**7. Final Reflections**

Through reflection we came up with the six practices any interorganizational collaboration would do well to adopt. Taking the plunge and suspending disbelief was fundamental to getting started on collaboration in the context of health and social care integration. Defining a shared purpose and developing accountability to one another for working towards that purpose gave an impetus and a clear direction to the collaboration. Taking the time to build relationships, explore diversity and tackle the difficult dynamics inherent in difference, ultimately facilitated faster and more purposeful action. And finally, modelling courageous and systemic leadership at every level renewed energy and motivation.

What we have learned is that good intentions are not enough. For collaboration to be effective there needs to be a very clear purpose which is foreground and center all of the time. Even with that clear purpose, effective collaboration takes time, effort and commitment, so finding real ways to notice the difference it makes from the outset is crucial. These differences do not have to be large. For practitioners to commit themselves they just needed to see small improvements in the lives of their patients, which ignites their hope that working together could be far more productive than working on their own or in their own silo.

The work of Heifetz, Wilber and Kegan and Lahey has proved useful both to us in developing our thinking and our approach as facilitators and consultants, and to participants in interorganizational collaborations when we have used it directly. We are still discovering which elements of our Stretch approach work best in the interorganizational context. Encouraging curiosity, developing new ways of communicating and providing conditions in which people can be courageous have definitely worked, but undoubtedly there is more that we can learn about this. Senior leadership came to endorse the value of spending time together to work on developing relationships and exploring roles and purpose before plunging into action. It was not without frustration but it did allow us to explore pain and frustration in a meaningful and ultimately productive way.

The last words come from participants in the Beston collaboration who have continued to meet and address their common issues in smaller configurations:

"I feel really energized, the openness has been really encouraging—this work could have such a big impact." (Occupational Therapist)

"I am sensing real enthusiasm from our different roles—this work is really important— and it is about aligning needs with support rather than having an agenda about cutting services." (service manager)

**Author Contributions:** These authors contributed equally to this work.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.
