Improving together: collaboration needs to start with regulators

Abstract

Nicola Burgess and colleagues argue for a move away from top-down regulation to a new approach that facilitates rather than hinders learning across organisations The regulatory landscape in the UK is changing again. From 1 April 2019 NHS England and NHS Improvement became what is effectively a single organisation with far reaching responsibility for the oversight of the system. The structural features of this change, which will eventually require legislative reform, have been widely debated, not least by those affected by plans for a collaborative approach to improvement in the NHS.12 But there has been less discussion about the style and approach to regulation that might be best suited to drive improvement in the NHS as set out in the long term plan.3 We contend that a major change is required in the way the system interacts with service providers if we are to be successful in developing a new service model for the 21st century. Currently the NHS relies on positional authority—a hierarchical system in which regulators use their power and leverage to drive change. Drawing on organisational theory we contend that structural change in the regulatory landscape is insufficient to drive interorganisational learning for improvement. Specifically, we argue that regulation needs to shift towards a more relational form of governance in which informal social systems foster learning across organisations. This relational authority emerges through interpersonal relationships characterised by trust and mutual respect and has to be earnt over time.4 To support our argument we draw on our experience analysing a major experiment in delivering service transformation in five NHS hospital trusts in partnership with NHS Improvement and the Virginia Mason Institute in the US (box 1).3 Box 1 ### NHS-Virginia Mason Institute partnership In 2015 a five year partnership was established between the NHS and US based Virginia Mason … RETURN TO TEXT