Networks Readiness Tool
What are Networks?
Localities are increasingly being urged to establish a network approach to a range of problems that cross organisational and professional boundaries, but it is not always clear what this means and what sorts of actions need to be taken. The Networks RT offers a means of assessing readiness to use a network model, as well as a way of measuring progress. It includes preparatory links and sources for localities that need to develop their ideas from scratch.
The Purpose of Networks?
The desirability of working as a network has become increasingly common in health and social care policy. Integrated care pathways and managed clinical networks have been around for some time in healthcare, but now the debate is being extended to other areas.
- The Choosing Health White Paper recommended the development of local managed networks for sexual health;
- The Our health, our care, our say White Paper proposed a range of network developments including end-of-life care networks, multi-disciplinary networks to support people with complex needs, and self-care networks;
- The Every Child Matters Green Paper envisaged the development of networks across universal and specialist professions working in children’s services.
Despite all of this, there is still uncertainty about what is actually meant by a ‘network’, and how this will different from, or be better than, traditional models based upon either hierarchical direction or market solutions. It would be unwise for network development to take place without proper consideration of what is meant by a network and why it might be a useful approach to develop. If this important initial step has not been taken then it is recommended that use be made of the links and references at the end of this tool prior to its use.
Given this initial step, the purpose of the Networks Readiness Tool is to provide a relatively simple and cost-effective way of assessing the readiness of local systems to develop a network approach to service delivery. It enables a rapid appraisal of a system’s readiness and progress in using a network model, and by identifying areas of potential difficulty it also enables a focus upon remedial action commensurate with the significance of the problems.
The tool is sequential, and it may well be that localities just beginning network development will want to concentrate upon the first two principles in the sequence at the outset. As planning turns into action, then it will be appropriate to include the final two principles as part of a comprehensive self-assessment. However, even for localities in the first stages of activity, it will be useful to consider how far local partners anticipate their likely achievements on the other three principles.
The Networks Readiness Tool can do three main things:
- provide material to conduct an assessment on the current readiness of local systems to work as a network;
- prompt a dialogue amongst partners and an examination of the key process required to work together in this way;
- provide a common framework and vocabulary for network partners to develop a jointly owned approach to tackling some of the barriers to effective delivery.
The RT is in four stages, shown below.
The Four Stages of Networks?
Stage 1: Preparation
It is important at the start of the process that partners agree the reasons for using the tool. Is the process to be mainly developmental, more of a routine audit or part of a more extensive remedial programme? Opening up this initial debate is often an important step in individual partners becoming more honest in their views about the readiness of the local system to work as a network.
Stage 2: Gathering Data
At the heart of the Networks RT is the process of gathering data from the network members through answers to a questionnaire. Network members are asked to respond to 30 statements by reflecting on their perspectives and selecting from a range of possible responses.
Stage 3: Analysis and Interpretation of Data
The individual scores of network members are brought together to provide a picture of how the whole system is working, and to compare the responses of the different stakeholders.
Stage 4: Action Planning for Alternative Findings
Finally, an assessment has to be made about what the scores mean about the local systems readiness, and what action to take in the light of this exercise. This will involve determination of priorities and drawing up action plans to ensure change happens.
Stage 1: Preparation
For the tool to work properly there needs to be clear agreement about the reasons for using it. There are several possibilities:
- a prospective exercise undertaken by partners just embarking on network development with a view to identification of ‘success’ factors
- to undertake a series of regular 'health checks' as part of a wider programme of monitoring and review
- to explore and expose problems or to confirm apparent success
- a retrospective exercise by partners renewing or revising their arrangements.
In the early stages it is likely that the use of the Networks RT will be prospective, focusing upon robust preparatory work and anticipated achievements. Whatever the purpose, it is important that everyone affected has the chance to discuss the reasons for using the tool and what is expected to be achieved. Facilitation of the process is important at two stages in particular:
- in introducing partners to the wider national and local policy context, and in helping them become familiar with the tool;
- in analysis of findings across the partners, examination of issues arising and action planning.
