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

Abstract

Partnerships are an important mechanism to tackle complex problems that extend beyond traditional organizational divides. Partnerships are widely endorsed, but there is a need to strengthen the evidence base relating to claims of their effectiveness. This article presents findings from a mixed methods study conducted with the aim of understanding partnership processes and how various partnership factors contribute to partnership effectiveness. The study involved five multi-stakeholder partnerships in Canada and Australia working towards improving accessibility to primary health care for vulnerable populations. Qualitative data were collected through the observation of 14 partnership meetings and individual semi-structured interviews (n = 16) and informed the adaptation of an existing Partnership Self-Assessment Tool. The instrument was administered to five partnerships (n = 54). The results highlight partnership complexity and the dynamic and contingent nature of partnership processes. Synergistic action among multiple stakeholders was achieved through facilitative processes at the interpersonal, operational and system levels. Synergy was associated with partnership leadership, administration and management, decision-making, the ability of partnerships to optimize the involvement of partners and the sufficiency of non-financial resources. The Partnership Synergy framework was useful in assessing the intermediate outcomes of ongoing partnerships when it was too early to assess the achievement of long-term intended outcomes.

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis

“…The overall characteristics of included studies are summarized in each section of the key attributes of good PHC delivery [19]. Of 112 studies included, methodologically, 29 were qualitative studies [17,, 20 were cross-sectional [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71], 15 were mixed-method studies [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86], 10 were national / state based surveys / census [87][88][89][90][91][92][93][94][95][96], nine were retrospective / prospective cohort [97][98]…”

“…In our analysis, the Australian PHC delivery is comprehensive that it provides a wide range of services for a variety of target populations. In terms of the ranges of services, Australian PHC assess and deal with social determinants and / or risk factors [17,24,25,30,36,45,48,53,62,63,65,90,98,99,125], acute and chronic diseases [27,47,52,59,81,82,84,96,97,101,104,105,108,110,111,114,117,118,120 ], mental health [26,46,61,68,126,132], cancer and palliative care including aged care [43,86,103,122], pharmacy and medication safety [35,107], evidence-based practice and knowledge translation [55,…”

“…Yet, several challenges -including communication / language barriers, limited health literacy, cost [37], infrastructure and territorialism [39] affect PHC service coordination / integration. Given that service integration or inter-sectoral coordination has a synergistic effect in PHC service [81], service coordination / integration or transitioning care for the disadvantaged population such as refugees, prisoners [37,51,77] and indigenous populations [64] needs critical policy and programmatic interventions (Table S4 in the Online Supplementary Document). The innovative community discussion model -YARN -an Indigenous cultural form of conversation that creates safe space for discussion and debate -is effective to identify social determinants of health [24] and other barriers [119].…”