What are the barriers to effective involvement in collaborative working?

The main barriers are co-option and incorporation threats, which dilute or mute patient and public voices by bringing them too close to the systems of power they want to influence. Friendly relationships with staff and managers can make people reluctant to challenge the status quo, so boundaries are needed. External pressures such as staffing levels, lack of continuity from agency staff, job insecurity, workload, and workplace environment can also constrain staff time and motivation. Without deliberate design and proper support, involvement can become tokenistic or co-opted.

The source identifies the main barriers to meaningful public involvement as co-option and incorporation threats. These occur when patient and public voices are diluted or muted because they become too close to the systems of power they seek to influence or change. This often happens through the development of friendly relationships with healthcare staff and managers, to the point that it feels uncomfortable to challenge the status quo. The source notes that healthy friendly relationships can also drive the most effective involvement, so careful attention to boundaries is required. Additionally, involvement practices can fail due to external pressures on resources that constrain staff time or motivation, such as staffing levels, lack of continuity from employment of agency staff, job security, workload, and workplace environments. Where organizations have not yet perfected collaborative practices, or have not embedded collaborative values in leadership and human resource policies, involvement may not be adequately valued or supported, resulting in tokenism or co-opted forms.