Our Relational Healthcare project ran between 1998 and 2005. Although no longer a dedicated project area we continue to be involved in research projects including working with the Care Quality Commission on assessing relationships as part of Local System Reviews.

Relationships are both means and ends: they are essential to the good provision of healthcare but relationships are also part of what it means to be healthy.

Building on our work on relational justice and prisons, we worked with Professor Geoff Meads to look at how our relational audit tools could be used to support new organisational developments in primary care.

Our first project for the Health Education Authority, Mixing Oil and Water: how can primary care organisations improve health as well as deliver effective health care? looked at the relationships between public health and primary care. The use of our relational audit metrics [ling to our metrics] in half day workshops demonstrated the potential to crystallise issues and enable constructive dialogue on a topic – organisational and professional relationships – that often been neglected as ‘too difficult’.

A continuing programme of work with leading primary organisations was published in 2000 by the Royal Society of Medicine – Relationships in the NHS: bridging the gap. Some of challenges of an institution undergoing rapid and constant policy, organisational and cultural change addressed in the book are as true today as they were then:

  • The NHS: “The contemporary NHS, as it translate itself from a traditional bureaucratic institution into a modern healthcare system commits a great deal of time, energy and attention to the structuring and restructuring of its relationships.”
  • GPs: “Their relationship will remain that of an essential intermediary between the state and the individual, semi-detached from both, and the medium through which the basic dynamic which fuses collaborative and personal responsibilities for health and healthcare finds much of its expression.”
  • New primary care organisations: “This may include a four-fold multiplication of the number of relationships with all their potential for competing demands and loyalties; conflicting models of relationship; and an environment which can put relationships under extreme pressure.”
  • Hospitals: “The hospital, as both a conceptual and capital construct, has oscillated over the past century between a focus on locally geographic areas and a specialist emphasis, reflecting very often the changing balance between popular and professional interest groups. The different components of the NHS do not simply make up a healthcare system; they also contribute significantly to the relational fabric of society itself.”
  • Policy and leadership: “What the new NHS will prove to be is uncertain, not least with regard to its relationships. It will need wise leadership to look to the future and nurture new and fragile relationships through a transitional process which will, at times, be difficult.”

 

Our third major project was in partnership with the Centre for the Advancement of Interprofessional Education.  Our 2005 book The Case for Interprofessional Collaboration in Health and Social Care reviewed the relational lessons from countries modernising their health systems as the relational lessons from major service failures. We found that in both higher and lower income countries modernisation of health systems include five relational themes:

  • local resource management (or decentralisation)
  • governance (with new forms of independent regulation)
  • integration (based on cross boundary partnerships)
  • stewardship for public health (and thence community development)
  • quality (linking evidence based health care to choice and consumerism)

In this context, collaborative professionalism in health and social care is required in six key relationships with:

  • same profession
  • other professions
  • (new) organisational partners
  • policy actors (in many different guises)
  • the public (and their representatives)
  • patients (and their proxies)

Analysis of service failures such as Victoria Climbie or Bristol heart deaths revealed weaknesses in all of these relationships. We analysed these through the lens of our Relational Proximity metrics to identify the factors that had generated such catastrophic relational risks.