A rapid review of barriers and enablers of organisational collaboration: Identifying challenges in disability reform in Australia

Abstract

A rapid review of the literature on inter-organisational collaboration was undertaken to identify and describe key barriers and enablers of relevance to current disability policy developments in Australia. Term searches of four databases resulted in the identification of 433 articles published between 2009 and 2019. After removal of duplicates and refinement, 17 peerreviewed articles underwent full review, data extraction and synthesis to distil barriers and enablers of inter-organisational collaboration at three levels. At the macro-level, policy instruments, institutional arrangements and resources were salient. At the mesolevel, clarity of organisational purposes and roles, and organisational systems and processes were important, as were factors of leadership, management, power and workforce. At the micro-level, values, trust, culture and personal relationships could be either barriers or enablers, depending on context. The review indicated that meaningful and sustained collaboration across organisations is unlikely without careful planning, clear actions and significant investment at all three levels, providing important learnings for the Australian National Disability Insurance Scheme context.

NDIS Participants with Psychosocial Disabilities and Life-Limiting Diagnoses: A Scoping Review

“…However, this limited research reveals that formal support systems are inadequate [ 5 , 16 , 18 , 22 , 54 ] despite the multiple service providers involved in the lives of people with SPMI [ 14 , 17 , 51 ]. Furthermore, even though mental health, NDIS, and palliative care providers share person-centred values [ 15 , 19 , 40 , 92 , 93 ], collaboration between providers, though highly recommended and encouraged, is poor, limited or non-existent [ 15 , 16 , 18 , 21 , 22 , 27 , 38 , 40 , 53 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 ]. The NDIS does not fund case management or care coordination, a recognised and highly valued role in mental health systems [ 100 , 101 ], to the detriment of NDIS participants with complex support needs.…”

“…The NDIS does not fund case management or care coordination, a recognised and highly valued role in mental health systems [ 100 , 101 ], to the detriment of NDIS participants with complex support needs. Support coordination, specialist support coordination, and LAC roles do not have clear guidelines on how to provide support, nor the funding nor jurisdiction to provide this complex support [ 94 , 102 ]. The NDIA does briefly explain the role of specialist support coordinators on its website; however, the criteria to obtain funding for specialist coordination in an NDIS plan are not provided.…”

“…The complex care needs of people with SPMI with life-limiting conditions, and a lack of appropriate referrals to specialist palliative care, results in unmet needs, distressing end-of-life outcomes, and the inability to develop trust, a therapeutic alliance, and advance care directives [ 18 , 22 , 27 , 49 , 53 , 68 , 86 ]. Workers in the palliative care [ 14 , 107 ], mental health [ 18 ], and NDIS sectors [ 50 ] need to ‘bend the rules’, work unpaid hours and go above and beyond their system’s funding to support people with SPMI throughout their lives and as they die [ 16 , 25 , 27 , 38 , 61 , 94 , 108 ]. The literature describes concerns about the risks to and safety of staff and other patients that can negatively impact the delivery of palliative and end-of-life care to people with SPMI [ 5 , 14 , 18 , 22 , 26 , 39 , 109 ], sometimes leading to the need for restrictive practices such as chemical or physical restraint [ 40 , 109 ].…”

“…The literature shows that this leaves people with SPMI and life-limiting conditions feeling abandoned and dying alone in unfamiliar environments [ 22 , 79 ]. The literature also highlights the need for continuity of care and continued support from a multidisciplinary team where pre-existing therapeutic relationships are maintained and fostered, and medication management responsibilities are shared [ 22 , 24 , 53 , 79 , 94 ]. However, the research indicates that the mental health workforce often finds working with dying patients/clients challenging [ 5 , 16 , 28 ].…”

“…In addition, thin market issues have not been alleviated by the new, inexperienced NDIS providers entering the sector [ 95 ]. Competition is also impacting NDIS providers’ collaboration: while Foster et al report that providers reducing the types of services offered has increased collaboration [ 99 ], competition often negatively impacts interagency cooperation [ 94 , 95 ]. Even though the NDIS stresses the importance of collaboration between NDIS providers and other service systems, no funding, policy or legislation frameworks support this [ 94 ].…”