Taking the Labor Out of Collaboration

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By Nina Bondre, MPO, and John Brinkmann, MA, CPO/L, FAAOP

All work environments involve some degree of working with others. Although many daily tasks can be completed independently, projects with broader impact are often accomplished most effectively through the involvement of various interested parties who have diverse interests and abilities. Some collaborations are voluntary, while others are required to accomplish the task at hand. For instance, a practitioner may choose to consult with another clinician on a difficult case but is required to collaborate with referral sources to obtain the necessary documentation to justify O&P services. Much of the work done by O&P practitioners is independent of others. Clinicians typically work one-on-one with patients and have sole responsibility for the process and outcome. Learning to effectively share resources and responsibilities can expand our personal and professional influence and improve our efforts on behalf of our patients.

John Cleese quote

While most professionals acknowledge that there are rewards to successful collaboration, working with others can be challenging. Many people have had at least one experience of being frustrated with the outcome of a collaborative project or have known the disappointment of a joint project's complete failure. There are myriad ways for projects to go wrong: One team member may end up doing a disproportionate amount of work on the project, yet the rewards are distributed equally; peers may have different expectations regarding the outcome of a common endeavor; or a joint venture may fail due to disparate visions, commitment levels, or resourcing by collaborative partners. For example, in O&P, reimbursement can be detrimentally affected when the priorities of referral sources, on whom practitioners depend for specific information, are not in line with payer requirements.

Past negative experiences can discourage professionals from engaging in future collaborations. However, avoiding them may result in missed opportunities to broaden your knowledge base and achieve greater results for your patients and your career. When executed properly, collaboration can enrich your career, improve business and clinical outcomes, and even move the profession forward. For instance, new materials, technologies, and methods that have introduced some of the most positive developments in patient care and business practices often come from collaboration with professionals outside of O&P.

This article identifies collaboration best practices for a successful outcome and ways in which to make it a more rewarding experience.

The Wilder Research Center

The Wilder Research Center, in research published in 1992 and updated in 2001, reported the results of screening more than 300 published studies on collaboration and focused on more than 50 that met its criteria for validity and relevance. It identified 20 "factors that influence the success of collaboration."1 While the focus of the Wilder Research Center is primarily on organizational collaboration, the principles of success in these endeavors can be applied to smaller companies or individuals. This article examines eight of the factors described in the book Collaboration: What Makes It Work, a Review of Research Literature on Factors Influencing Successful Collaboration, published by the Amherst H. Wilder Foundation, and demonstrates their application to collaborations specific to the O&P profession. A self-scoring checklist of the 20 factors, The Wilder Collaboration Factors Inventory, can be obtained free of charge for noncommercial use by visiting tinyurl.com/nh763v2.

Definitions

Working with others is often described as cooperation and coordination, terms that are frequently used interchangeably with collaboration. However, not all endeavors that involve working with others are necessarily collaboration. According to the Wilder Research Center, each of these terms describes different levels of shared relationships, autonomy, and resources.

Cooperation involves informal relationships that do not have a commonly defined mission, structure, or planning effort. The resources, rewards, and authority of cooperating individuals are separate, and all of these factors together create a low-risk relationship. Coordination occurs when individuals enter into more formal relationships, often sharing a common mission, resources, and rewards. Collaboration is "a mutually beneficial and well-defined relationship entered into by two or more organizations [parties] to achieve common goals. The relationship includes a commitment to mutual relationships and goals; a jointly developed structure and shared responsibility; mutual authority and accountability for success; and sharing of resources and rewards."1

Factors for Successful Collaboration

Members See Collaboration as in Their Self-interest

Collaboration is essentially combining the strengths of multiple contributors in a professional relationship for mutual benefit. Effective collaboration involves real costs (including loss of autonomy, added time, and less control over the process) and significant risk. If a joint effort will not advance each organization's or participant's goals, it is unreasonable to expect them to commit the necessary time, energy, and resources to it. Understanding that the shared talent and resources involved in the collaboration can accomplish specific goals for each organization or individual is a great motivator to accept the risks associated with the inevitable costs.

Mutual Respect, Understanding, and Trust

Collaborators need to respect one another as professionals, above all. Collaboration involves integrating differing viewpoints into a common vision and action plan. Time must be taken before the collaborative effort begins to ensure that the parties involved share values that will be at the core of the combined effort. With a foundation of respect between individuals, disagreements may occur, but the relationship (and project) will not crumble. This includes an understanding and respect for personal and organizational norms and values, since these qualities form the basis for a different style of working with others and differing objectives.

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Members Share a Stake in the Process and Outcome

Once respect and trust have been established, a collaboration has a greater chance of success when all members directly influence both the process and the outcome. This engagement in a project is often referred to as ownership. When group members have ownership of the end result as well as the steps that will be taken to achieve that result, they will typically accept higher levels of responsibility and make more significant contributions.

