Partnership synergy: a practical framework for studying and strengthening the collaborative advantage

Multisector partnerships in population health improvement

Many new initiatives for population health improvement feature partnerships of leaders and organizations across multiple sectors of society. The purpose of this article is to review 1) the rationale for such partnerships as an important, if not essential, tool for population health improvement; 2) key organizational and contextual factors that appear to be associated with effective multisector partnerships; and 3) the limited evidence regarding the effect of such partnerships on population health outcomes. We conclude that systems thinking - accounting for the collective effect of many actors and actions - is essential to organizing and sustaining efforts to improve population health, and to evaluating them. More research is needed to understand how and why multisector partnerships are formed and sustained and the conditions under which multisector partnerships are necessary or more effective than other strategies for population health improvement. Research on and evaluation of multisector partnerships also need to incorporate more standard measures of partnership contexts, characteristics, and strategies and adopt longitudinal and prospective designs to accelerate social learning in this area. Finally, studies of multisector partnerships must be alert to the value of such initiatives to individuals and communities apart from any direct and measurable impact on population health.

Pofessional Practice and Innovation: Geographical Information Systems: An Effective Planning and Decision-Making Platform for Community Health Coalitions in Australia

The development of locally-based healthcare initiatives, such as community health coalitions that focus on capacity building programs and multi-faceted responses to long-term health problems, have become an increasingly important part of the public health landscape. As a result of their complexity and the level of investment, it has become necessary to develop innovative ways to help manage these new healthcare approaches. Geographical Information Systems (GIS) have been suggested as one of the innovative approaches that will allow community health coalitions to better manage and plan their activities. The focus of this paper is to provide a commentary on the use of GIS as a tool for community coalitions and discuss some of the potential benefits and issues surrounding the development of these tools.

Parental perceptions of the Children In Need Of Treatment dental program

This paper discusses the collaborative partnership involving the Middlesex-London Public Health Research, Education and Development site, the Ontario Ministry of Health Promotion and Sport, then Chronic Disease Prevention and Health Promotion Branch, and an academic institution in the first-ever research of parental perceptions of the Children In Need Of Treatment. This paper provides an overview of the Children In Need Of Treatment program, reviews the results of the research (a mailed, self-administered survey with a systematic random sample of parents from three health units whose children received dental treatment that was paid by Children In Need Of Treatment in 2006), and its subsequent recommendations. How these recommendations affected program planning and policy are examined. In conclusion, parents were very satisfied with the treating dentist and the Children In Need Of Treatment program, and found Children In Need Of Treatment to be vital in addressing the health of their children by attending to their urgent dental needs.

University-community mental health center collaboration: encouraging the dissemination of empirically-based treatment and practice

Community Mental Health Centers (CMHC) are valuable resources for urban youth and families across the nation. Community demands for high volumes of clinical service, however, often render these agencies without ability to fully evaluate provided services or conduct rigorous research with their target populations. This report asserts the importance of establishing effective collaborations between research-oriented universities and CMHCs in an effort to bridge the gap between empirically-based treatments and "real world" clinical practice. Furthermore, this report explains the establishment of a mutually informative and beneficial university-CMHC collaboration between the Disruptive Behavior Clinic at the University of Illinois-Chicago and the Community Mental Health Council (CMHC) on an evidence-based outpatient family therapy protocol for urban youth with behavior problems. Values and guidelines to facilitate evidence-based practice for fellow academic institutions are asserted. University-CMHC collaboration is an effective way to bring empirically-based practice to the "real world," front-line practice settings of community-based agencies that serve urban youth. Further research with regard to the maintenance and sustainability of these collaborations is suggested.

A model for successful nursing home-hospice partnerships

BACKGROUND

While benefits of hospice care in nursing homes have been documented, interorganizational challenges such as staff conflicts regarding planned care or their respective roles have also been documented. Through case studies, this research aimed to characterize the partnerships of successful nursing home-hospice collaborators.

METHODS

Six nursing homes and hospices with self-identified successful collaborations were studied. Interviews of care providers and chief executive and financial officers collected information on practices relating to seven domains identified as critical to the collaboration. The organizational factors and activities relating to infrastructure development and care collaboration and provision most common across sites were identified.

RESULTS

Nursing home-hospice collaborators were philosophically and otherwise aligned; they had similar missions, understood their differing approaches to care, and administrators demonstrated an openness and support for the collaboration. Hospices developed infrastructures to correspond to the uniqueness and complexity of the nursing home environment. For example, they hired nurses with nursing home backgrounds, created teams dedicated to nursing home care, and trained hospice staff in problem solving and conflict resolution. Care collaboration processes focused on the importance of two-way communication by actively soliciting and sharing information with nursing home staff and responding to nursing home staff and administrators' concerns.

CONCLUSION

While successful collaborators were organizational aligned, hospice leaders' acknowledgement that palliative care provision in nursing homes is complex and unique was important to success. Accordingly, the prevalent partnership model was a product of strategic efforts by leaders aimed at matching their staffing to the nursing home environment and promoting good communication and skills needed for problem solving.