Often someone from one of the key agencies will conduct this facilitation internally. Where this is the case, then it should be made clear to participants that this activity has the strong support of all key stakeholders from all involved agencies at executive level. Sometimes, and especially where it is expected to be difficult or sensitive, it may be better facilitated externally by agencies or individuals with experience in this area. Another important preliminary step is to be clear about - and to communicate - what will conclude the process in terms of feedback and action planning. Those participating need to be assured not only that taking the trouble to undertake the assessment is worthwhile but that they can be, and should be, frank and honest in their responses.
Stage 2: Collecting Data
This is the main part of the exercise. In this section you will find 30 statements about the steps and systems required to develop and deliver a network approach grouped around five principles. In relation to each statement you are being asked to do three things:
- answer the question realistically: make a judgement about how well prepared you think the system actually is, not how you would like it to be;
- give your opinion as an individual: this is about what you think, rather than trying to reflect what your organisation thinks;
- make your comments: there is room for comment in an expanding box, and the more you use this box the better it will be an accurate tool
In each section you are asked to respond to a number of statements about networks and network development. All you have to do is decide your opinion on these statements by choosing one of four options, each of which carries a score which we would like you to insert in the appropriate box:
- Strongly Agree [SA] – Score 4
- Agree [A] – Score 3
- Disagree [D] – Score 2
- Strongly Disagree [SD] – Score 1
Principle 1 - Support and Clarity of Understanding
Score 4 |
Score 3 |
Score 2 |
Score 1 |
There is a clear understanding of what is meant by a ‘network’ and how it differs from other forms of joint working |
|
|
|
|
A network approach is being developed because it has clear advantages over other types of arrangement |
|
|
|
|
There is full ownership of the concept of networking across all of the necessary stakeholders |
|
|
|
|
The type of network being developed is the right one for the problem it has been set up to address |
|
|
|
|
The network is developing a robust intelligence base in order to understand the issues it has to address |
|
|
|
|
It is recognised that it takes time to build robust networks, and this is reflected in the timescales for development |
|
|
|
|
Please briefly suggest ways in which you think performance on this principle could be improved:
|
Total Score
|
|
Principle 2 - Clarity of Purpose
Score 4 |
Score 3 |
Score 2 |
Score 1 |
Everyone understands why the network is being developed |
|
|
|
|
The population and the problem that the network has been set up to address are clearly defined |
|
|
|
|
Clear and realistic aims and objectives have been established for the network |
|
|
|
|
There are adequate time scales in place for achieving the network’s purpose |
|
|
|
|
The network has identified initial outcomes that would constitute an ‘early win’ |
|
|
|
|
The network has identified longer term outcomes that need to be met through network achievements |
|
|
|
|
Please briefly suggest ways in which you think performance on this principle could be improved:
|
Total Score
|
|
Principle 3 - Effective Network Management
Score 4 |
Score 3 |
Score 2 |
Score 1 |
There is recognition that the network needs some infrastructure and support in order to develop |
|
|
|
|
The network has the right balance between top-down steering and the freedom to be innovative and take risks |
|
|
|
|
There is a clear commitment to the network from the most senior levels of the contributing agencies |
|
|
|
|
Management style is facilitative rather than hierarchical |
|
|
|
|
There is a ‘network office’ that acts as a point of contact and support for network members |
|
|
|
|
The network is able to draw upon individuals with skills in building coalitions and developing alliances |
|
|
|
|
Please briefly suggest ways in which you think performance on this principle could be improved:
|
Total Score
|
|
Principle 4 - Robust Network Governance
Score 4 |
Score 3 |
Score 2 |
Score 1 |
It is accepted that the network requires some form of governance |
|
|
|
|
Membership of the network is commensurate with the problems it has been set up to address |
|
|
|
|
Network members believe that the calls upon their time and resources by the network are legitimate |
|
|
|
|
The way in which the business of the network is conducted is open and fair |
|
|
|
|
An appropriate balance has been struck between giving the network freedom to operate and ensuring accountability for its actions |
|
|
|
|
There is a clear relationship between the network and other sources of decision-making and governance |
|
|
|
|
Please briefly suggest ways in which you think performance on this principle could be improved:
|
Total Score
|
|
Principle 5 - Monitor, Measure and Learn
Score 4 |
Score 3 |
Score 2 |
Score 1 |
There are robust procedures in place for monitoring the progress of the network |
|
|
|
|
Clear criteria exist to judge the extent to which the goals of the network have been achieved |
|
|
|
|
Network achievements are well communicated amongst network members and beyond |
|
|
|
|
The network has demonstrated evidence of learning and changing in the light of experience |
|
|
|
|
The network has clear ideas on how it can further improve its performance |
|
|
|
|
The network has made good progress against its aims and objectives and is valued in the locality |
|
|
|
|
Please briefly suggest ways in which you think performance on this principle could be improved:
|
Total Score
|
|
Stage 3: Analysis & Interpretation of Data
Having filled in the scores for each section of Networks Readiness Tool, you now need to interpret the meaning of the scores for each section, as well as the aggregate score. This is detailed in the boxes below.
