Members’ Perceptions of Community Care Network Partnerships’ Effectiveness

Examining the creation of synergy in community coalitions for smoke-free environments in Armenia and Georgia

Community coalitions depend on their members to synergistically pool diverse resources, including knowledge and expertise, community connections and varied perspectives, to identify and implement strategies and make progress toward community health improvement. Several coalition theories suggest synergy is the key mechanism driving coalition effectiveness. The Community Coalition Action Theory (CCAT) asserts that synergy depends on how well coalitions engage their members and leverage their resources, which is influenced by coalition processes, member participation and satisfaction and benefits outweighing costs. The current study used mixed methods, including coalition member surveys (n = 83) and semi-structured interviews with leaders and members (n = 42), to examine the process of creating collaborative synergy in 14 community coalitions for smoke-free environments in Armenia and Georgia. Members, typically seven per coalition representing education, public health, health care and municipal administration sectors, spent an average of 16 hr/month on coalition-related work. Common benefits included making the community a better place to live and learning more about tobacco control. The greatest cost was attending meetings or events at inconvenient times. Members contributed various resources, including their connections and influence, skills and expertise and access to population groups and settings. Strong coalition processes, greater benefits and fewer costs of participation and satisfaction were correlated with leveraging of member resources, which in turn, was highly correlated with collaborative synergy. Consistent with CCAT, effective coalition processes created a positive climate where membership benefits outweighed costs, and members contributed their resources in a way that created collaborative synergy.

Community coalitions for smoke-free environments in Armenia and Georgia: A mixed methods analysis of coalition formation, implementation and perceived effectiveness

Effective models for aligning public health and civil society at the local level have the potential to impact various global health issues, including tobacco. Georgia and Armenia Teams for Healthy Environments and Research (GATHER) is a collaboration between Armenia, Georgia and U.S. researchers involving a community randomized trial testing the impact of community coalitions to promote smoke-free policy adoption and compliance in various settings. Community Coalition Action Theory (CCAT) was used to guide and describe coalition formation, implementation and effectiveness. Mixed methods were used to evaluate 14 municipality-based coalitions in Georgia and Armenia, including semi-structured interviews (n = 42) with coalition leaders and active members, coalition member surveys at two timepoints (n = 85 and n = 83), and review of action plans and progress reports. Results indicated successful creation of 14 multi-sectoral coalitions, most commonly representing education, public health, health care, and municipal administration. Half of the coalitions created at least one smoke-free policy in specific settings (e.g., factories, parks), and all 14 promoted compliance with existing policies through no-smoking signage and stickers. The majority also conducted awareness events in school, health care, and community settings, in addition to educating the public about COVID and the dangers of tobacco use. Consistent with CCAT, coalition processes (e.g., communication) were associated with member engagement and collaborative synergy which, in turn, correlated with perceived community impact, skills gained by coalition members, and interest in sustainability. Findings suggest that community coalitions can be formed in varied sociopolitical contexts and facilitate locally-driven, multi-sectoral collaborations to promote health. Despite major contextual challenges (e.g., national legislation, global pandemic, war), coalitions were resilient, nimble and remained active. Additionally, CCAT propositions appear to be generalizable, suggesting that coalition-building guidance may be relevant for local public health in at least some global contexts.

Charting a Course: A Research Agenda for Studying the Governance of Health Care Networks

Networked forms of organizing in health care are increasingly viewed as an effective means of addressing "wicked", multifaceted health and societal challenges. This is because networks attempt to address these challenges via collaborative approaches in which diverse stakeholders together define the problem(s) and implement solutions. Consequently, there has been a sharp increase in the number and types of networks used in health care. Despite this growth, our understanding of how these networks are governed has not kept pace. The purpose of this chapter is to chart a research agenda for scholars who are interested in studying health care network governance (i.e., the systems of rules and decision-making within networks), which is of particular importance in deliberate networks between organizations. We do so based on our knowledge of the literature and interviews with subject matter experts, both of which are used to identify core network governance concepts that represent gaps in our current knowledge. Our analysis identified various conceptualizations of networks and of their governance, as well as four primary knowledge gaps: "bread and butter" studies of network governance in health care, the role of single organizations in managing health care networks, governance through the life-cycle stages of health care networks, and governing across the multiple levels of health care networks. We first seek to provide some conceptual clarity around networks and network governance. Subsequently, we describe some of the challenges that researchers may confront while addressing the associated knowledge gaps and potential ways to overcome these challenges.