Challenges of Capacity Building in Multisector Community Health Alliances

Capacity building is often described as fundamental to the success of health alliances, yet there are few evaluations that provide alliances with clear guidance on the challenges related to capacity building. This article attempts to identify potential challenges of capacity building in multistakeholder health alliances. The study uses a multiple case study design to identify potential challenges and trade-offs associated with capacity building in four community health alliances in the United States. Multiple challenges were found to be common across the four alliances, including specifying appropriate governance structures and decision-making frameworks, aligning stakeholder interests with the vision of the alliance, balancing short-term objectives with long-term goals, and securing resources to sustain the effort without compromising it. These challenges often involved trade-offs and choices that alliances need to prepare for if they are to approach capacity building in a planful rather than a reactive manner.

Challenges in Developing Community and Clinician Partnerships for Prevention

Developing links between primary care practices and community organizations to help manage patients with unhealthy behaviors has been proposed as a strategy to improve health care delivery. The objective of this study was to evaluate easily reproducible interventions to improve referral rates between primary care practices and community organizations to help manage tobacco use, poor diet, and physical inactivity. A 6-month, 3-group clinical trial involving 9 adult primary care practices was conducted beginning in February 2008. The 3 groups included usual care, a passive intervention in which practices received referral material, and an active intervention group in which practices also nominated a “champion” to support the project and had access to a Web site to assist in the development of links with community organizations. Charts were abstracted at baseline, at the midpoint of the project (3 months), and at the completion of the project (6 months). Field notes were collected from the project members during the intervention period. Over the course of the project, regardless of group, the rate of detection of the 3 unhealthy behaviors was lower than expected. Few of those identified with an unhealthy behavior were referred to a community organization. Barriers included concerns among the health care providers about costs to their patients, lack of time to facilitate referral, and staff turnover at the community organizations that precluded the development of partnerships. Thus, the interventions evaluated to develop links between primary care practices and community organizations were not successful.

USING SOCIAL NETWORK ANALYSIS TO EVALUATE COMMUNITY CAPACITY BUILDING OF A REGIONAL COMMUNITY CANCER NETWORK

The Tampa Bay Community Cancer Network (TBCCN) is one of 25 Community Network Programs funded by the National Cancer Institute's (NCI's) Center to Reduce Cancer Health Disparities with the objectives to create a collaborative infrastructure of academic and community based organizations and to develop effective and sustainable interventions to reduce cancer health disparities. In order to describe the network characteristics of the TBCCN as part of our ongoing evaluation efforts, we conducted social network analysis surveys with our community partners in 2007 and 2008. One key finding showed that the mean trust value for the 20 community partners in the study increased from 1.8 to 2.1 (p<0.01), suggesting a trend toward increased trust in the network. These preliminary results suggest that TBCCN has led to greater collaboration among the community partners that were formed through its capacity-building and evidence-based dissemination activities for impacting cancer health disparities at the community level.

CAN DO Houston: a community-based approach to preventing childhood obesity

BACKGROUND

Comprehensive, community-based efforts may reduce rates of childhood obesity.

COMMUNITY CONTEXT

Almost half of the children in Houston are overweight or obese, even though Houston has many available resources that support good nutrition, physical activity, and prevention of weight gain among children.

METHODS

We used existing resources to implement a community-based, childhood obesity prevention initiative in 2 low-income neighborhoods in Houston. On the basis of input from community members, we coordinated various activities to promote healthy living, including after-school programs, grocery store tours, wellness seminars, cooking classes, and staff wellness clubs.

OUTCOME

Preliminary findings indicated that residents in the communities are using additional opportunities to participate in physical activity and nutrition education.

INTERPRETATION

Implementing a successful childhood obesity prevention initiative in an urban setting is feasible with minimal funding through the use of existing resources.

Description of an integrated framework for building linkages among primary care clinics and community organizations for the prevention of type 2 diabetes: emerging themes from the CC-Link study

Strong clinic-community linkages are pivotal for the success of preventive services that combine clinical and community resources. Unfortunately, there has been limited guidance for how clinical and community groups can partner to improve self-care and prevention for chronic conditions. This manuscript describes the development and implementation of an integrated framework to guide clinic-community linkages for the prevention of type 2 diabetes in an ongoing randomized effectiveness trial known as Clinical-Community Linkages to Prevent Diabetes (CC-Link) study. This study involves 10 primary care practices in a metropolitan area of the Midwest US. The study provided each practice location with technical assistance to select, implement, evaluate and refine different strategies to identify and address pre-diabetes using a clinic-community linkage. Sites were also randomized to receive either direct or indirect involvement by a community liaison/expert from the YMCA of Greater Indianapolis. Early implementation of the CC-Link Framework has underscored the importance of strong leadership and partnership synergy, and it uncovered several examples of how linkages can be designed to make the most of partner strengths. This success is promising, and an evaluation of the effectiveness of these efforts to improve lifestyle behaviours of adults with prediabetes is now underway.

Using network analysis to assess the evolution of organizational collaboration in response to a major environmental health threat

Effective inter-organizational collaboration is essential to a community's ability to leverage social and material resources for community problem solving, particularly in the face of complex public health problems. This study used network analysis to document the evolution of collaboration among 21 organizations in the Tar Creek Superfund site in northeastern Oklahoma from 1997 to 2005. The Tar Creek Superfund site was part of a major lead and zinc mining operation and suffers from widespread heavy metal contamination. An organizational network of 21 organizations and a subset of eight tribes were assessed through interviews at three points in time for density and centrality. In addition to collaboration on any topic, we examined information exchange and joint planning related to lead. Density scores were consistently higher in 2005 than in 1997 for both the full and tribal networks. Centralization indices for information exchange showed a marked reduction in the hierarchical structure of information exchange over time. Of particular note is that tribal linkages with local, state and federal agencies increased over time, as did inter-tribal linkages to address the lead issue.