Principle 1: Support and Clarity of Understanding
A: 21-24 |
There is a clear understanding of what is meant by a ‘network’ and how it differs from other forms of joint working |
B: 16-20 |
A network approach is being developed because it has clear advantages over other types of arrangement |
C: 11-15 |
There is full ownership of the concept of networking across all of the necessary stakeholders |
D: 10 or less |
The type of network being developed is the right one for the problem it has been set up to address |
Principle 2: Clarity of Purpose
SCORE |
INTERPRETATION |
A: 21-24 |
Everyone understands why the network is being developed |
B: 16-20 |
The population and the problem that the network has been set up to address are clearly defined |
C: 11-15 |
Clear and realistic aims and objectives have been established for the network |
D: 10 or less |
There are adequate time scales in place for achieving the network’s purpose |
Principle 3: Effective Network Management
SCORE |
INTERPRETATION |
A: 21-24 |
There is recognition that the network needs some infrastructure and support in order to develop |
B: 16-20 |
The network has the right balance between top-down steering and the freedom to be innovative and take risks |
C: 11-15 |
There is a clear commitment to the network from the most senior levels of the contributing agencies |
D: 10 or less |
Management style is facilitative rather than hierarchical |
Principle 4: Robust Network Governance
SCORE |
INTERPRETATION |
A: 21-24 |
It is accepted that the network requires some form of governance |
B: 16-20 |
Membership of the network is commensurate with the problems it has been set up to address |
C: 11-15 |
Network members believe that the calls upon their time and resources by the network are legitimate |
D: 10 or less |
The way in which the business of the network is conducted is open and fair |
Principle 5: Monitor, Measure and Learn
SCORE |
INTERPRETATION |
A: 21-24 |
There are robust procedures in place for monitoring the progress of the network |
B: 16-20 |
Clear criteria exist to judge the extent to which the goals of the network have been achieved |
C: 11-15 |
Network achievements are well communicated amongst network members and beyond |
D: 10 or less |
The network has demonstrated evidence of learning and changing in the light of experience |
Aggregation of Data
A final step in data interpretation is to form an overall view on the significance of the aggregate Networks scores in order to decide what further steps – if any – to take. The first step here is to complete the aggregate scoring box below, and compare these with the following table on how these scores should be interpreted.
Networks PRINCIPLE |
MAXIMUM SCORE |
ACTUAL SCORE |
Principle 1: Support and Clarity of Understanding |
24 |
|
Principle 2: Clarity of Purpose |
24 |
|
Principle 3: Effective Network Management |
24 |
|
Principle 4: Robust Network Governance |
24 |
|
Principle 5: Monitor, Measure and Learn |
24 |
|
TOTAL SCORE |
Maximum = 120 |
Actual = |
Interpretation of Aggregate Networks Score
SCORE |
INTERPRETATION |
105 + |
A highly prepared local system which has in place all of the ingredients to develop an effective network. |
80-104 |
A local system that has in place many of the ingredients to develop an effective network, but remains in need of some further development. |
55-79 |
A local system that has in place some of the ingredients that could result in an effective network, but is in need of significant improvement in several important respects. |
54 or less |
The local system is not well placed to develop a network approach and needs urgent remedial work to improve its position. |
The Dartboard Presentation
The final scores and their interpretation can be accessed pictorially on an integration dartboard, along with a summary analysis of team functioning.
