Mathehu's Weblog

mulling over (research) ideas

Partnership working in health care – Ontological and epistemological perspectives

Partnership working: What is it and how do we know it when we see it?

The following is a summary and reflection on Janette Pow’s PhD Thesis entitled “Assessing partnership working: Evidence from the National Sexual Health Demonstration Project“.  I had the honour of being one of her supervisors and I am now able to reap the harvest from her excellent work. All the substantial information provided is taken out of her thesis, which is an excellent read!! My only contributions are the odd comments and bridges.

Reference: Pow, J. (2010). Assessing partnership working: Evidence from the National Sexual Health Demonstration Project. Unpublished thesis: Napier University.

Partnership working has been a buzz word within health care and beyond for quite a while. Yet, defining partnership working is a “terminological quagmire” (Lloyd, et al 2001). Terms such as collaboration, cooperation, coordination, coalition, network, alliance and partnership are often used interchangeably within the same literature (Huxham 1996, Percy-Smith 2005 and Sloper 2004).  Indeed, the Audit Commission (2004) argued that “the term partnership is increasingly losing credibility, as it has become a catch all for a wide range of concepts, and a panacea for a multitude of ills”.

Thankfully, various systems to identify and evaluate partnership working have been developed. Overall, partnership working is likely also to involve a combination of social, political, environmental and health care factors (Baron-Epel et al 2003).  Various ways to characterise partnerships in more detail have also been suggested. For example, the Audit Commission (1998) differentiates between formal and informal partnerships, whereas Lasker et al (2003) distinguish between strategic and operational partnerships.

Wildridge (2004)  is one of many authors who provided  assistance in navigating this quagmire by identifying several commonalities between the different conceptualisations of partnerships.

Commonalities between the different conceptualisations of partnerships (Wildridge, 2004)

  • Between organizations, groups, agencies, individuals, disciplines

  • Common aim or aims, vision, goals, mission or interests

  • Joint rights, resources and responsibilities

  • New structure(s) and processes

  • Autonomous, independent

  • Improve and enhance access to services for users and carer’s

  • Equality

  • Trust

Ling (2002), on the other hand, provided an  illuminating perspective on variations in partnership characteristica.

Varying characteristics in partnership working (Ling, 2002)

Partnership Members

Links between partners

Scale and Boundaries

Organizational context of partnership


High or low trust


‘Fit’ with existing institutional architecture

Parts of organizations

Equal or hierarchical

Numbers of partners

Maturity of relationships

Whole organizations

Focused or broad sweep

Boundaries (where they are drawn)

Legitimate or illegitimate


Co-evolution, coupling and convergence

Boundaries (tight or loose)

Resource dependency



Boundaries (own or mandate)

Impact/steerage capacity


While identification and recognition of these factors is informative, the English and Welsh Department of Health (1999) highlighted one of many challenges of partnership working: “Partnerships should be a tool for achieving an outcome and in order to achieve that outcome, there needs to be a shared vision and agreement on what to do, by whom and when”. Developing a shared vision and agreements among autonomous and empowered health professionals who are used to working on their own is a formidable quest. Indeed, facilitating effective partnership working ranks among the toughest challenges facing public sector organisations (El Ansari et al 2001).

On a similar notion, Pratt et al (1998) provide a systems perspective, which can be used to frame partnership working as  “an approach to … development that views groups of people coming together around a shared purpose as living systems”. I like this approach as it does not include any suggestion of coercion or hierarchy. Rather it suggests dynamic growth driven by a sense of purpose, which echoes the ideas promoted in Fromm’s concept of Biophilia.

Horwarth provides a more necrophile perspective (in Fromm’s view) as he provides a tabled overview of the progression from communication between agencies to integrated endeavours. Integration refers to highest degree of collaboration when whole systems work together with regard to the planning, commissioning and management of services. I found this table illuminating and helpful.

Features of Collaborative endeavours (from Horwarth et al 2007)






Low level collaboration

→ →  →  →  →  →  →  →

High level collaboration

Limited or no formal agreements

→ →  →  →  →  →  →  → Formal agreements
Agencies remain autonomous → →  →  →  →  →  →  →

Agencies sacrifice autonomy

Work towards different targets & goals

→ →  →  →  →  →  →  → Work to shared goals and targets
Agency maintains control of resources & funding → →  →  →  →  →  →  →

Joint responsibility for resources & funding

Staff managed by individual service → →  →  →  →  →  →  →

Staff managed by partnership

Focus on individual case → →  →  →  →  →  →  →

Focus on whole service

Decision-making responsibility of agency → →  →  →  →  →  →  →

Joint decision-making

Collaboration likely to be voluntary or within guidance → →  →  →  →  →  →  →

Clear mandate for collaboration at strategic level

Variable practice dependent on individual → →  →  →  →  →  →  →

Specific focus on activity outlined in strategic plans

Affiliation to own agency/discipline → →  →  →  →  →  →  →

Affiliation to partnership

Accountable to agency → →  →  →  →  →  →  →

Accountable to partnership

Agency -focused

→ →  →  →  →  →  →  →


Despite all these developments, it is wise to keep criticisms in mind. Davies (2002) muses that it is ‘easy to assume partnerships generate added value in a political-ideological culture that assumes they will’ but raises the possibility that partnerships can lead to governance failure, may generate more costs than benefits, and may not provide an unqualified answer to the problems they were set up to address.

All references used are available on request.


July 20, 2010 - Posted by | Uncategorized

1 Comment »

  1. […] The project builds on changes to existing service delivery within the area, particularly on improved partnership working. Here is the second (and related) challenge, what does partnership working mean? […]

    Pingback by Tackling health inequality and mental wellbeing in the community: Reflection on a project evaluation « Mathehu's Weblog | July 27, 2010 | Reply

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