A proposed systems approach to the evaluation of integrated palliative care

BACKGROUND

There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care.

METHODS

In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors.

RESULTS

The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network.

CONCLUSIONS

Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations.

Public-academic partnerships: improving depression care for disadvantaged adults by partnering with non-mental health agencies

Reaching disadvantaged adults who need mental health care is challenging, partly because of mistrust of institutions, cultural insensitivity, and stigma. Researchers from Western Psychiatric Institute and Clinic and leaders of 11 non-mental health community organizations formed a partnership to improve depression care, especially for elders and individuals from difficult-to-reach racial and ethnic minority groups. The overarching goal is to reduce disparities by providing and improving care. This column describes challenges overcome in working with a heterogeneous group of agencies to address issues of mental illness, stigma, inadequate staff training, and privacy--challenges that influenced the direction of research and ensuing projects.

How does community context influence coalitions in the formation stage? A multiple case study based on the Community Coalition Action Theory

BACKGROUND

Community coalitions are rooted in complex and dynamic community systems. Despite recognition that environmental factors affect coalition behavior, few studies have examined how community context impacts coalition formation. Using the Community Coalition Action theory as an organizing framework, the current study employs multiple case study methodology to examine how five domains of community context affect coalitions in the formation stage of coalition development. Domains are history of collaboration, geography, community demographics and economic conditions, community politics and history, and community norms and values.

METHODS

Data were from 8 sites that participated in an evaluation of a healthy cities and communities initiative in California. Twenty-three focus groups were conducted with coalition members, and 76 semi-structured interviews were conducted with local coordinators and coalition leaders. Cross-site analyses were conducted to identify the ways contextual domains influenced selection of the lead agency, coalition membership, staffing and leadership, and coalition processes and structures.

RESULTS

History of collaboration influenced all four coalition factors examined, from lead agency selection to coalition structure. Geography influenced coalition formation largely through membership and staffing, whereas the demographic and economic makeup of the community had an impact on coalition membership, staffing, and infrastructure for coalition processes. The influence of community politics, history, norms and values was most noticeable on coalition membership.

CONCLUSIONS

Findings contribute to an ecologic and theory-based understanding of the range of ways community context influences coalitions in their formative stage.

Public-academic partnerships: improving depression care for disadvantaged adults by partnering with non-mental health agencies

Reaching disadvantaged adults who need mental health care is challenging, partly because of mistrust of institutions, cultural insensitivity, and stigma. Researchers from Western Psychiatric Institute and Clinic and leaders of 11 non-mental health community organizations formed a partnership to improve depression care, especially for elders and individuals from difficult-to-reach racial and ethnic minority groups. The overarching goal is to reduce disparities by providing and improving care. This column describes challenges overcome in working with a heterogeneous group of agencies to address issues of mental illness, stigma, inadequate staff training, and privacy--challenges that influenced the direction of research and ensuing projects.

An analysis of ophthalmology services in Finland - has the time come for a Public-Private Partnership?

BACKGROUND

We studied the prerequisites for Public-Private Partnership (PPP) in the context of the Finnish health care system and more specifically in the field of ophthalmology. PPP can be defined as a more or less permanent cooperation between public and private actors, through which the joint products or services are developed and in which the risks, costs and profits are shared.The Finnish eye care services system is heterogeneous with several different providers and can be regarded as sub-optimal in terms of overall resource use. What is more, the public sector is suffering from a shortage of ophthalmologists, which further decreases its possibilities to meet the present needs. As ophthalmology has traditionally been a medical specialty with a substantial private sector involvement in service provision, PPP could be a feasible policy to be used in the field. We thus ask the following research question: Is there, and to what extent, an open window of opportunity for PPP?

METHODS

In addition to the previously published literature, the research data consisted of 17 thematic interviews with public and private experts in the field of ophthalmology. The analysis was conducted in two stages. First, a literature-based content analysis was used to explore the prerequisites for PPP. Second, Kingdon's (1995) multiple streams theory was used to study the opening of the window of opportunity for PPP.

RESULTS

Public and private parties reported similar problems in the current situation but defined them differently. Also, there is no consensus on policy alternatives. Public opinion seems to be somewhat uncertain as to the attitudes towards private service providers. The analysis thus showed that although there are prerequisites for PPP, the time has not yet come for a Public-Private Partnership.

CONCLUSION

Should the window open fully, the emergence of policy entrepreneurs and an opportunity for a win-win situation between public and private organizations are required.

Evaluation findings on community participation in the California Healthy Cities and Communities program

As part of an evaluation of the California Healthy Cities and Communities (CHCC) program, we evaluated resident involvement, broad representation and civic engagement beyond the local CHCC initiative. The evaluation design was a case study of 20 participating communities with cross-case analysis. Data collection methods included: coalition member surveys at two points in time, semi-structured interviews with key informants, focus groups with coalition members and document review. Participating communities were diverse in terms of population density, geography and socio-demographic characteristics. Over a 3-year period, grantees developed a broad-based coalition of residents and community sectors, produced a shared vision, conducted an asset-based community assessment, identified a priority community improvement focus, developed an action plan, implemented the plan and evaluated their efforts. Local residents were engaged through coalition membership, assessment activities and implementation activities. Ten of the 20 coalitions had memberships comprised of mainly local residents in the planning phase, with 5 maintaining a high level of resident involvement in governance during the implementation phase. Ninety percent of the coalitions had six or more community sectors represented (e.g. education, faith). The majority of coalitions described at least one example of increased input into local government decision-making and at least one instance in which a resident became more actively involved in the life of their community. Findings suggest that the Healthy Cities and Communities model can be successful in facilitating community participation.

