Leading public sector interorganizational collaboration in healthcare: Lessons from the intersection of climate and health

O'Leary S., Lieberman S., Gulyas A., Ogilvie M., Bates D., Heath T., Pelz C., Williams S., Shalet D.

Initiatives to tackle the climate emergency have tended to focus on large-scale actions that governments and investors (societal macro-levels) can take and smaller-scale individual habits, with limited attention given to the groups that form society between those ends of the spectrum (societal micro/meso-levels). This research aims to traverse that gap by studying three societal micro/meso-level groups; from the private, public and voluntary sectors, as represented by business, community and campaign groups. Existing literature and focus groups are used to identify what motivates actions on climate change, while exposing barriers that may drive choices of inaction. The study shows that concerns for the future and personal ethics play vital roles across business, community and campaign groups, while the principal barriers include difficulties in accessing support schemes and changes in political priorities. Better networking and knowledge exchange are considered essential for meaningful progress. This provides a new framework for management education to support organisations in tackling climate-related issues. Action guides may be developed and task-forces trained to provide hands-on support, especially for SMEs and local communities. The enthusiasm of younger people and campaigners, combined with others’ experiences, would create a powerful platform for climate emergency actions.

Crooks K., Law C., Taylor K., Brett K., Murray P., Kohlhagen J., Hope K., Durrheim D.N.

This case study describes the development and implementation of a governance structure that prioritised First Nations peoples in a local public health Incident Command System activated for the COVID-19 pandemic response in New South Wales, Australia. Using lessons learnt from past pandemics and planning exercises, public health leaders embedded an approach whereby First Nations peoples determined and led community and culturally informed pandemic control strategies and actions.In March 2020, First Nations governance was embedded into the local public health emergency response to COVID-19 in the Hunter New England region of New South Wales, Australia, enabling First Nations staff and community members to actively participate in strategic and operational decision-making with the objective of minimising COVID-19-related risks to First Nations peoples and communities. The model provided cultural insight and oversight to the local COVID-19 response; strengthened and advanced First Nations leadership; increased the First Nations public health workforce; led the development of First Nations disease surveillance strategies; and supported working groups to appropriately respond to local needs and priorities. This model demonstrates the feasibility of reframing a standard Incident Command System to embed and value First Nations principles of self-determination and empowerment to appropriately plan and respond to public health emergencies.

Kim J.

Abstract This article explores how deliberation affects distributive justice for minority view participants in policy decisions made through collaborative governance. It also examines whether the quality of deliberation (i.e., willingness to accept opposing viewpoints) and quantity of deliberation (i.e., length of discussion) can be an effective tool for minority view participants to overcome power imbalances in such collective decision-making processes. I use Agent-Based Modeling (ABM), a computer simulation experiment method, to examine interactions among participants in a collaborative governance arrangement. I develop a series of theoretical propositions based on the simulation results, which are robust to various changes in the parameters and assumptions of the model. First, both the quality and quantity of deliberation may enhance the decision acceptability of participants with minority views. Second, the quality of deliberation may be more effective at empowering underrepresented minority view participants than the quantity of deliberation. Third, the quantity of deliberation may better promote minority views than the quality of deliberation when minority view participants are overrepresented. These findings indicate that interpersonal justice in collaborative processes may enhance distributive justice for minority viewpoints in collaborative outputs, even when procedural justice in the design of collaboration is weakened by an underrepresentation of minority view participants. I conclude with suggestions for future research that can further improve the external validity of the theoretical propositions.

Feo R., Urry K., Conroy T., Kitson A.L.