Cross-Sector Strategic Alliances Between Health Care Organizations and Community-Based Organizations: Marrying Theory and Practice

While it has long been established that social factors, such as housing, transportation, and income, influence health and health care outcomes, over the last decade, attention to this topic has grown dramatically. Reforms that promote high-quality care as well as responsibility for total cost of care have shifted focus among health care providers toward upstream determinants of health care outcomes. As a result, there has been a proliferation of activity focused on integrating and aligning social and medical care, many of which depend critically on cross-sector alliances. Despite considerable activity in this area, cross-sector alliances in health care remain largely undertheorized. Both literatures stand to gain from more attention to carefully knitting together the theoretical and management literature on alliances with the empirical, health policy and health services literature on cross-sector alliances in health care. In this chapter, we lay out what exists in the current scientific literature as well as a framework for considering much needed work in this area. We organize the literature and our commentary around the lifecycle of alliances: alliance formation, including factors prompting alliance formation, partner selection, and alliance goals; alliance maturity, including the work of these cross-sector alliances, governance, finance and contracts, staffing structure, and rewards; and critical crossroads, including alliance timelines, definitions of success, and dissolution. We also lay out critical areas for future inquiry, including better theorizing on cross-sector alliances, developing typologies of these cross-sector health care alliances, and the role of policy in cross-sector alliances.

So Happy Together: A Review of the Literature on the Determinants of Effectiveness of Purpose-Oriented Networks in Health Care

While purpose-oriented networks are widely recognized as organizational forms to address wicked problems in health care such as increasing demands and expenditure, the associated literature is fragmented. We therefore reviewed empirical studies to identify the determinants of the effectiveness of these networks. Our search yielded 3,657 unique articles, of which 19 met our eligibility criteria. After backward snowballing and expert consultation, 33 articles were included. Results reveal no less than 283 determinants of effective health care networks. The majority of these determinants are processual and involving professionals from the operational level is particularly salient. In addition, most studies relate determinants to process outcomes (e.g., improved collaboration or sustainability of the network) and only a few to members' perception of whether the network attains its goals. We urge future research to adopt configurational approaches to identify which sets of determinants are associated with networks' ability to attain their goal of addressing wicked problems.

Member engagement in multi-sector health care alliances

Many communities are developing innovative forms of collaborative organizations such as multi-sector health care alliances (MHCAs) to address problems of misaligned incentives among providers, payers, and community stakeholders and improve health and health care. Member engagement is essential to the success of these organizations due to their dependence on volunteer members to develop and implement strategy and provide material and in-kind support for alliance efforts, yet relatively little research has examined how alliances can foster engagement. This study examined behavioral indicators of member engagement (e.g., recruitment and retention of organizational and individual members) and how they are related to two foundational dimensions of alliance functioning - alliance leadership and community centrality. Using three rounds of an internet-based survey of alliance members from 14 alliances, the study found that organizational recruitment and retention increased over time, from 26.6% to 41.5% and 56.0% to 65.2%, respectively. Recruitment of individuals increased over the study period (38.3% to 47.2%, while retention of individual members declined over the study period (61.0% to 53.2%). Alliance leadership was associated with lower levels of recruitment (both organizational and individual members) but higher levels of organizational retention (both organizational and individual members). Collectively, our findings suggest that behavioral aspects of alliances are more effective at retaining members than relatively stable characteristics such as size and positioning in the community. Contrasting relationships between recruitment and retention, however, suggest that different forms of leadership may be required to simultaneously attract new members while retaining existing ones.

