Relationships & culture change – Case StudyA relational take on strategic development in the public sectorBackgroundNew health policies required greater emphasis on public health and the creation of new primary care organisations. GPs have to develop relationships within the new organisations while at the same time developing new partnerships with other agencies.The challengeHealth Authorities and lead GPs with responsibility for bringing the new organisations into being and for promoting public health were not confident that the relationships were in place to develop and implement new strategies. In many locations there was a legacy of difficult personal and organisational relationships. Specific obstacles to progress included:low morale, work pressures and financial constraintsmisunderstanding and poor communicationterritorial interests and tribalism – defending power, status and influencedifferent professional cultures and training.The briefTo provide a baseline assessment of the relationship between lead GPs and Health Authorities in order to find better ways of working together and to develop public health strategies for new primary care organisations.The interventionLead GPs and Health Authority directors completed a Relational Audit questionnaire. These results, together with an analysis of local public health policy development, formed the basis of a half-day workshop to address issues raised by the audit. The combined results from six sites informed two strategy simulations with a wider reference group. This included mapping the new relationships with partner agencies that were required, the creation of a typology of new organisational forms, and assessing the potential of these emerging organisational forms to develop and sustain the required relationships.The outcomeThe project offered three main benefits:building commonality at a personal level helped overcome organisational obstacles to progresscritical obstacles to progress and quick wins to resolve them were identifiedclear highlighting of the gap between the reality of relationships and those presumed and required by strategy created a longer-term development agenda.The workshops and audit results crystallised concerns about organisational relationships which were impeding progress but which participants had not previously been able to articulate and discuss. Examples of issues highlighted includedsuperficially good relationships concealing failure to address difficult strategic issuesthe need for more inclusive leadership, and for leaders to identify and communicate the tangible benefits of new ways of workingconflicting organisational priorities, personal defensiveness and lack of mutual understanding was hindering progressa four-fold increase in the number of key strategic relationships risked implosion of new organisations or let down of new partnerssome new organisational forms which responded effectively to short-term pressures and demands risked becoming an obstacle to medium to longer-term strategic objectives.“Once the weaknesses in the relationship can be shown in a rational way, you can then plan to improve that relationship.” (Participant comment).