Collaborative Capacity Building in Complex Community-Based Health Partnerships: A Model for Translating Knowledge Into Action

Towards achieving interorganisational collaboration between health-care providers: a realist evidence synthesis

Background

Interorganisational collaboration is currently being promoted to improve the performance of NHS providers. However, up to now, there has, to the best of our knowledge, been no systematic attempt to assess the effect of different approaches to collaboration or to understand the mechanisms through which interorganisational collaborations can work in particular contexts.

Objectives

Our objectives were to (1) explore the main strands of the literature about interorganisational collaboration and to identify the main theoretical and conceptual frameworks, (2) assess the empirical evidence with regard to how different interorganisational collaborations may (or may not) lead to improved performance and outcomes, (3) understand and learn from NHS evidence users and other stakeholders about how and where interorganisational collaborations can best be used to support turnaround processes, (4) develop a typology of interorganisational collaboration that considers different types and scales of collaboration appropriate to NHS provider contexts and (5) generate evidence-informed practical guidance for NHS providers, policy-makers and others with responsibility for implementing and assessing interorganisational collaboration arrangements.

Design

A realist synthesis was carried out to develop, test and refine theories about how interorganisational collaborations work, for whom and in what circumstances.

Data sources

Data sources were gathered from peer-reviewed and grey literature, realist interviews with 34 stakeholders and a focus group with patient and public representatives.

Review methods

Initial theories and ideas were gathered from scoping reviews that were gleaned and refined through a realist review of the literature. A range of stakeholder interviews and a focus group sought to further refine understandings of what works, for whom and in what circumstances with regard to high-performing interorganisational collaborations.

Results

A realist review and synthesis identified key mechanisms, such as trust, faith, confidence and risk tolerance, within the functioning of effective interorganisational collaborations. A stakeholder analysis refined this understanding and, in addition, developed a new programme theory of collaborative performance, with mechanisms related to cultural efficacy, organisational efficiency and technological effectiveness. A series of translatable tools, including a diagnostic survey and a collaboration maturity index, were also developed.

Limitations

The breadth of interorganisational collaboration arrangements included made it difficult to make specific recommendations for individual interorganisational collaboration types. The stakeholder analysis focused exclusively on England, UK, where the COVID-19 pandemic posed challenges for fieldwork.

Conclusions

Implementing successful interorganisational collaborations is a difficult, complex task that requires significant time, resource and energy to achieve the collaborative functioning that generates performance improvements. A delicate balance of building trust, instilling faith and maintaining confidence is required for high-performing interorganisational collaborations to flourish.

Future work

Future research should further refine our theory by incorporating other workforce and user perspectives. Research into digital platforms for interorganisational collaborations and outcome measurement are advocated, along with place-based and cross-sectoral partnerships, as well as regulatory models for overseeing interorganisational collaborations.

Study registration

The study is registered as PROSPERO CRD42019149009.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 6. See the NIHR Journals Library website for further project information.

Integration as a Tool for Interprofessional Work: A Synthesis of the Literature Regarding How to Use Integrative Strategies to Address Complex Public Health Problems

Background and Purpose

There has been limited success addressing complex public health problems using "siloed" approaches. A next important step in addressing persistent public health problems is adopting an "integrative" approach-intentional collaboration across the domains of research, clinical practice, community, and policy. This synthesis of the literature aggregates and synthesizes the diffuse and multi-disciplinary integration literature base to describe key concepts, aspects of praxis, and challenges and successes to help guide interprofessional practice.

Methods

A three-step approach was used: 1) a wide-ranging search for articles on integration theory/praxis; 2) a more focused search in the health literature bases; 3) a snowball strategy to identify additional studies.

Discussion/Conclusions

Identified themes included elements of successful integration; characteristics of an effective integrator; and dynamics between stakeholders in integration praxis. Results of this synthesis of the integration literature provide a deeper understanding of integration and points to clear and exciting next steps for integration praxis and inquiry.