Put the total score for each principle in the appropriate segment below and shade that segment
The profile shows overall performance across all five principles. The nearer the shading is to the centre of the diagram then the healthier is the assessment of team performance. It is possible for a team to be doing relatively well on some aspects and less well on others.
Stage 4: Action Planing for Alternative Findings
The Networks-RT cannot, on its own, offer detailed prescriptions for addressing any problems identified as a result of the exercise. How system weaknesses or barriers are tackled must depend upon local circumstances and is likely to require specialist organisational development expertise. What is clear generally, however, is that whatever the findings, the assessment process must be seen to conclude with a plan for action. Three broad alternative scenarios are outlined below.
ACTION PLANNING FOR ALTERNATIVE FINDINGS
4a | 4b | 4c |
Assessment suggests the network is in a good position to deliver the outcomes required; agencies only need to consider how often to build in a regular review. | Assessment suggests that many of the key ingredients for success are in place, but there are concerns about others. Agencies need to decide how to jointly address these areas of concern. | Assessment highlights significant areas of concern that require urgent attention and a detailed plan of action. |
Taking the first case (4a) if the findings show a broad consensus about the system being in a good position, the action planning may need to consist of little more than agreeing how and when to undertake the next assessment. This could be a repeat exercise with the same individuals, or it could also entail assessments at different levels in the partner organisations. There might also be an agreement that no further formal assessment takes place unless there are important changes within the system or the context within which it operates. Whatever the apparent success of the current arrangements, it will be worthwhile acknowledging that even the healthiest system should have regular health checks.
In the case of the second broad scenario (4b) where some problems or weaknesses are identified, the action planning will focus on these areas. Where there is little sensitivity about the issues raised – whether individual or organisational – more detailed analysis of what underlies the assessment findings may well be conducted internally and informally. Where there is greater sensitivity, external facilitation may be preferable. Such exercises should help to provide:
- structured information about people's perceptions throughout the key stakeholders and the contributing partners;
- opportunities to compare and contrast the views of different stakeholders, thereby providing an opportunity to plan remedial action;
- a process which in itself opens up a debate that introduces more openness and transparency about partners' views on fitness to deliver. .
In the case of the third scenario (4c) action planning will need to embrace extensive and possibly urgent remedial action. This may involve a thorough re–examination of the system. Indeed, if the problems are serious enough it may require that the system be radically reformed. Whatever the outcome, it is strongly recommended that skilled and trusted external facilitators are used for scenarios 4b and 4c.
Getting Further Help
In those cases where further help is needed, it will usually be best to bring in external support and facilitation. It is not appropriate in this tool to recommend any specific consultancies, though the Readiness Tool framework has been devised by Professor Bob Hudson (bob@bobhudsonconsulting.com.) and built upon by Simon Ricketts, (simon@warwick-insight.co.uk) and Janet Crampton (janet.crampton@dh.gsi.gov.uk) General sources of support and information are:
The design task for Networks-RT has been undertaken by Densen Digital Experiences: www.densen.co.uk.
Understanding Networks
For localities setting out on network development it is vital that time is taken to consider the different types of networks and to ensure the right approach is taken for the right problem. The following references are suggested:
- Department of Health (2005), A Guide to Promote a Shared Understanding of the Benefits of Managed Local Networks. London.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114364 - Agranoff, R.(2006), Inside Collaborative Networks: Ten Lessons for Public Managers, Public Administration Review, December p 56-65.
- 6 P, Goodwin, N., Peck, E., Freeman, T. and Posaner, R. (2004), Managing Across Diverse Networks of Care: lessons from other sectors. Final Report to the NHS SDO R&D Programme. Health Services Management Centre, University of Birmingham.
http://www.sdo.lshtm.ac.uk/files/adhoc/39-policy-report.pdf - Hudson, B.(2006), A Managed Care Network for Older People in Lanarkshire: A Scoping Report. http://www.jitscotland.org.uk/action-areas/themes/lanarkshire-programme.html
- Hudson, B. [2007], Partnering Through Networks: Can Scotland Crack It? Journal of Integrated Care 15[1]