Partnership disengagement from primary community care networks (PCCNs): A qualitative study for a national demonstration project

Abstract

BackgroundThe Primary Community Care Network (PCCN) Demonstration Project, launched by the Bureau of National Health Insurance (BNHI) in 2003, is still in progress. Partnership structures in PCCNs represent both contractual clinic-to-clinic and clinic-to-hospital member relationships of organizational aspects. The partnership structures are the formal relationships between individuals and the total network. Their organizational design aims to ensure effective communication, coordination, and integration across the total network. Previous studies have focused largely on how contractual integration among the partnerships works and on its effects. Few studies, however, have tried to understand partnership disengagement in PCCNs. This study explores why some partnerships in PCCNs disengage.MethodsThis study used a qualitative methodology with semi-structured questions for in-depth interviews. The semi-structured questions were pre-designed to explore the factors driving partnership disengagement. Thirty-seven clinic members who had withdrawn from their PCCNs were identified from the 2003-2005 Taiwan Primary Community Care Network Lists.ResultsOrganization/participant factors (extra working time spend and facility competency), network factors (partner collaboration), and community factors (health policy design incompatibility, patient-physician relationship, and effectiveness) are reasons for clinic physicians to withdraw or change their partnerships within the PCCNs.ConclusionsTo strengthen partnership relationships, several suggestions are made, including to establish clinic and hospital member relationships, and to reduce administrative work. In addition, both educating the public about the concept of family doctors and ensuring well-organized national health policies could help health care providers improve the integration processes.

Political Challenges in Complex Place-Based Health Promotion Partnerships

“…Change management processes, where they do exist, could be improved with more participatory input 29 especially as the context of joint working evolves continuously. Support through change processes may not stop the attrition of all staff 34 ; however, as the impact of losing champions is significant, an effort should be made to retain organizational level leaders.…”

“…Attempts to evaluate the success of partnership working suggest mixed outcomes, 29 and recommendations have included monitoring of partnership functioning criteria 30 and caution policy makers and services to maintain a clear perspective on the partnership aims. 17,31 Increasingly the literature highlights lessons learned from multiorganization partnership experiences 32 including factors that impede partnership development, 33 circumstances leading to withdrawal from partnerships, 34 and the impact of politics and policy change. 9,35 As an example of partnership working, models of service integration across health and social care systems have emerged in response to fragmentation that exists across systems and services.…”

Developing community partnerships for primary healthcare: An integrative review on management challenges

“…We encountered this in thirty-five articles. The lack of or fragile connection between the partnership and the actual community [10][11][12][13][14][15][16][17][18] as well as the absence of participation by the community [10,19,20] were highlighted. Factors relating to the actual participants from the community were also found to hinder the development of the partnership [21].…”

“…It should have a sense of community and all of its actions should have the community as a base or focus. In turn, the partnership must also be accepted by the community itself [10,15,18,19,21,23,24,27,33,[35][36][37][38][39][40][41][42][43][44].…”

“…Geographical factors such as distance between partners and distance to the facility for participants from the community were also determined to be barriers to the partnership and this was discussed in seven articles [13,15,[44][45][46][47][48].…”