Community perspectives on factors that influence collaboration in public health research

Community collaboration in research may lead to better methods, results, and dissemination of interventions. Little systematic research has examined specific factors that influence community-based organizations (CBOs) to collaborate in public health research. There is an urgent need to advance knowledge on this topic so that together, researchers and CBOs can minimize barriers to collaboration. This study advances a CBOfocused characterization of collaboration in HIV-prevention research. By focusing on the perspectives of 20 key informants in 10 HIV-prevention CBOs, qualitative data revealed factors that influenced their collaborations in four domains: (a) Researchers' Characteristics (expertise, availability), (b) Collaborative Research Characteristics (ought to improve services and CBO infrastructure); (c) Community Partner-Researcher Relationships (resolving social and professional issues); and (d) Barriers to HIV-Prevention Research Collaboration (cultural and social disconnect between CBO and academia). To reduce barriers, researchers ought to enhance motivators that facilitate collaboration. To use the advantages of community-based research, prevention scientists and policy makers ought to embrace CBOs' characterization of what makes health research genuinely collaborative.

Measuring collaboration and integration activities in criminal justice and substance abuse treatment agencies

Individuals with substance abuse problems who are involved in the criminal justice system frequently need community-based drug and alcohol abuse treatment and other services. To reduce the risk of relapse to illicit drugs and criminal recidivism, criminal justice agencies may need to establish collaborations with substance abuse treatment and other community-based service providers. Although there are many variations of interorganizational relationships, the nature of these interagency collaborations among justice agencies and treatment providers has received little systematic study. As a first step,we present an instrument to measure interagency collaboration and integration activities using items in the National Criminal Justice Treatment Practices Surveys conducted as part of the Criminal Justice Drug Abuse Treatment Studies(CJ-DATS). Collaboration and integration activities related to drug-involved offenders were examined between substance abuse treatment providers, correctional agencies, and the judiciary. The measurement scale reliably identified two levels of collaboration: less structured, informal networking and coordination and more structured and formalized levels of cooperation and collaboration. An illustration of the use of the systems integration tool is presented.

A partnership model of early intervention in psychosis programme--a Canadian experience

AIM

To describe how a new partnership model of early intervention in psychosis, early intervention in psychosis (EIP) programme delivery in Canada attracted the interest of the community and acquired government funding.

METHODS

The process by which a few individuals used a conceptual framework of integrated, collaborative, flexible and recovery focused principles to engage community partners and attract government funding is described.

RESULTS

The establishment of a small EIP programme and its expansion to a regional programme serving an area of 20,000 square kilometers and a population of approximately 500,000 people were achieved. A programme specific logic prototype was developed. A synergy of public, private and academic services emerged with an infrastructure for ongoing cohesiveness and productivity. Annual clinic visits increased from 641 in 2002 to 1904 in 2007 and annual new patients enrollments grew from 46 to 128 within the same period. Staffing grew from an interdisciplinary staff of 1.5 full-time equivalent (FTE) to the current 10.0 FTE.

CONCLUSIONS

A carefully orchestrated programme organization that is inclusive rather than exclusive can produce a balance of evidence-based best practices in client focused service, community mental health integration and academic productivity.

Organizational factors and collaboration and integration activities in criminal justice and drug abuse treatment agencies

Despite strong interest in improving collaborations between correctional and substance abuse treatment organizations, there is a lack of empirical data describing the existing practices. The current study used a national survey of correctional administrators to examine organizational factors related to cross-agency collaboration and integration activities between corrections and substance abuse treatment organizations. Using a measure of collaboration that scaled cross-agency activities from less structured, informal networking and coordination to more structured and formalized levels of cooperation and collaboration, we found that different correctional settings (e.g., community corrections, jails, prisons) differed significantly in terms of their collaborative activities with substance abuse treatment agencies. We also found that the organizational characteristics that were associated with different levels of collaboration and integration differed across the correctional settings. Further research is needed to better understand how and why correctional agencies decide to formalize collaborative arrangements with treatment agencies and whether these efforts lead to more favorable outcomes.

Use of partnership strategies to build radiation oncology disparities research programs in five Western Pennsylvania communities: an organizational case study

Many cancer treatment and prevention trials as well as surveillance programs suffer from a disproportionately low rate of accrual and a high rate of noncompliance or dropouts of racial minorities and the poor. One suggested strategy to help remediate this trend is to directly involve those targeted populations within the development, implementation, and evaluation of these services. The Radiation Oncology Community Outreach Group (ROCOG) and Neighborhood Cancer Care Cooperative (NCCC) are designed based upon this type of highly collaborative organizational structure, consistent with the general principles of community-based participatory research. Funded by the National Cancer Institute Cancer Disparities Research Partnership program, ROCOG/NCCC provide oncology-focused, community hospital-based initiatives intended to help close the cancer disparities gap. This article presents a descriptive case study of the organizational and political process that preceded our grant proposal submission, the potential benefits and difficulties associated with our extensive collaborative model, and an example of how highly competitive health care organizations can become partners in narrowly focused initiatives aimed at a greater social good.

