The COVID pandemic, and the wider governmental and societal response, have brought the need for collaboration into focus. As we rang in a new decade, none of us really knew what the impact of a little understood virus would be on health, wellbeing and social norms in the UK and worldwide. After all, we have seen and tackled other novel challenges before – SARS, MERS, H1N1 flu to name a few – although the scale of the challenge was far smaller.

Positively, many care organisations came together in a way not experienced before. Critical care capacity was ramped up to an unprecedented degree, Nightingale hospitals were conceived, planned and made ready within days, and NHS Trusts shared information to guide collective hour by hour decision making.

As we see a resurgence in COVID cases across the country, there will be an ever-increasing need for both collaboration between providers within a place and collaboration across mental health or acute providers in a system with mutual aid provided across systems and the ability to flex capacity across systems. Systems face this challenge alongside usual winter pressures, while continuing to recover and restore elective services against a background of a national focus on addressing disparities in health equality.

Formal collaborative efforts such as partnership agreements and group mergers are unlikely to yield the immediate results that are needed. That’s not to say there isn’t a place for formal agreements – in fact in the medium to long term they can create formal joint accountability, spread risk equally across organisations and create a sense of something new being built that all can align behind. However, with so many competing priorities, the reality is you’ve got no time for an MOU so what can you do? We’ve set out five features that hold the key to successful collaboration without the need for formal legal structures.

Make the most of what you already have

Where possible, working within existing structures allows energy to be directed to the objectives of the collaboration, rather than towards agreeing and setting up new governance arrangements. A loose collaboration maintains the sovereignty of each organisation, ensuring that the focus is on the collective work that needs to be done, rather than protecting personal priorities and agendas.

Use a shared challenge to work on together

“If you want to build a ship, don’t drum up people to collect wood rather, teach them to long for the endless immensity of the sea”.

Having a common purpose helps to establish the partnership as a brand that is jointly owned across organisation with people keen and able to support its objectives, letting go of traditional organisational boundaries without the need for any formal structures.

Invest as much time as possible in building relationships and trust

Real collaboration requires people to know, trust and respect one another. Where there is common purpose, building relationships based on the shared concern allows relationships to mature faster, becoming less transactional and more relational.

If trust and good relationships are established and sustained, almost all forms of meeting and interaction can be moved to a virtual format with no loss of effectiveness1. While it may have been a challenge at first, getting individuals and teams together has never been easier in a virtual world and doing this regularly will only strengthen the collaboration.

Critical to the success of collaboration is open sharing of information and trust building between people helps to create an environment where people feel safe to share data, even if that may expose weaknesses in their own organisation.

Embrace distributed leadership

Distributed leadership builds the capacity for change and improvement, and can accelerate progress. In practice this means at every level staff are given autonomy to make decisions and are held to account for their actions with joint ownership of priorities. Leaders take responsibility for the collective success of the whole and mobilise resources proactively behind whichever issue needs addressing first. This frees up time for executives who can step back into sponsorship of workstreams, on hand to provide input to allow quick problem solving and unblocking of issues.

Dedicate resources to the task

Joint programmes can often been seen as separate entities but success requires dedicated resources to enable aligned action. Consequently a balance is needed between people and resources that are dedicated and impartial to organisational loyalties.​ It is critical to have a highly capable dedicated resource with the necessary skills and expertise, ability to flex between workstreams, focusing exclusively and working iteratively on the collective work.

Current pressures on the health and care system necessitate ongoing collective action and rather than bracing for temporary hardship before a return to normalcy, leaders must prepare for a permanent shift in how to plan, prioritise and deliver services. By continuing to work together with transparency, open communication and honesty, systems build back better, with collaborative efforts at the heart of this.