Basic Criteria, Models, and Indicators of Intersectoral Collaboration in Health Promotion: A Scoping Review

Background:

In this study, the basic criteria, models, and indicators of intersectoral collaboration in health promotion were investigated to facilitate the implementation of collaboration.

Methods:

This scoping review was conducted using datasets of Embase, Web of Science, Scopus, and PubMed, and search engines of Google, Google Scholar, and ProQuest.

Results:

52 studies were included, and 32 codes in Micro, Meso, and Macro level, were obtained. Micro-level criteria had the highest frequency. Among the models used in the reviewed studies, social network analysis, Diagnosis of Sustainable Collaboration, Bergen, and logic models had the highest frequency. Among the indicators studied, the number of participants and the level of collaboration as well as its sustainability were the most frequent indicators.

Conclusion:

The findings identified the most important and widely used criteria, models, and indicators of intersectoral collaboration in health promotion which can be useful for decision-makers and planners in the domain of health promotion, in designing, implementing, and evaluating collaborative programs.

Why do some inter-organisational collaborations in healthcare work when others do not? A realist review

BACKGROUND

Inter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, enabling resource sharing, and promoting innovations. However, in practice, due to the complexity of the process, such efforts are often rife with difficulty. Notable contributions have sought to make sense of this area; however, further understanding is needed in order to gain a better understanding of why some inter-organisational collaborations work when others do not, to be able to more effectively implement collaborations in the future.

METHODS

Realist review methodology was used with the intention of formulating context-mechanism-outcome configurations (CMOCs) to explain how inter-organisational collaborations work and why, combining systematic and purposive literature search techniques. The systematic review encompassed searches for reviews, commentaries, opinion pieces, and case studies on HMIC, MEDLINE, PsycINFO, and Social Policy and Practice databases, and further searches were conducted using Google Scholar. Data were extracted from included studies according to relevance to the realist review.

RESULTS

Fifty-three papers were included, informing the development of programme theories of how, why, and when inter-organisational collaborations in healthcare work. Formulation of our programme theories incorporated the concepts of partnership synergy and collaborative inertia and found that it was essential to consider mechanisms underlying partnership functioning, such as building trust and faith in the collaboration to maximise synergy and thus collaborative performance. More integrative or mandated collaboration may lean more heavily on contract to drive collaborative behaviour.

CONCLUSION

As the first realist review of inter-organisational collaborations in healthcare as an intervention for improvement, this review provides actionable evidence for policymakers and implementers, enhancing understanding of mechanisms underlying the functioning and performing of inter-organisational collaborations, as well as how to configure the context to aid success. Next steps in this research will test the results against further case studies and primary data to produce a further refined theory.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019149009.

Partnering to address rural health workforce challenges in Western NSW

Purpose

While one-third of Australians live outside major cities, there are ongoing challenges in providing accessible, sustainable, and appropriate primary health care services in rural and remote communities. The purpose of this paper is to explore a partnership approach to understanding and addressing complex primary health workforce issues in the western region of New South Wales (NSW), Australia.

Design/methodology/approach

The authors describe how a collaboration of five organisations worked together to engage a broader group of stakeholders and secure commitment and resources for a regional approach to address workforce challenges in Western NSW. A literature review and formal interviews with stakeholders gathered knowledge, identified issues and informed the overarching approach, including the development of the Western NSW Partnership Model and Primary Health Workforce Planning Framework. A stakeholder forum tested the proposed approach and gained endorsement for a collaborative priority action plan.

Findings

The Western NSW Partnership Model successfully engaged regional stakeholders and guided the development of a collaborative approach to building a sustainable primary health workforce for the future.

Originality/value

Given the scarcity of literature about effective partnerships approaches to address rural health workforce challenges, this paper contributes to an understanding of how to build sustainable partnerships to positively impact on the rural health workforce. This approach is replicable and potentially valuable elsewhere in NSW, other parts of Australia and internationally.

Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity

Multi-level multi-component (MLMC) strategies have been recommended to prevent and reduce childhood obesity, but results of such trials have been mixed. The present work discusses lessons learned from three recently completed MLMC interventions to inform future research and policy addressing childhood obesity. B’more Healthy Communities for Kids (BHCK), Children’s Healthy Living (CHL), and Health and Local Community (SoL) trials had distinct cultural contexts, global regions, and study designs, but intervened at multiple levels of the socioecological model with strategies that address multiple components of complex food and physical activity environments to prevent childhood obesity. We discuss four common themes: (i) How to engage with community partners and involve them in development of intervention and study design; (ii) build and maintain intervention intensity by creating mutual promotion and reinforcement of the intervention activities across the multiple levels and components; (iii) conduct process evaluation for monitoring, midcourse corrections, and to engage stakeholder groups; and (iv) sustaining MLMC interventions and its effect by developing enduring and systems focused collaborations. The paper expands on each of these themes with specific lessons learned and presents future directions for MLMC trials.

Collaboration between key populations in a global partnership for health and human rights: Lessons learned from 'Bridging the Gaps'

Because HIV and AIDS key populations share common social-cultural factors challenging their sexual health and rights (e.g. stigma, criminalisation), there is an assumed benefit of collaborative programmes where various key populations work in solidarity. In this paper, we reflect on how partners collaborated in a complex alliance of over 100 different NGOs, representing and supporting three key populations - lesbian, gay, bisexual and transgender (LGBT) people, sex workers and people who use drugs - working across 16 countries. We used a multiple-method approach of participant observation, qualitative interviews, and a survey to explore the benefits, facilitators and challenges of collaboration. Results show that motivators for collaboration included being part of the larger funding structure with applied impacts, a repressive human rights context, and intersectionality. Barriers for collaboration included identity politics, stigma, and constraints regarding the appropriate timing of new collaborations. Finally, facilitators include practical support for engagement, the framing of human rights in a medical agenda, and recognition of implicit differences. We conclude that for building the capacity for collaboration among socially marginalised groups it is important to develop trust and the ability to recognise strength in difference beyond the initial identification of shared norms and common goals.

Validation of a Collaboration Readiness Assessment Tool for Use by Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Agencies and Partners

OBJECTIVE

To evaluate content and face validity of a collaboration readiness assessment tool developed to facilitate collaborative efforts to implement policy, systems, and environment changes in Supplemental Nutrition Assistance Program-Education (SNAP-Ed).

METHODS

Evaluation of the validity of the tool involved 2 steps. Step 1 was conducted with 4 subject matter experts to evaluate content validity. Step 2 used an iterative cognitive testing process with 4 rounds and 16 SNAP-Ed staff and community partners to evaluate face validity.

RESULTS

Subject matter experts found that survey items appropriately matched the content area indicated and adequately covered collective efficacy, change efficacy, and readiness. Cognitive testing with SNAP-Ed staff and partners informed modifications and resulted in adequate face validity.

CONCLUSIONS AND IMPLICATIONS

The ability to measure collaboration readiness will allow agencies and community partners that implement SNAP-Ed to target areas that facilitate collaboration efforts needed for policy, systems, and environment change and collective efficacy. Further cognitive testing of the tool with other populations is needed to ensure its applicability and usefulness. Evaluation of the reliability of the tool with a broad range of SNAP-Ed programs and community agencies is also recommended.

A Socially Just Leadership Approach to Community-Partnered Research for Reducing Health Disparities

Significant health disparities continue to plague many groups of people who have been systematically oppressed and largely unrepresented in health research. Community-based participatory research (CBPR) is a collaborative research approach that has been shown to be effective in addressing health disparities; a community–university partnership approach can be used to conduct this research. Counseling psychologists are well suited to establish and lead CBPR partnerships, yet there is a paucity of research to guide them in utilizing effective leadership approaches when conducting CBPR for reducing health disparities. Therefore, the aims of the present study were to (a) review existing leadership models applicable to conducting CBPR; (b) identify guiding principles of socially just leadership that emerged from the aforementioned review; (c) offer an example of how the guiding principles were used in a community–university partnership, highlighting challenges, solutions, and lessons learned; and (d) discuss the benefits of socially just leadership for counseling psychologists.