Physician, physical therapist, and O&P clinical team members collaborate by contributing their unique experiences and expertise to develop optimal solutions for their patients. While these types of clinical collaborative efforts might be difficult to coordinate, and professionals may not be reimbursed for their time, each member ultimately benefits from the collaboration. As the professional collaboration develops, each clinician can more easily obtain the expertise and information, including documentation, needed to provide an intervention that is most likely to benefit the patient. In addition, as the practitioners develop more understanding of each other's practice specialty, respect grows for the value each professional brings to the collaboration. All members invest their time and reputation in the process and benefit from the improved outcomes. Understanding this, each member takes ownership of the process and accepts responsibility for making the collaboration work. Achieving the optimal outcome for the patient is also important for such professionals, as achieving the best solution not only benefits the patient, but saves time, money, and energy for everyone involved.

Concrete, Attainable Goals and Objectives

A clear statement of goals not only provides direction for all subsequent collaborative activity, it also allows each contributor to monitor individual and team performance. Goals may be modified as the project progresses, but this must also occur collaboratively so that all parties retain ownership of the new vision and mission.

The type of goals in a collaborative effort can determine the success of the endeavor. "When performance goals dominate an environment, people are motivated to show others that they have a valued attribute, such as intelligence or leadership. When learning goals dominate, they are motivated to develop the attribute."2 Simply establishing the intent of the collaboration by defining what type of goals it will entail can fundamentally change the environment of the interaction. Establishing from the outset that one of the end goals of collaboration is to learn and grow, rather than prove one's worth and intellectual prowess, can lead to more positive interactions.

Without such a goal established, practitioners collaborating on a difficult case could use the opportunity as a chance to prove their clinical authority, pouring their energies into demonstrating their superior clinical knowledge and skills. The desire to outdo each other may overtake the goal of providing the best solution for the patient. If, instead, they view the situation as a chance to learn from one another and combine their knowledge and experience to improve the outcome for the patient, they can shift their focus to a learning objective rather than a performance objective. In the end, a learning focus results in developing attributes, rather than trying to impress one another in a performance-focused situation.

Development of Clear Roles and Responsibilities

Once the overall goals of the collaboration have been determined, identification of general roles and assignment of responsibilities should be undertaken with a clear understanding of the interests and strengths of each party. One of the primary benefits of collaboration is that diverse interests and strengths are combined in mutually beneficial ways. Clarifying specific roles allows these strengths to be applied most effectively to achieve a superior result.

Defining collaborators' roles can also help preserve an appropriate level of autonomy. Establishing the boundaries of each person's territory ensures that collaborators do not feel peers are encroaching on his or her responsibilities or trying to take control of the project. This process helps eliminate potential power struggles and rein in individuals who may have a tendency to be overly controlling in such situations. Defining roles also allows work to be divided evenly and encourages each collaborator to contribute in a substantial way.

Open and Frequent Communication

Compared to coordination and cooperation, collaboration involves a closer connection between parties that can only be maintained with an appropriate level of communication. The project specifics and the intended output will determine the frequency of communication. Having a protocol for communication (who should be informed under various circumstances) can be a helpful way to avoid one party acting without the input of the other, or certain team members acting without consulting other relevant members of the group. A communication protocol can help collaborators know when they are free to work independently or when team approval is needed. The expected frequency and length of communication should be established, such that the exchange of key information occurs without a flurry of communication regarding minor details.

Ability to Compromise

Few people enjoy conflict. Some people shy away from disagreements or avoid bringing up their own viewpoints in an attempt to avoid conflict, while others may strongly engage peers in an attempt to end disagreements with a show of force. However, when conflicting opinions are handled appropriately, they can often be the catalyst for the creation of novel solutions. "Clashes between parties are the crucibles in which creative solutions are developed and wise trade-offs among competing objectives are made."2 Avoiding different perspectives or trying to persuade others to simply accept a viewpoint is not collaboration. The synthesis of divergent viewpoints toward a common goal can produce a more powerful solution. Each collaborator may have a slightly different bias or focus; therefore, the solution produced from joint efforts can be more robust.

Sufficient Funds, Staff, Materials, and Time

Insufficient time, funds, or resources to support the effort may create tension and an unequal work distribution, and may result in failure. Collaborative efforts require sufficient time to coordinate those efforts and ensure that high-quality work is performed. In some cases, the cost of a project may be lower with a collaborator versus working alone because different members will have access to various resources and equipment, thereby reducing the overall cost per person to complete a particular project. It is important for each collaborator to have a clear understanding of what resources, materials, and personnel each member can contribute to a joint effort.

Summary

Collaboration increases the potential to grow as a practitioner, business owner, and person, but working collaboratively involves a risk for each person involved. Applying these principles increases the likelihood that this risk is rewarded. With these tools in hand, your next collaborative effort may be one that pushes your boundaries, challenges you, and produces rewards that you and your collaborators can enjoy together.

Nina Bondre, MPO, is a resident prosthetist/orthotist at Dankmeyer, headquartered in Linthicum Heights, Maryland.

John Brinkmann, MA, CPO/L, FAAOP, is an assistant professor at Northwestern University Prosthetics-Orthotics Center. He has more than 20 years of experience treating a wide variety of patients.

References

  1. Mattessich, P. W., M. Murray-Close, and B. R. Monsey. 2001. Collaboration: What Makes It Work, 2nd Edition: A Review of Research Literature on Factors Influencing Successful Collaboration. St. Paul, MN: Amherst H. Wilder Foundation.
  2. Goleman, D., R. Boyatzis, and M. Hansen. 2013. HBR's 10 Must Reads on Collaboration. Boston: Harvard Business School Publishing.