The Missing Ingredient for Successful Multi-Stakeholder Partnerships: Cooperative Capacity

Multi-stakeholder partnerships are an essential vehicle for solving complex societal problems. Agreements governing these partnerships often lack equitable partner agency in framing and enforcing multi-stakeholder agreements. This challenges the partner cooperation needed of partnerships to be effective. This theoretical paper introduces a new original model to measure and develop the cooperative capacity of multi-stakeholder partnerships so that future agreements involving the partnership are framed to share governance equitably among all partners and hence, increase partnership performance and effectiveness. The model provides a methodology to measure and develop the cooperative capacity of multi-stakeholder partnerships through key performance indicators that identify the cooperative state of partners and predicts partnership effectiveness in achieving common goals. The paper traces the theoretical genesis of the model, presents a comprehensive explanation of the model, and provides cases of the model’s application.

A mixed-methods evaluation using effectiveness perception surveys, social network analysis, and county-level health statistics: A pilot study of eight rural Indiana community health coalitions

Community health coalitions (CHCs) are a promising approach for addressing disparities in rural health statistics. However, their effectiveness has been variable, and evaluation methods have been insufficient and inconsistent. Thus, we propose a mixed-methods evaluation framework and discuss pilot study findings. CHCs in our pilot study partnered with Purdue Extension. Extension links communities and land grant universities, providing programming and support for community-engaged research. We conducted social network analysis and effectiveness perception surveys in CHCs in 8 rural Indiana counties during summer 2017 and accessed county-level health statistics from 2015-16. We compared calculated variables (i.e., effectiveness survey k-means clusters, network measures, health status/outcomes) using Pearson's correlations. CHC members' positive perceptions of their leadership and functioning correlated with interconnectedness in their partnership networks, while more centralized partnership networks correlated with CHC members reporting problems in their coalitions. CHCs with highly rated leadership and functioning developed in counties with poor infant/maternal health and opioid outcomes. Likewise, CHCs reporting fewer problems for participation developed in counties with poor infant/maternal health, poor opioid outcomes, and more people without healthcare coverage. This pilot study provides a framework for iterative CHC evaluation. As the evidence grows, we will make recommendations for best practices that optimize CHC partnerships to improve local health in rural areas.

How to Identify Success Among Networks That Promote Active Living

OBJECTIVES

We evaluated organization- and network-level factors that influence organizations' perceived success. This is important for managing interorganizational networks, which can mobilize communities to address complex health issues such as physical activity, and for achieving change.

METHODS

In 2011, we used structured interview and network survey data from 22 states in the United States to estimate multilevel random-intercept models to understand organization- and network-level factors that explain perceived network success.

RESULTS

A total of 53 of 59 "whole networks" met the criteria for inclusion in the analysis (89.8%). Coordinators identified 559 organizations, with 3 to 12 organizations from each network taking the online survey (response rate = 69.7%; range = 33%-100%). Occupying a leadership position (P < .01), the amount of time with the network (P < .05), and support from community leaders (P < .05) emerged as correlates of perceived success.

CONCLUSIONS

Organizations' perceptions of success can influence decisions about continuing involvement and investment in networks designed to promote environment and policy change for active living. Understanding these factors can help leaders manage complex networks that involve diverse memberships, varied interests, and competing community-level priorities.

Connective management and governance network performance: the mediating role of throughput legitimacy. Findings from survey research on complex water projects in the Netherlands

In this paper we empirically examine the relationship between connective management, democratic legitimacy, and network performance in governance networks around complex water projects in the Netherlands. Realizing effective and legitimate solutions in such a context is highly challenging, as a variety of interests are at stake, and actors often disagree about goals of the water issue at stake. Although previous research has indicated the importance of network management for the performance of governance networks, the issue of democratic legitimacy is not much addressed in this relationship. Building on the literature, we expect to find that throughput legitimacy has a partly mediating role in the relationship between connective management and network performance. The results, based on survey research, indicate that governance networks have indeed democratic potential but, in order to make this potential manifest, network managers can play a key ‘connective’ role. Furthermore, the results confirm our hypotheses that throughput legitimacy positively affects network performance and that it has a mediating effect on the relationship between connective management and network performance. Network managers can create important conditions for the evolution of a democratic governance process, but are dependent on the way stakeholders interact with one another and the democratic quality of that interaction.

Improving the performance of interorganizational networks for preventing chronic disease: identifying and acting on research needs

This article describes the role of interorganizational networks in chronic disease prevention and an action research agenda for promoting understanding and improvement. Through a model of engaged scholarship, leaders with expertise and experience in chronic disease prevention networks helped shape research directions focused on network value, governance, and evolution. The guiding principles for facilitating this research include applying existing knowledge, developing network-appropriate methods and measures, creating structural change, promoting an impact orientation, and fostering cultural change.

Implementation of collaborative governance in cross-sector innovation and education networks: evidence from the National Health Service in England

Background

Increasingly, health policy-makers and managers all over the world look for alternative forms of organisation and governance in order to add more value and quality to their health systems. In recent years, the central government in England mandated several cross-sector health initiatives based on collaborative governance arrangements. However, there is little empirical evidence that examines local implementation responses to such centrally-mandated collaborations.

Methods

Data from the national study of Health Innovation and Education Clusters (HIECs) are used to provide comprehensive empirical evidence about the implementation of collaborative governance arrangements in cross-sector health networks in England. The study employed a mixed-methods approach, integrating both quantitative and qualitative data from a national survey of the entire population of HIEC directors (N = 17; response rate = 100%), a group discussion with 7 HIEC directors, and 15 in-depth interviews with HIEC directors and chairs.

Results

The study provides a description and analysis of local implementation responses to the central government mandate to establish HIECs. The latter represent cross-sector health networks characterised by a vague mandate with the provision of a small amount of new resources. Our findings indicate that in the case of HIECs such a mandate resulted in the creation of rather fluid and informal partnerships, which over the period of three years made partial-to-full progress on governance activities and, in most cases, did not become self-sustaining without government funding.

Conclusion

This study has produced valuable insights into the implementation responses in HIECs and possibly other cross-sector collaborations characterised by a vague mandate with the provision of a small amount of new resources. There is little evidence that local dominant coalitions appropriated the central HIEC mandate to their own ends. On the other hand, there is evidence of interpretation and implementation of the central mandate by HIEC leaders to serve their local needs. These findings augur well for Academic Health Science Networks, which pick up the mantle of large-scale, cross-sector collaborations for health and innovation. This study also highlights that a supportive policy environment and sufficient time would be crucial to the successful implementation of new cross-sector health collaborations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-014-0552-y) contains supplementary material, which is available to authorized users.

Governance processes and change within organizational participants of multi-sectoral community health care alliances: the mediating role of vision, mission, strategy agreement and perceived alliance value

Multi-sectoral community health care alliances are organizations that bring together individuals and organizations from different industry sectors to work collaboratively on improving the health and health care in local communities. Long-term success and sustainability of alliances are dependent on their ability to galvanize participants to take action within their 'home' organizations and institutionalize the vision, goals, and programs within participating organizations and the broader community. The purpose of this study was to investigate two mechanisms by which alliance leadership and management processes may promote such changes within organizations participating in alliances. The findings of the study suggest that, despite modest levels of change undertaken by participating organizations, more positive perceptions of alliance leadership, decision making, and conflict management were associated with a greater likelihood of participating organizations making changes as a result of their participation in the alliance, in part by promoting greater vision, mission, and strategy agreement and higher levels of perceived value. Leadership processes had a stronger relationship with change within participating organizations than decision-making style and conflict management processes. Open-ended responses by participants indicated that participating organizations most often incorporated new measures or goals into their existing portfolio of strategic plans and activities in response to alliance participation.