Participatory epidemiology: the contribution of participatory research to epidemiology

Background

Epidemiology has contributed in many ways to identifying various risk factors for disease and to promoting population health. However, there is a continuing debate about the ability of epidemiology not only to describe, but also to provide results which can be better translated into public health practice. It has been proposed that participatory research approaches be applied to epidemiology as a way to bridge this gap between description and action. A systematic account of what constitutes participatory epidemiology practice has, however, been lacking.

Methods

A scoping review was carried out focused on the question of what constitutes participatory approaches to epidemiology for the purpose of demonstrating their potential for advancing epidemiologic research. Relevant databases were searched, including both the published and non-published (grey) literature. The 102 identified sources were analyzed in terms of comparing common epidemiologic approaches to participatory counterparts regarding central aspects of the research process. Exemplary studies applying participatory approaches were examined more closely.

Results

A highly diverse, interdisciplinary body of literature was synthesized, resulting in a framework comprised of seven aspects of the research process: research goal, research question, population, context, data synthesis, research management, and dissemination of findings. The framework specifies how participatory approaches not only differ from, but also how they can enhance common approaches in epidemiology. Finally, recommendations for the further development of participatory approaches are given. These include: enhancing data collection, data analysis, and data validation; advancing capacity building for research at the local level; and developing data synthesis.

Conclusion

The proposed framework provides a basis for systematically developing the emergent science of participatory epidemiology.

The success of the Uttarakhand Cluster: a case study of organisational change towards disability inclusive development

Background

Persons with disability are often marginalised and excluded from international development efforts. This case study reviews the success of Uttarakhand Cluster of development NGOs in changing organisational behaviour towards being disability inclusive in their development (DID) activities.

Methods

A triangulation of qualitative research methods was used, including key informant interviews, focus group discussions and review of textual data.

Results

The results synthesise data into Kotter’s framework for organisational change, explaining the different stages of change experienced by the Cluster as it moved towards DID. Development of a disability mission, sharing of capacity and resources, and presence of disability champions were key in the organisations' transition towards DID.

Conclusion

This case study demonstrates that the Cluster, a low - cost network, was able to drive organisational change and promote DID.

Social network analysis of public health programs to measure partnership

In order to prevent chronic diseases, community-based programs are encouraged to take an ecological approach to public health promotion and involve many diverse partners. Little is known about measuring partnership in implementing public health strategies. We collected data from 23 Missouri communities in early 2012 that received funding from three separate programs to prevent obesity and/or reduce tobacco use. While all of these funding programs encourage partnership, only the Social Innovation for Missouri (SIM) program included a focus on building community capacity and enhancing collaboration. Social network analysis techniques were used to understand contact and collaboration networks in community organizations. Measurements of average degree, density, degree centralization, and betweenness centralization were calculated for each network. Because of the various sizes of the networks, we conducted comparative analyses with and without adjustment for network size. SIM programs had increased measurements of average degree for partner collaboration and larger networks. When controlling for network size, SIM groups had higher measures of network density and lower measures of degree centralization and betweenness centralization. SIM collaboration networks were more dense and less centralized, indicating increased partnership. The methods described in this paper can be used to compare partnership in community networks of various sizes. Further research is necessary to define causal mechanisms of partnership development and their relationship to public health outcomes.

Networking between community health programs: a team-work approach to improving health service provision

Background

Networking between non-government organisations in the health sector is recognised as an effective method of improving service delivery. The Uttarakhand Cluster was established in 2008 as a collaboration of community health programs in rural north India with the aim of building capacity, increasing visibility and improving linkages with the government. This qualitative research, conducted between 2011-2012, examined the factors contributing to formation and sustainability of this clustering approach.

Methods

Annual focus group discussions, indicator surveys and participant observation were used to document and observe the factors involved in the formation and sustainability of an NGO network in North India.

