Our Secret Weapon: Fortifying health systems through partnerships and collaboration (By Lucy Bertino)

There are a formidable number of adversaries facing healthcare systems globally: workforce shortages, deferred COVID “catch up” care and rising demand associated with demographic and disease trend shifts just to name a few!

To face the onslaught, health service managers and policy makers are arming themselves with innovative models of care, novel virtual solutions, workforce policies grounded in evidence and investments in capital, particularly for high growth areas and specialised high-volume care.

But is there another piece of artillery in our armour? Perhaps even a secret weapon?

Throughout my final year of the internship, I have had the opportunity to reflect on models of collaboration and partnership in jurisdictions near and afar. Globally, collaboration is being adopted in developed health systems to position providers to deliver scale and coordination benefits vital to face the onslaught of critical contemporary challenges and to deliver the high quality, safe and accessible care consumers expect.

Examples of structures promoting collaboration are not hard to find..

In the UK, the NHS has implemented Provider Collaboratives. These partnerships are non-legislated formalised partnership arrangements between at least two trusts (public NHS services)1. Provider collaboratives are expected to leverage the benefits of scale to support clinical, clinical support and/or corporate services and can promote either vertical care integration (a care pathway across settings from primary to acute for example) or horizontal care integration (shared vascular service across acute hospitals for example)1.

In Canada, Ontario Health Teams have been established, enabling organisations to work together to deliver coordinated services to a defined geographic population across the continuum of care2. 

Closer to home in Victoria; Health Service Partnerships are an example of a structure designed to facilitate collaboration for geographically co-located health services.  These partnerships aim to promote shared expertise, deliver scale and coordination, and create common goals3.

So, what does the literature tell us about the essential ingredients for collaboration? There are many, but here are six critical enablers:

• Relationships

Relationships with high levels of trust and integrity support strategic collaboration. Effective working relationships can be promoted through strong processes, knowledge sharing and regular communication4,5,6,7.

• Motivation and purpose 

Shared vision and culture are vital for collaboration. Clear and attainable mutual goals and objectives serve effective inter-organisation cooperation4,5.

• Governance and leadership

Well defined roles and responsibilities paired with robust accountability and decision-making mechanisms go a long way to uplift collaboration5. Ensuring the collaboration process, and the grounding principles, values and evidence upon which decisions are made, are open to scrutiny is imperative6.

• Perceptions

Importance of perceptions should not be underestimated. Models of collaboration perceived to be lower in complexity are more likely to succeed4. Likewise, a partnership’s legitimacy can be a deciding factor in its success or failure4.

• Resources and capabilities

Appropriate and equitable shared resourcing uplifts collaboration. This can include funding, time, materials, and staff including skilled leaders5,7.

• External factors

Environmental and structural factors including broader context and policies can promote joint working. Significantly, a history of cooperation and appropriate pace of development can also promote collaboration7.

While there is no silver bullet to tackle all system challenges; novel partnership models can be leveraged to harness collective strengths in our challenging landscape. Enablers of collaboration offer points of reflection to design partnerships and maximise effectiveness.

Disclaimer: the opinion (and analysis) expressed in this post are my own personal views.

References

1. The King’s Fund. (2022). Provider collaboratives: explaining their role in system working. https://www.kingsfund.org.uk/publications/provider-collaboratives
2. Ontario Health Teams: Guidance for Health Care Providers and Organisations. (date unknown). https://health.gov.on.ca/en/pro/programs/connectedcare/oht/docs/guidance_doc_en.pdf    
3. Victorian Department of Health. (2021). Health Service Partnership policy and guidelines. https://www.health.vic.gov.au/publications/health-service-partnership-policy-and-guidelines
4. Aunger, J.A., Millar, R., Rafferty, A.M., Mannion, R., Greenhalgh, J., & Faulks, D.  (2022). How, when, and why do inter-organisational collaborations in healthcare work? A realist evaluation. PLoS ONE 17(4) https://doi.org/10.1371/journal.pone.0266899
5. 5. Alderwick, H., Hutchings, A., Briggs, A., & Mays, N. (2021). The impacts of collaboration between local health care and non-healthcare organizations and factors shaping how they work: a systematic review of reviews. BMC Public Health 21, 753. https://doi.org/10.1186/s12889-021-10630-1
6. Australian Consensus Framework for the Ethical Collaboration in the Healthcare Sector. A consensus Statement of Shared Values and Ethical Principles for Collaboration and Interaction Among Organisations in the Healthcare Sector. (2018). acf_september_10_2018_w_apec_web.pdf (ahha.asn.au)
7. Wildridge, V., Childs, S., Cawthra, L. & Madge, B. (2008). How to create successful partnerships—a review of the literature. Health Information & Libraries Journal, 21: 3-19. https://doi.org/10.1111/j.1740-3324.2004.00497.x