Using a participatory evaluation design to create an online data collection and monitoring system for New Mexico's Community Health Councils

We present the collaborative development of a web-based data collection and monitoring plan for thirty-two county councils within New Mexico's health council system. The monitoring plan, a key component in our multiyear participatory statewide evaluation process, was co-developed with the end users: representatives of the health councils. Guided by the Institute of Medicine's Community, Health Improvement Process framework, we first developed a logic model that delineated processes and intermediate systems-level outcomes in council development, planning, and community action. Through the online system, health councils reported data on intermediate outcomes, including policy changes and funds leveraged. The system captured data that were common across the health council system, yet was also flexible so that councils could report their unique accomplishments at the county level. A main benefit of the online system was that it provided the ability to assess intermediate, outcomes across the health council system. Developing the system was not without challenges, including creating processes to ensure participation across a large rural state; creating shared understanding of intermediate outcomes and indicators; and overcoming technological issues. Even through the challenges, however, the benefits of committing to using participatory processes far outweighed the challenges.

Community size as a factor in health partnerships in community parks and recreation, 2007

Introduction

Although partnerships between park and recreation agencies and health agencies are prevalent, little research has examined partnership characteristics and effectiveness among communities of different sizes. The objective of this study was to determine whether park and recreation leaders’ perceptions of partnership characteristics, effectiveness, and outcomes vary by community size.

Methods

A web-based survey was completed in 2007 by 1,217 National Recreation and Park Association members. Community size was divided into 4 categories: very small, small, medium, and large. Questions measured agencies’ recognition of the need for partnerships, their level of experience, and the effectiveness and outcomes of partnerships.

Results

Larger communities were significantly more likely to recognize the need for and have more experience with partnerships than smaller communities. Very small and large communities partnered significantly more often with senior services, nonprofit health promotion agencies, and public health agencies than did small and medium ones. Large and small communities were significantly more likely than very small and medium communities to agree that their decision making in partnerships is inclusive and that they have clearly defined goals and objectives. Large communities were significantly more likely than very small communities to report that their partnership helped leverage resources, make policy changes, meet their mission statement, and link to funding opportunities.

Conclusion

Community size shapes partnership practices, effectiveness, and outcomes. Very small communities are disadvantaged in developing and managing health partnerships. Increasing education, training, and funding opportunities for small and rural park and recreation agencies may enable them to more effectively partner with organizations to address community health concerns.

Municipalities collaborating in public health: the Danish Smoking Prevention and Cessation Partnership

This study explored the Smoking Prevention and Cessation Partnership (SPCP) which builds upon a collaboration between two Danish municipalities targeted at the prevention of tobacco smoking. The aim of the study was to describe the processes of SPCP, to examine the difficulties this collaboration faced, and to assess how these experiences could be used to improve future partnership collaboration. We employed qualitative methodology comprising 12 semi-structured one-to-one interviews with SPCP’s stakeholders and an analysis of the partnership documents and reports. The findings suggested that the main potentials of the partnership were the personal relations between the members and stakeholders with the possibilities of the creation of new connections with other actors. Barriers to successful partnership building were the implementation of the new Local Government Reform as a competing task, and that the two municipalities were heterogenic in respect to organizational issues and working methods. Other impediments included the lack of continuity in leadership, the lack of clarity regarding the form of collaboration and roles, as well as different expectations of the stakeholders. We conclude that four factors remain critical for partnerships. The first is the clarity of the collaborative effort. Second, partnerships need to take into account the structural circumstances and culture/value systems of all stakeholders. Third is the impact of contextual factors on the development of the partnership; and the fourth factor is the bearing of personal/individual factors on the partnership e.g., personal engagement in the project. Early attention to these four factors could contribute to more effective partnership working.

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.