Results

The analysis demonstrated that relationships were central to the formation and sustainability of the cluster. The elements of small group relationships: forming, storming, norming and performing emerged as a helpful way to describe the phases which have contributed to the functioning of this network with common values, strong leadership, resource sharing and visible progress encouraging the ongoing commitment of programs to the network goals.

Conclusions

In conclusion, this case study demonstrates an example of a successful and effective network of community health programs. The development of relationships was seen to be to be an important part of promoting effective resource sharing, training opportunities, government networking and resource mobilisation and will be important for other health networks to consider.

Building sustainable organizational capacity to deliver HIV programs in resource-constrained settings: stakeholder perspectives

Background

In 2008, the US government mandated that HIV/AIDS care and treatment programs funded by the US President's Emergency Plan for AIDS Relief (PEPFAR) should shift from US-based international partners (IPs) to registered locally owned organizations (local partners, or LPs). The US Health Resources and Services Administration (HRSA) developed the Clinical Assessment for Systems Strengthening (ClASS) framework for technical assistance in resource-constrained settings. The ClASS framework involves all stakeholders in the identification of LPs’ strengths and needs for technical assistance.

Objective

This article examines the role of ClASS in building capacity of LPs that can endure and adapt to changing financial and policy environments.

Design

All stakeholders (n=68) in Kenya, Zambia, and Nigeria who had participated in the ClASS from LPs and IPs, the US Centers for Disease Control and Prevention (CDC), and, in Nigeria, HIV/AIDS treatment facilities (TFs) were interviewed individually or in groups (n=42) using an open-ended interview guide. Thematic analysis revealed stakeholder perspectives on ClASS-initiated changes and their sustainability.

Results

Local organizations were motivated to make changes in internal operations with the ClASS approach, PEPFAR's competitive funding climate, organizational goals, and desired patient health outcomes. Local organizations drew on internal resources and, if needed, technical assistance from IPs. Reportedly, ClASS-initiated changes and remedial action plans made LPs more competitive for PEPFAR funding. LPs also attributed their successful funding applications to their preexisting systems and reputation. Bureaucracy, complex and competing tasks, and staff attrition impeded progress toward the desired changes. Although CDC continues to provide technical assistance through IPs, declining PEPFAR funds threaten the consolidation of gains, smooth program transition, and continuity of treatment services.

Conclusions

The well-timed adaptation and implementation of ClASS successfully engaged stakeholders who committed their own resources toward strengthening organizational capacity. The sustainability of built capacity depends on continued investment in leadership, staff retention, and quality improvement.

Collaborative approaches towards building midwifery capacity in low income countries: a review of experiences

OBJECTIVE

to explore collaborative approaches undertaken to build midwifery education, regulation and professional association in low income countries and identify evidence of strategies that may be useful to scale-up midwifery to achieve MDG 5.

DESIGN

an integrative review involving a mapping exercise and a narrative synthesis of the literature was undertaken. The search included peer reviewed research and discursive literature published between 2002 and 2012.

FINDINGS

fifteen papers were found that related to this topic: 10 discursive papers and five research studies. Collaborative approaches to build midwifery capacity come mainly from Africa and involve partnerships between low income countries and between low and high income countries. Most collaborations focus on building capacity across more than one area and arose through opportunistic and strategic means. A number of factors were found to be integral to maintaining collaborations including the establishment of clear processes for communication, leadership and appropriate membership, effective management, mutual respect, learning and an understanding of the context. Collaborative action can result in effective clinical and research skill building, the development of tailored education programmes and the establishment of structures and systems to enhance the midwifery workforce and ultimately, improve maternal and child health.

KEY CONCLUSIONS

between country collaborations are one component to building midwifery workforce capacity in order to improve maternal health outcomes.

IMPLICATIONS FOR PRACTICE

the findings provide insights into how collaboration can be established and maintained and how the contribution collaboration makes to capacity building can be evaluated.