Research collaboration in Tehran University of Medical Sciences: two decades after integration

Background

In 1985 medical schools were integrated into the Ministry of Health, and the Ministry of Health and Medical Education was created in Iran. Under this infrastructure education, research and service provision are unified, and it is expected that collaboration between researchers and decision makers become easier in such an integrated context.

The question here is how the researchers behavior in the biggest medical university of the country towards collaboration is, i.e. how much do decision makers participate in different stages of research? Which factors affect it?

Methodology

The samples under study were all Tehran University of Medical Sciences (TUMS) completed research projects that had gotten grants in 2004 and were over by the time this study was done. Two questionnaires were designed for this study: i) the research checklist which was filled for 301 projects, ii) the researcher's questionnaire, which was sent to principle investigators, 208 of which were collected. Multiple linear regression analysis was used for evaluating the potential factors affecting individuals 'collaboration score'.

Results

Only 2.2 percent of TUMS' projects initiated in 2004 have had collaboration as a joint PI or co-investigator from non-academic organizations. The principle investigators mean collaboration score was 2.09, where 6 was the total score. So the collaboration score obtained was 35%. The 'type of research' had significant association with the collaboration score which is shown in the linear regression; collaboration was seen more in clinical (p = 0.007) and health system researches (p = 0.001) as compared to basic research.

Conclusion

The present study shows that not many individuals collaborated as co-investigators from outside the university. This finding shows that research policy makers need to introduce interventions in this field. And assessment of barriers to collaboration and its facilitating factors should be considered in order to make it actually happen.

The growth of partnerships to support patient safety practice adoption

OBJECTIVES

To document the numbers and types of interorganizational partnerships within the national patient safety domain, changes over time in these networks, and their potential for disseminating patient safety knowledge and practices.

DATA SOURCES

Self-reported information gathered from representatives of national-level organizations active in promoting patient safety.

STUDY DESIGN

Social network analysis was used to examine the structure and composition of partnership networks and changes between 2004 and 2006.

DATA COLLECTION

Two rounds of structured telephone interviews (n=35 organizations in 2004 and 55 in 2006).

PRINCIPAL FINDINGS

Patient safety partnerships expanded between 2004 and 2006. The average number of partnerships per interviewed organization increased 40 percent and activities per reported partnership increased over 50 percent. Partnerships increased in all activity domains, particularly dissemination and tools development. Fragmentation of the overall partnership network decreased and potential for information flow increased. Yet network centralization increased, suggesting vulnerability to partnership failure if key participants disengage.

CONCLUSIONS

Growth in partnerships signifies growing strength in the capacity to disseminate and implement patient safety advancements in the U.S. health care system. The centrality of AHRQ in these networks of partnerships bodes well for its leadership role in disseminating information, tools, and practices generated by patient safety research projects.

Factors Affecting Member Perceptions of Coalition Impact

The purpose of this study was to identify attributes of community-based coalitions associated with member perceptions of greater impact. Based on Hackman's model of work group effectiveness, we hypothesized that member effort, knowledge and skill, and performance strategies would affect their perceptions of coalition impact. Findings from a lagged regression on a sample of forty-five youth-oriented coalitions indicated that two aspects of member effort were associated with subsequent perceived impact, as were performance strategies for both coalition governance and community interventions. There were no associations, however, between member knowledge and skill and perceived impact. These results suggest that leaders may improve perceived coalition impact by encouraging member participation in discussions and interventions and by developing effective strategies for both governance and implementation.

The private partners of public health: public-private alliances for public good

OBJECTIVE

We sought to convey lessons learned by the Centers for Disease Control and Prevention's (CDC's) Prevention Research Centers (PRCs) about the value and challenges of private-sector alliances resulting in innovative health promotion strategies. Several PRCs based in a variety of workplace and community settings contributed.

METHODS

We conducted interviews with principal investigators, a literature review, and a review of case studies of private-sector alliances in a microbusiness model, a macrobusiness model, and as multiparty partnerships supporting public health research, implementation, and human resource services.

RESULTS

Private-sector alliances provide many advantages, particularly access to specialized skills generally beyond the expertise of public health entities. These skills include manufacturing, distribution, marketing, business planning, and development. Alliances also allow ready access to employee populations. Public health entities can offer private-sector partners funding opportunities through special grants, data gathering and analysis skills, and enhanced project credibility and trust. Challenges to successful partnerships include time and resource availability and negotiating the cultural divide between public health and the private sector. Critical to success are knowledge of organizational culture, values, mission, currency, and methods of operation; an understanding of and ability to articulate the benefits of the alliance for each partner; and the ability and time to respond to unexpected changes and opportunities.

CONCLUSION

Private-public health alliances are challenging, and developing them takes time and resources, but aspects of these alliances can capitalize on partners' strengths, counteract weaknesses, and build collaborations that produce better outcomes than otherwise possible. Private partners may be necessary for program initiation or success. CDC guidelines and support materials may help nurture these alliances.

Evaluating intersectoral collaboration: a model for assessment by service users

INTRODUCTION

DELTA was launched as a project in 1997 to improve intersectoral collaboration in the rehabilitation field. In 2005 DELTA was transformed into a local association for financial co-ordination between the institutions involved. Based on a study of the DELTA service users, the purpose of this article is to develop and to validate a model that can be used to assess the integration of welfare services from the perspective of the service users.

