Relationship competence for healthcare management: peer to peer
International Journal of Integrated Care, 19 June 2008 - ISSN 1568-4156
Book review
Relationship competence for healthcare management: peer to peer
Jennifer Landau and Elio Borgonovi
Basingstoke: Palgrave Macmillan, 2008, pp 187,
ISBN 978 0 230 51596 3
Helen Dickinson, Lecturer in Healthcare Policy and Management, School of Public Policy, University of Birmingham, Park House, 40 Edgbaston Park Road, Birmingham, UK

What is apparent in the field of integrated care is that there are no magic bullets: there are no recipes which one can follow that will automatically produce high quality and effective integrated care. To paraphrase and adapt a phrase from mental health reformer and academic Peter Beresford [1], “this isn't rocket science. It's much more complex and important than that.” One of the reasons integrated care is so complex is that it often involves incorporating a wide range of stakeholders who are required to form relationships with one another which extend beyond formal structures. These relationships are often the reason why integrated care is so difficult to research and to codify in an abstract sense.

Landay and Borgonovi suggest “Peer relationships tend to be explained by members of the organization as either effective because friendly or ineffective because unfriendly. Peer to peer relationships follow patterns of dysfunction, and are not as arbitrary or as personal as they are often perceived”. The authors argue that disruptions in relationships are often the result of systemic, rather than personal issues and that by identifying patterns and developing effective horizontal competences, relationships may be better managed and produce appropriate and quality care at a sustainable cost. That is, although we tend to think of personal relationships as difficult to control, they are actually often influenced by broader systemic forces some of which fall under the influence of leaders and managers.

The first chapter looks at the nature of ‘roles’ within health care and critically compares this to the way these are normally defined in organizational theory. The chapter suggests that often roles are associated with personal relationships but suggests the framework of ‘blended relationships’ as a more effective analytical tool. The second chapter looks at why relationships are important for quality of care for patients, whilst the third chapter draws on John Nash's theory of the non-cooperative game and of equilibrium to understand why dysfunctional patterns in relationships arise. The fourth chapter reflects on how organizational culture and language can help develop relationships and the importance of trust. Chapter five then goes on to reflect on trust and rational choice in decision making and chapter six the type of relationship skills needed to be an effective manager. The concluding chapter then turns to considering the nature of management and leadership education, before making its final concluding statements.

The book incorporates a range of examples for Italy and the USA throughout, which are very clear and easy to understand. Indeed, a strength of the book is that it is very practical and accessible. However, there is quite a bit of inconsistency in layout; some boxes are labelled, whilst others are not. It would be a big help if all the boxes had been labelled and numbered, and perhaps added into a table of contents so they would be easy to come back to—particularly given that later chapters often refer to examples which came a good way earlier in the book. Although chapters do cross refer to each other, they do have a tendency to appear a little standalone and it is often difficult to discern precisely what the core argument of the book is. This difficulty is further compounded because the concluding chapter introduces new arguments and material around management development, which perhaps would have been better placed in an earlier or preceding chapter.

Despite being persuasively written, the book draws on a limited evidence base (both in numbers of empirical and conceptual pieces and also the depth of knowledge presented) which may be considered problematic to an academic audience. Although it covers a range of different topics there do seem to be a range of seminal pieces which go without a mention (particularly when covering topics such as culture, trust and management development). Although the aim of the book is to be practical, it does also wish to appeal to students of health care management, but in this respect may be limited.

I would recommend this book for practitioners who want some ready examples of a range of different issues concerning peer to peer relationships. I would not necessarily recommend this book for academics; although it is fairly well and convincingly written, the evidence base which the book draws on is limited—both in quantity and in depth of knowledge. The examples could prove helpful for teachers to draw upon when seeking to illuminate particular areas of relationships within and between organisations.

I would give this book two stars out of five.

Beresford P. Recasting the future of social care [quote in press release, issued on 15 November] London: Brunel University; 2007 [accessed 2007 30 Nov]. Available from: