaniment system In one of the two clusters - as few as 2½ workshop days of the cluster project-team organized up to the pilot project - produced 55 A4 pages in small print. Some project-team members - who at the beginning had been extremely skeptical of the chances the project had for success in view of the short time available - said that once they knew about the facilitation process and experienced the benefits of the material compiled, they were really able to start working constructively and put their energy into the mandate.

Trigger event Important activities Final event Part process xy Client Failure recipes Efficiency features Output Snapshots of project aspects relevant to success As the members of a project team – all of them representatives of cooperating institutions – devise an ideal map of the process which has nothing to do with the current practice and reality on site, they shake off their institutions and their views derived from socialization within these. Together, they create a new common reference system to guide their actions. Based on that reference system, they diagnose the strengths and weaknesses of the status quo and jointly propose functional solutions to relate to citizens/patients. Relativization of existing views by introduction of a toolbox for efficient processes Eventually, the ideal process map turns into a new real process map. With the help of a target process map, solutions can be communicated to third parties or those players who will in future have to act according to the solutions in a relatively easy way.

Snapshots of project aspects relevant to success Relativization of existing views by introduction of a toolbox for efficient processes As the members of a project team – all of them representatives of cooperating institutions – devise an ideal map of the process which has nothing to do with the current practice and reality on site, they shake off their institutions and their views derived from socialization within these. Together, they create a new common reference system to guide their actions. Based on that reference system, they diagnose the strengths and weaknesses of the status quo and jointly propose functional solutions to relate to citizens/patients. Eventually, the ideal process map turns into a new real process map. With the help of a target process map, solutions can be communicated to third parties or those players who will in future have to act according to the solutions in a relatively easy way.

I. Initial screening, disachrge prognosis Hospitalization Positive evaluation Results for „Discharge Management“ in districts of Cluster A II. Medical/nursing decision-making and accompaniment of case IV. Discharge carried out and completed VI. Evaluation of care case V. Transport carried out III. Activities in preparationof discharge • Initial event: Registration in hospitalClosing event:Determination of care category, in case of category III confirmation of takeover by „transition nursing“. • Responsibility: ward physician in charge of treatment • Rendering of service: Physician and nurse compile patient‘s medical history in the sense of a haarmonized „team decision“ and do an initial screening to establish the scope of follow-up care. In doing so, they also use material from the reference process. • Tools: • Care categories: Cat.I: no accompaniment; Cat.II: care by ward; Cat.III: care by transition nursing In this part process, handling has to be seen as an initial follow-up carehypothesis. In the course of part processes II/III the category first identified can be adjusted in a dialogue between ward and transition nursing. • Discharge management board In the interest of quality assurance for these services, a discharge management board is created if needed for Cat. III. It is cmposed of relevant players who have to be involved (intra- and extra-mural; medical, nursing). • Reference form with social history module(Minimum social history aspects: * unknown, * phone number of next of kin, * current nursing/care: - mobile service, - relative with care skills, - 24 h care, - no care)

Consulting inter-organizational relations in the public sector Symposium Ralph Grossmann, iff