Paper
Actualizing synergy in a community mental health system of care through assessing leadership collaboration
- issue: Issue 3 / 2008
- authors: Anita Lightburn
- keywords: Usa, system of care, synergy
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- downloaded: 0
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abstract
Background. The agency in this study, the Guidance Center Inc., (GCI), in Cambridge, Massachusetts, is a recognized as a leader in the transformation of mental health services to children and families. GCI's service model for children with severe emotional and behavioral disturbance is in the tradition established by the System of Care model in the United States. Major changes in the way mental health services are provided, represented by the system of care approach, has progressively transformed fragmented, inaccessible, and unresponsive services (Ayers & Lyman, 2006). The transformation of a mental health agency, such as GCI, depends on effective collaboration to reach their goal to reduce dependence on residential care through providing the needed mental health care for children with serious emotional and behavioral disturbances in their community. For effective service delivery with desired consumer/client outcomes, a community-based, family focused mental health agency depends on the quality of synergy in all of their multi-disciplinary collaborations.
Purpose. This study reports on an exploratory study utilizing a measure of partnership synergy to assess leadership team collaboration. Ongoing system of care research continues to focus on evaluating the effectiveness of collaboration and partnerships, critical to service integration and client outcomes. A recent national study of collaboration in community-based health care system partnerships identified synergy as an important system integrator that was described as "the collaborative advantage" (Lasker, Weiss & Miller, 2001). Studies in community-based family support programs describe synergy as an important mediator of service outcomes. Synergy is a common descriptor of a productive, creative process between people. Used in exclamation, "there was great synergy between us!", a team describes an energetic coming together that has lead to a satisfying result. Successful organizations, programs and collaborations want to have good synergy. Synergy is a non linear additive, dynamic process, frequently characterized by the statement, "synergy is more than the sum of the parts". Synergy results in creative problem solving, transformations, and the maximizing of shared resources (Lasker et. Al., 2001). Even though synergy has been identified as a dynamic in collaboration, it has not been measured or studied in mental health services, or systems of care concerned with integrated mental health care for the most emotionally challenged children and adolescents.
This study sought to examine the applicability of the assessment of synergy using the Partnership Self Assessment Tool (Psat), that was developed for assessing community health care partnerships. The GCI leadership team believed that synergy is important to their collaboration in their multi-service, comprehensive mental health agency. The leadership team wanted to increase synergy in their work in transforming GCI's siloed services into a more integrative continuum of care for children and families. Therefore, the leadership team collaborated with the researcher in exploring the usefulness of the Psat for a mental health agency concerned with providing effective, integrated mental health care through understanding and potentially increasing their team's synergy. The purpose of this study was to evaluate the usefulness of the Psat for this mental health agency, and to understand how the experiences and processes that are described by the Psat contribute to collaborative synergy.
Methods. Quantitative method included a pre-test, post-test of a well developed and nationally tested partnership assessment measure (Psat) (Weiss, Anderson & Lasker, 2002) In the first year, 2006, there was an introduction to the study, definition of terms used in the Psat measure, then completion of the Psat measure (completed by all six members of the leadership team members via a computerized test, available through the New York Academy of Medicine's Center for the Advancement of Collaborative Strategies in Health). The report of findings consisted of a detailed review of Team Synergy, including the domains of Leadership Effectiveness; Effectiveness of Management & Administration; Efficiency; Non-financial Resources; Financial Resources & Capital Resources; and a report on the Decision Making Process and Team participation. Based on the initial assessment, a report for the team was collaboratively developed that detailed possible areas for organizational development for the following year. Priorities included team decision making and collaborative process. The outcome of the leadership team's work was evaluated again using the Psat in 2007.
Qualitative methods were used to described GCI leadership's assessment of the Psat - did the description of synergy relate to their experience? Were the major factors from the Psat contributors to the synergy they experienced in their work together? Examples of synergy were solicited individually and from the team. A focus group with the leadership team reviewed their goals and expectations and how this related to agency functioning. Methods included: structured interviews, focus groups, and use of narrative that described collaborative events, as well as observations of team functioning to produce text for analysis. Analysis included identification of themes regarding the usefulness of the PSAT's assessment of synergy; and qualification of the meanings and value of the PSAT; with implications for further use. Extensive interviews and focus groups were conducted at the beginning of the study, with more focused structured interviews and focus groups held at the conclusion of the study.
Findings. This exploratory study found that the Psat's assessment of synergy for the GCI leadership team was both accurate in representing an assessment of their complex organizational experience, and useful as an indicator of team functioning. Synergy was recognized as a complex factor that contributed to the quality of collaboration and the leadership team's work toward their system of care goals. Pre-test, post-test results indicated that the areas that were targeted for development provided a focus for work, and that this work was reflected in improved scores one year later, improvement in team synergy (+.8), leadership effectiveness (+.6) and efficiency (.7), and effectiveness of management/administration (.5) (on a 5 point scale). Two factors, areas of considerable challenge, financial and capital resources (.0) and non financial resources (+.3) saw no or limited change, which corresponded to the realities of the agency's resources. While a number of factors are possible contributors to improved synergy, the GCI team's improvement in targeted areas was seen by the team as an indication of the accuracy and usefulness of the measure. The degree of change was recognized by descriptions of improved changes in the team's collaborative process and decision making.
The Psat is a measure that would be useful as tool for quality improvement in complex mental health agencies where organizational development and transformation are important in supporting services for children and adolescent with serious emotional and behavioral problems that require shared values regarding family centered, community-based care, with the use of evidence-based practice, that includes effective decision making, and collaborative process that promotes service integration. The Psat also has potential as a measure of synergy and partnership collaboration for outcome studies of systems of care, as the factors included in this measure represent the complexities in these systems that have been challenging to measure. The Psat also provides a foundation for the study of synergy - as the integrative phenomena that is essential to quality collaboration, and should be a mediating factor that would contribute to explanations of outcomes of service provision.
Key references
Ayers, S. & Lyman, R., (2006). The development of a community-based system of care. In A. Lightburn & P. Sessions (Eds.), The handbook of community-based clinical practice (pp. 221-243). New York: Oxford University Press.
Lasker, R., Weiss, E., & Miller, R., (2001). Partnership synergy: A Practical framework for studying and strengthening the collaborative advantage. Millbank Quarterly, 79(2), 179-205.
Weiss, E., Anderson, R., & Lasker, R. (2002). Making the most of collaboration: exploring the relationships between partnership synergy and partnership functioning. Health Education Behavior, 29, 683-698.
Contact: Anita Lightburn, Professor, Fordham University, Graduate School of Social Service, Gerard Hall, Fordham at Marymount, Tarrytown, New York 10591, USA, E-mail: lightburn@fordham.edu