THEORY

The foundation of integration is a well functioning structure of integration. Without such structural conditions, it is difficult to develop a process of integration that combines the resources and competences of the collaborating organisations to create services advantageous for the service users. In this way, both the structure and the process will contribute to the outcome of integration.

METHOD

The study was carried out as a retrospective cross-sectional survey during two weeks, including all the current service users of DELTA. The questionnaire contained 32 questions, which were derived from the theoretical framework and research on service users, capturing perceptions of integration structure, process and outcome. Ordinal scales and open questions where used for the assessment.

RESULTS

The survey had a response rate of 82% and no serious biases of the results were detected. The study shows that the users of the rehabilitation services perceived the services as well integrated, relevant and adapted to their needs. The assessment model was tested for reliability and validity and a few modifications were suggested. Some key measurement themes were derived from the study.

CONCLUSION

The model developed in this study is an important step towards an assessment of service integration from the perspective of the service users. It needs to be further refined, however, before it can be used in other evaluations of collaboration in the provision of integrated welfare services.

Using the balanced scorecard in the development of community partnerships

The benefits of community partnerships have been well established in the health service literature. However, measuring these benefits and associated outcomes is relatively new. This paper presents an innovative initiative in the application of a balanced scorecard framework for measuring and monitoring partnership activity at the community level, while adopting principles of evidence-based practice to the partnership process. In addition, it serves as an excellent example of how organizations can apply scorecard methodology to move away from relationship-based partnerships and into new collaborations of which they can select - using a formal skill and competency assessment for partnership success.

Understanding the effectiveness of partnership-based early childhood interventions

In this paper, we seek to understand the relationship between partnership effectiveness and preschool enrolment in Best Start, an early childhood intervention for children living in disadvantaged areas in Victoria, an Australian State. We will examine the application of theories of partnership effectiveness at a whole of intervention level and in the context of local evaluation initiatives at the Broadmeadows Early Years Partnership. For the statewide intervention, partnership effectiveness was measured using the VicHealth Partnership Analysis Tool at 11 Best Start Sites. The dependent variable was preschool enrolment in Best Start local government area. For the Broadmeadows Early Years Partnership case study, partnership is conceptualised in terms of the Lasker and Weiss (2003) model of collaborative decision making. Scores rose significantly between the two applications of the VicHealth Partnership Analysis Tool at the beginning and end of the Best Start funding period on almost all of the dimensions of the VicHealth Tool. Support for ‘making partnerships work’, ‘minimising barriers to partnerships’ and the ‘total’ partnership scores were associated with increased preschool enrolments. The results of the case study supported the model for collaborative decision making with particular emphasis on the role of shared leadership, synergy and bridging social ties as crucial processes in improving service integration. The results of the statewide intervention and the case study both provide evidence of the value of partnership approaches in improving service uptake and integration for children living in disadvantaged areas. The study also supports current conceptualisations of partnership value and effectiveness.

Transforming the Cross Cultural Collaborative of Pierce County through assessment capacity building

BACKGROUND

Underserved populations are underrepresented in public health initiatives such as tobacco control and in cancer clinical trials. Community involvement is crucial to interventions aimed at reducing health disparities, and local health departments increasingly are called upon to provide both leadership and funding. The Tacoma Pierce County Health Department (TPCHD), in conjunction with 13 key community-based organizations and healthcare systems, formed the Cross Cultural Collaborative of Pierce County (CCC) that successfully employs needs-assessment and evaluation techniques to identify community health initiatives.

METHODS

Community leaders from six underserved populations of the CCC were trained in needs-assessments techniques. Assessments measured effectiveness of the collaborative process and community health initiatives by using key informant (n = 18) and group interviews (n = 3).

RESULTS

The CCC, facilitated by its partnership with the TPCHD, built capacity and competence across community groups to successfully obtain two funded public health initiatives for six priority populations. Members expressed overall satisfaction with the training, organizational structure, and leadership. The CCC's diversity, cultural competency, and sharing of resources were viewed both as a strength and a decision-making challenge.

CONCLUSION

Public health department leadership, collaboration, and evidence-based assessment and evaluation were key to demonstrating effectiveness of the interventions, ensuring the CCC's sustainability.

Which comes first: the partnership or the tool? Reflections on the effective use of partnership tools in local health partnerships

This paper focuses on the use of a partnership self-evaluation tool in local health partnerships in Australia. Partnership tools are intended to be used across all phases of partnership development and are typically delivered in the form of a self-administered survey. Survey questions are designed to encourage members of local partnerships to reflect on their progress to date and, if necessary, to reorient future activities to satisfy objectives and desired outcomes. In this paper we argue that without a broader surrounding framework of partnership development and appropriate assistance in administering partnership tools, the potential benefits of self evaluation in local partnerships may be restricted. We base these comments on a study of the use of a partnership self-evaluation tool as part of a broader chronic disease initiative in 17 communities across regional Australia during 2008. Although participants reported favourable outcomes from being involved in the local partnerships, and some found the tool to be of benefit, only 8 of the 17 partnerships actually used the self-evaluation tool. The reported reasons for non-use related primarily to: (1) lack of time; (2) perceptions that it was too early to ‘evaluate’ the partnership; and (3) difficulty in administering the tool. These barriers to use indicate that participants may have been unaware of the potential of the tool to assist in partnership development over time. Partnership participants may require more preparation to use partnership tools in a way that can secure high quality sustainable local health partnerships.

