The Joint Appointments Guide 2014: An updated guide to setting up, managing and maintaining joint appointments between health organisations and local government in Scotland

Sustaining the Partnership

Critical Success Factors

9. A systematic process for strategic review
10. A process for influencing partner agendas
11. Formative reflection and evaluation

Critical Success Factor 9: A systematic process for strategic review

Joint appointments will work across partner organisations as vehicles to improve delivery of the national outcomes for health and wellbeing.

Joint appointees will also require a strategic management framework including people drawn from partner organisations with responsibility for delivering on objectives and being accountable for these. It is important that the mechanism developed for doing this groundwork and establishing the post is sustained, in order to make sure that the post holder stays on track and the post delivers its strategic aims.

The national outcomes and specific objectives need to be clearly stated in the groundwork stage of setting up a joint appointment. The joint appointee's operational objectives, i.e. what they need to do in order to help strategic aims and objectives of the post to be delivered, will develop from the agreed outcomes.

It may also be helpful for members of the post's strategic management framework to be clear about their role and have some objectives of their own.

For example 'to contribute to bringing into the mainstream within their own organisations the issues arising from the post.'

Strategic management of Health and Social Care Partnerships will be provided by an Integration Joint Board or a Joint Monitoring Committee depending on the delivery model.

The Board or Committee is responsible for ensuring the delivery of the national health and wellbeing outcomes and managing the interface between the partnership's decisions and decisions made by the individual organisations.

National outcomes for health and wellbeing

Joint appointments will help organisations to deliver on national outcomes and associated national performance indicators. This will require the collection of information against these indicators, to be returned to a central source for monitoring purposes.

Health boards will almost certainly have different performance indicators from local government for their contribution to what may well be the same national outcome. The same may be true of other partner agencies.

If the national performance indicators are used directly to performance manage a joint appointment, this will be burdensome for all involved and create tensions and frustrations for both the joint appointee and their strategic managers. Rather than trying to correlate the effect of the joint appointment with the national performance indicator directly, it may be better to use proxies based on evidence-based assumptions. The examples below illustrate how this can be done.

Example 1

Imagine that the strategic aim of a joint appointment is to contribute to an increase in the health and wellbeing of older people. An objective of the appointment may be to increase the number of well older people who engage in physical activity. This objective could have been set on an evidence-based assumption that those people involved in physical activity are less likely to suffer from depression, less likely to have falls, use health services less, and perceive themselves as healthier than those well older people who do not engage in physical activity.

(Remember this is hypothetical.) Therefore, if you get more people using leisure facilities, out walking or engaging in other physical activity, this will improve health and help maintain good health for longer. Say that the performance indicator for one of the health partners is the 'reduction in falls of the elderly resulting in fractured hips from X to Y by 2015.' Given the objectives above it would be unwise to try to performance manage the joint appointee or the joint appointment in the short term on the national performance indicator.

Example 2

Imagine that a partnership has a joint appointment resource to improve the health and quality of life of young people. One of the national performance indicators for health might be reducing teenage pregnancies; one of the national performance indicators for local government may be to increase take up of further or higher education; for the Police it may be reduction in youth crime rates; and for the Criminal Justice Team it may be reduction in re-offending rates of young offenders. A partnership and joint appointment may seek to contribute to all of these but it cannot realistically be performance managed directly on these indicators.

However, this kind of confusion over performance management indicators does happen, as was found out from the OPM research. It is vitally important that this aspect of the work is given proper thought, discussion and consideration by the management framework. Advice and input from those with expertise in this area should be sought if necessary.

Critical Success Factor 10: A process for influencing partner agendas

If there is no sense in which the joint appointment influences or affects the mainstream agenda of the partner organisations, there is a good argument for exploring whether a joint appointment is worthwhile at all.

While some joint appointments have emerged from an opportunistic seizing of resources made available by two or more organisations, it is still important to think about insights or learning that the joint appointment has generated and to explore ways of sharing the learning with all partners.

A key role of the senior manager involved in the strategic management structure will be to ensure that the experience of the joint appointment influences the mainstream agenda of the partners.

Critical Success Factor 11: Formative reflection and evaluation

Formative evaluation, very simplistically, means reviewing and reflecting 'as you go'. There is an enormous amount of benefit to be derived from developing techniques and approaches for ongoing reflection, at the operational level for the joint appointee with the line manager, but also for the strategic management group. It is particularly useful for thinking and reflecting on how well the structures and processes around the joint appointment are working, as opposed to whether the outputs and outcomes are being achieved.

The benefits from this are:

• being able to recognise if there is a need to modify approaches and ways of working;
• keeping a record of the added value of the appointment by identifying positive activity that has happened as a result of the appointment over and above the objectives set;
• identifying and responding to opportunities and difficulties as they arise;
• anticipating challenges and difficulties and preventing conflict; providing a legitimate and recognised way of addressing tensions.

Formative evaluation requires a framework. For example, the framework used by the strategic management group in the formative evaluation of the joint appointment might include consideration, through discussion, of:

• how well the appointee has been supported to deliver his/her objectives;
• how well the strategic management function has performed in terms of providing clear direction and appropriate review and reflection;
• the extent to which the post has been mainstreamed within partner organisations;
• the ability of the post to influence and interface with other strategic activities and policies within partner organisations.

This framework should ideally be agreed at the start of the partnership and used as set points for reflection. The framework can be used by both the strategic management group and the joint appointee with his or her line manager.