Measuring partnership synergy and functioning: Multi-stakeholder collaboration in primary health care

Abstract

In primary health care, multi-stakeholder partnerships between clinicians, policy makers, academic representatives and other stakeholders to improve service delivery are becoming more common. Literature on processes and approaches that enhance partnership effectiveness is growing. However, evidence on the performance of the measures of partnership functioning and the achievement of desired outcomes is still limited, due to the field’s definitional ambiguity and the challenges inherent in measuring complex and evolving collaborative processes. Reliable measures are needed for external or self-assessment of partnership functioning, as intermediate steps in the achievement of desired outcomes. We adapted the Partnership Self-Assessment Tool (PSAT) and distributed it to multiple stakeholders within five partnerships in Canada and Australia. The instrument contained a number of partnership functioning sub-scales. New sub-scales were developed for the domains of communication and external environment. Partnership synergy was assessed using modified Partnership Synergy Processes and Partnership Synergy Outcomes sub-scales, and a combined Partnership Synergy scale. Ranking by partnership scores was compared with independent ranks based on a qualitative evaluation of the partnerships’ development. 55 (90%) questionnaires were returned. Our results indicate that the instrument was capable of discriminating between different levels of dimensions of partnership functioning and partnership synergy even in a limited sample. The sub-scales were sufficiently reliable to have the capacity to discriminate between individuals, and between partnerships. There was negligible difference in the correlations between different partnership functioning dimensions and Partnership Synergy sub-scales. The Communication and External Environment sub-scales did not perform well metrically. The adapted partnership assessment tool is suitable for assessing the achievement of partnership synergy and specific indicators of partnership functioning. Further development of Communication and External Environment sub-scales is warranted. The instrument could be applied to assess internal partnership performance on key indicators across settings, in order to determine if the collaborative process is working well.

Activating Partnership Assets to Produce Synergy in Primary Health Care: A Mixed Methods Study

“…Our Communication and External Environment sub-scales did not perform well metrically [63]. However, the Spearman rank correlations between all three communication items and partnership synergy were moderate, supporting our qualitative conclusion that communication was an important dimension of partnership functioning.…”

“…Spearman rank correlations among partnership synergy outcomes, partnership synergy processes, total partnership synergy and the different partnership assets and processes (n = 54). Values shaded in light grey denote weak correlations and in dark grey strong correlations (adapted from [63]). We subsequently analyzed the scores for partnership synergy outcomes, partnership synergy processes and total partnership synergy in each of the five partnerships.…”

“…Our quantitative results revealed a high score for financial resources across all studied partnerships but a low correlation with most other dimensions of partnership functioning and Partnership Synergy Outcomes. This low correlation suggests that the Financial Resources sub-scale that we used might not have reflected the complexity in the types of tangible resources that were at play in IMPACT partnerships [63]. Alternatively, it may be explained by the fact that some multi-stakeholder health partnerships have few tangible resources.…”

“…The qualitative phase entailed exploring, in a smaller sample, the different manifestations of partnership synergy, the types of partnership assets and broad categories of partnership processes relevant to multi-stakeholder partnerships PHC [62]. Based on the qualitative findings, the quantitative phase included measuring, in a larger sample of partnerships, the achievement of partnership synergy and exploring associations between partnership synergy, partnership assets and partnership processes [63]. Qualitative findings and quantitative results were subsequently integrated to obtain a deeper understanding of the multi-stakeholder partnership phenomenon [60].…”

“…Figure 2.Comparison of values of partnership assets, processes and total partnership synergy by partnership (n = 5) (reproduced from[63]). …”