Primary Care Partnerships: more than just one relationship

Victorian Primary Care Partnerships are complex. They occur within a multilayered institutional environment. They are not a simple singular relationship but rather manifest diverse forms that are consistent with a collaboration continuum across multilevel structures. Their function, process and structure differentiate these forms. This paper articulates a conceptualisation of partnership complexity that integrates these elements and interrelationships.

Effectiveness of a grant program's efforts to promote synergy within its funded initiatives: perceptions of participants of the Southern Rural Access Program

BACKGROUND

Foundations and public agencies commonly fund focused initiatives for individual grantees. These discrete, stand-alone initiatives can risk failure by being carried out in isolation. Fostering synergy among grantees' initiatives is one strategy proposed for promoting the success and impact of grant programs. We evaluate an explicit strategy to build synergy within the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), which awarded grants to collaboratives within eight southeastern U.S. states to strengthen basic health care services in targeted rural counties.

METHODS

We interviewed 39 key participants of the SRAP, including the program director within each state and the principal subcontractors heading the program's funded initiatives that supported heath professionals' recruitment, retention and training, made loans to health care providers, and built networks among providers. Interews were recorded and transcribed. Two investigators independently coded the transcripts and a third investigator distilled the main points.

RESULTS

Participants generally perceived that the SRAP yielded more synergies than other grant programs in which they had participated and that these synergies added to the program's impact. The synergies most often noted were achieved through relationship building among grantees and with outside agencies, sharing information and know-how, sharing resources, combining efforts to yield greater capacity, joining voices to advocate for common goals, and spotting gaps in services offered and then filling these gaps. The SRAP's strategies that participants felt fostered synergy included targeting funding to culturally and geographically similar states, supporting complementary types of initiatives, promoting opportunities to network through semi-annual meetings and regular conference calls, and the advocacy efforts of the program's leadership. Participants noted that synergies were sometimes hindered by turf issues and politics and the conflicting perspectives and cultures of participating organizations and racial groups. Inadequate funding through the SRAP, restricting program involvement to only a few needy counties, and instances of over- and under-involvement by the program's leadership were sometimes felt to inhibit synergies and/or their sustainability.

CONCLUSION

Participants of the SRAP generally perceived that the SRAP's deliberate strategies yielded synergies that added to the program's impact.

The Story Behind the Story of Collaborative Networks–Relationships Do Matter!

This study reports data about the real story behind the current trend of mandated interorganizational collaboration of health and human service agencies. By means of qualitative design (N-22), public health managers were interviewed about the extent and nature of their collaborative efforts in the Healthy Babies, Healthy Children (HBHC) Program in Ontario, Canada. Using a conceptual framework of resource exchange theory, this study found that relational processes specifically: (a) previous relationships with other agencies and (b) interpersonal relations namely: informality, local community, open communication and resolving conflicts were the reasons for successful collaborations. Implications are directed toward: health and social planners, administrators, board members, funding bodies and policy-makers. The study offers new knowledge about a subject which has received minimal attention in the literature.

Partnership lessons from the Global Programme for Health Promotion Effectiveness: a case study

It is an article of faith in health promotion that health challenges cannot be confronted successfully by actors working in isolation. The synergy produced through collaboration is seen as vital. Yet, collaboration is arduous and many collaborations fade before their goals are met. Research is needed to identify factors and processes that promote as well as inhibit the production of synergistic outcomes. To this end, a case study was undertaken of the Global Programme for Health Promotion Effectiveness (GPHPE). The GPHPE reviews and disseminates evidence for the effectiveness of health promotion. Interviews with 20 GPHPE participants were conducted, transcribed and analyzed, and GPHPE documentation provided additional data. The results were used to develop the Bergen Model of Collaborative Functioning. It is a systems model (input, throughput, output) building on earlier research, that adds three new elements suggested by the findings of this study. First, the partnership's mission--to disseminate evidence of effectiveness--was identified as a significant input (alongside the conventional inputs of partner resources and financing) that affected the GPHPE's functioning in fundamental ways. Second, positive and negative cycles of interaction were identified that simultaneously strengthened and weakened the GPHPE's ability to sustain itself and produce the desired outcomes. Third, the construct 'antagony' was introduced as a unique type of output, in addition to synergy and additive results, representing unwanted and disturbing outcomes. The Model is constructed to have wide applicability, and further research now underway tests its utility in the study of local and national collaborations.

Transdisciplinary research and evaluation for community health initiatives

Transdisciplinary research and evaluation projects provide valuable opportunities to collaborate on interventions to improve the health and well-being of individuals and communities. Given team members' diverse backgrounds and roles or responsibilities in such projects, members' perspectives are significant in strengthening a project's infrastructure and improving its organizational functioning. This article presents an evaluation mechanism that allows team members to express the successes and challenges incurred throughout their involvement in a multisite transdisciplinary research project. Furthermore, their feedback is used to promote future sustainability and growth. Guided by a framework known as organizational development, the evaluative process was conducted by a neutral entity, the Quality Assurance Team. A mixed-methods approach was utilized to garner feedback and clarify how the research project goals could be achieved more effectively and efficiently. The multiple benefits gained by those involved in this evaluation and implications for utilizing transdisciplinary research and evaluation teams for health initiatives are detailed.

Interprofessional partnerships in chronic illness care: a conceptual model for measuring partnership effectiveness

INTRODUCTION

Interprofessional health and social service partnerships (IHSSP) are internationally acknowledged as integral for comprehensive chronic illness care. However, the evidence-base for partnership effectiveness is lacking. This paper aims to clarify partnership measurement issues, conceptualize IHSSP at the front-line staff level, and identify tools valid for group process measurement.

THEORY AND METHODS

A systematic literature review utilizing three interrelated searches was conducted. Thematic analysis techniques were supported by NVivo 7 software. Complexity theory was used to guide the analysis, ground the new conceptualization and validate the selected measures. Other properties of the measures were critiqued using established criteria.

RESULTS

There is a need for a convergent view of what constitutes a partnership and its measurement. The salient attributes of IHSSP and their interorganizational context were described and grounded within complexity theory. Two measures were selected and validated for measurement of proximal group outcomes.

CONCLUSION

This paper depicts a novel complexity theory-based conceptual model for IHSSP of front-line staff who provide chronic illness care. The conceptualization provides the underpinnings for a comprehensive evaluative framework for partnerships. Two partnership process measurement tools, the PSAT and TCI are valid for IHSSP process measurement with consideration of their strengths and limitations.

Partnership--success factors of interorganizational relationships

AIM

Key factors of successful interorganizational partnerships are applied to the context of nursing and midwifery education.

BACKGROUND

Reports in nursing education emphasize the need for more collaborative partnerships between the education and healthcare sectors of nursing and midwifery education.

EVALUATION

There is little research examining the implementation of interorganizational relationships particularly in nursing.

KEY ISSUES

Key success factors are grouped into seven areas of trust and valuing the partner, leadership and managing change, a partnership framework, communication and interaction, equity and involvement in decision making, power and the role of partnership coordinator.

CONCLUSION

There is a need for contextual research in relation to implementing partnership in nursing and midwifery.

IMPLICATIONS FOR NURSING MANAGEMENT

Partnership arrangements are essential for quality nursing and midwifery education. This article adds knowledge by way of application of these factors to organizations that provide nursing and midwifery education. Nurse managers have an important role in determining the quality of learning experience within the health service. It is essential, therefore that both nurse managers and nurse educationalist know the key factors which promote successful interoganizational relationships to ensure these factors are manifest in practice.

Best practice implementation: lessons learned from 20 partnerships

BACKGROUND

Partnerships can facilitate effective implementation of best practices, but literature describing effective and ineffective strategies to address barriers to implementation in partnerships is lacking.

METHODS

Principal investigators (PIs) were surveyed to identify barriers to best practice implementation, rank their significance, and articulate the success and failure of solutions attempted.

RESULTS

The top four categories of barriers to implementation were partnership challenges, practitioner/local organization variables, time frame challenges, and financial concerns. Ninety-eight effective and 38 ineffective solutions used to overcome these barriers were identified. The most common categories of successful solutions were flexibility of interventions to align with unique local characteristics, schedules, and budgets (36.7% of listed successful solutions); communication strategies that emphasize frequent bidirectional information exchange in person (26.5%); and thoughtful use of personnel emphasizing sites' senior leadership and centralized quality and analytic content expertise (16.3%).

DISCUSSION

Despite substantial partnership diversity, consistent themes related to barriers to implementation and solutions to these barriers emerged. The successful and unsuccessful solutions provided should be proactively assessed to enhance the likelihood of future partnership success.

Making the connections: community capacity for tobacco control in an urban African American community

Developing community capacity to improve health is a cornerstone of community-based public health. The concept of community capacity reflects numerous facets and dimensions of community life and can have different meanings in different contexts. This paper explores how members of one community identify and interpret key aspects of their community's capacity to limit the availability and use of tobacco products. Particular attention is given to examining the interrelationship between various dimensions of community capacity in order to better understand the processes by which communities are able to mobilize for social change. The study is based on qualitative analysis of 19 in-depth interviews with key informants representing a variety of community sectors in Harlem, New York City. Findings indicate that the community is viewed as rich in human and social resources. A strong sense of community identity and connectedness underlies this reserve and serves as a catalyst for action.

Characteristics associated with US Walk to School programs

Participation in Walk to School (WTS) programs has grown substantially in the US since its inception; however, no attempt has been made to systematically describe program use or factors associated with implementation of environment/policy changes.

Describe the characteristics of schools' WTS programs by level of implementation.

Representatives from 450 schools from 42 states completed a survey about their WTS program's infrastructure and activities, and perceived impact on walking to school. Level of implementation was determined from a single question to which respondents reported participation in WTS Day only (low), WTS Day and additional programs (medium), or making policy/environmental change (high).

The final model showed number of community groups involved was positively associated with higher level of implementation (OR = 1.78, 95%CI = 1.44, 2.18), as was funding (OR = 1.56, 95%CI = 1.26, 1.92), years of participation (OR = 1.44, 95% CI = 1.23, 1.70), and use of a walkability assessment (OR = 3.22, 95%CI = 1.84, 5.64). Implementation level was modestly associated with increased walking (r = 0.18).

Strong community involvement, some funding, repeat participation, and environmental audits are associated with progms that adopt environmental/policy change, and seem to facilitate walking to school.