To investigate nursing and allied health professional perceptions of the interrelationship between avoidable hospital readmissions and fundamental care delivery.A qualitative, exploratory study using a critical realist approach.One-to-one semi-structured interviews with 14 nursing and allied health professionals conducted between May and September 2019.Several tensions and contradictions were identified in the data, which demonstrated clinicians' perceptions about the priority of both fundamental care and two avoidable readmission conditions (aspiration pneumonia and constipation). These tensions are illustrated in two major themes: Avoidable versus inevitable; and everyone versus no one. The first theme demonstrates clinicians' perceptions that readmissions for aspiration pneumonia and constipation are not common, despite acknowledging that they generally lacked knowledge on readmission rates; and that these conditions may not be preventable in acute settings. The second theme demonstrates clinicians' perception that preventing readmissions is everyone's responsibility, however, this was coupled with a lack of articulation around how this multidisciplinary approach could be achieved, leading to a distinct lack of agency for care delivery.Articulating the tensions described in the results provides vital knowledge for understanding how clinicians may respond to initiatives designed to reduce avoidable readmissions. Avoidable hospital readmissions may be usefully understood as a wicked problem: one that is complex and requires adaptive, not linear, solutions. Wicked problems pose a challenge for leaders and managers in healthcare because top-down, hierarchical strategies are unlikely to be successful. Effective prevention of avoidable readmissions requires leaders to enable facilitator-led change through relational leadership strategies.Avoidable hospital readmissions are a global problem increasingly addressed via funding changes and the introduction of penalties to hospitals. This study provides insights on clinicians' perspectives of avoidable hospital readmissions and their prevention, demonstrating the complexity of this challenge and the need for healthcare leaders to enable individual and organizational readiness for change.

Crowshoe L.(., Sehgal A., Montesanti S., Barnabe C., Kennedy A., Murry A., Roach P., Green M., Bablitz C., Tailfeathers E., Henderson R.

• Persistent colonial assimilation policies have manifested themselves in ongoing Indigenous health inequities. • Systems transformations in primary health care can promote Indigenous health equity. • Strategic collaborations can achieve primary health care change for Indigenous peoples. • A research-to-practice and policy platform can mobilize strategies to achieve change. In 2015, the Truth and Reconciliation Commission of Canada released its Final Report with 94 Calls to Action, several of which called upon the health care sector to reform based on the principles of reconciliation. In the province of Alberta, Canada, numerous initiatives have arisen to address the health legacy Calls to Action, yet there is no formal mechanism to connect them all. As such, these initiatives have resulted in limited improvements overall. Recognizing the need for clear leadership, responsibility, and dedicated funding, stakeholders from across Alberta were convened in the Spring of 2019 for two full-day roundtable meetings to provide direction for a proposed Canadian Institutes of Health Research Network Environment for Indigenous Health Research that focused on primary health care and policy research. The findings from these roundtable meetings were synthesized and integrated into the foundational principles of the Indigenous Primary Health Care and Policy Research (IPHCPR) Network. The IPHCPR Network has envisioned a renewed and transformed primary health care system to achieve Indigenous health equity, aligned with principles and health legacy Calls to Action advocated by the Truth and Reconciliation Commission of Canada.

Schramm P.J., Ahmed M., Siegel H., Donatuto J., Campbell L., Raab K., Svendsen E.

Climate change has direct impacts on human health, but those impacts vary widely by location. Local health impacts depend on a large number of factors including specific regional climate impacts, demographics and human vulnerabilities, and existing local adaptation capacity. There is a need to incorporate local data and concerns into climate adaptation plans and evaluate different approaches. The Centers for Disease Control and Prevention (CDC) has provided funding, technical assistance, and an adaptation framework to assist localities with climate planning and activities. The differing processes with which states, cities, and tribes develop and implement adaptation plans have been observed. We outline examples of the implementation of CDC’s framework and activities for local adaptation, with a focus on case studies at differing jurisdictional levels (a state, a city, and a sovereign tribe). The use of local considerations and data are important to inform climate adaptation. The adaptable implementation of CDC’s framework is helping communities protect health.

Gray B., Purdy J.

Organizations turn to multistakeholder partnerships (MSPs) to meet challenges they cannot handle alone. By tapping diverse stakeholders’ resources, MSPs develop the capability to address complex issues and problems, such as health care delivery, poverty, human rights, watershed management, education, sustainability, and innovation. This book provides a comprehensive understanding of MSPs, why they are needed, the challenges partners face in working together, and how to design them effectively. Through the process of collaboration partners combine their differing strengths, vantage points, and expertise to craft innovative responses to pressing societal concerns. The book offers valuable advice for leaders about how to design and scale up effective partnerships and how to address potential obstacles partners may face, such as dealing with the conflicts and power issues likely to arise as partners negotiate with each other. Drawing on three comprehensive cases and countless shorter examples from around the world, the book offers practical advice for organizations embarking on an MSP, as well as theoretical understanding of how partnerships function. Using an institutional theory lens, it explains how partnerships can effect change in institutional fields by reducing turbulence and negotiating a common set of norms and routines to govern partners’ future interactions within the field of concern. Topics covered include: the nature of working collaboratively, why partnerships are needed, types of partnerships, guidelines for partnership design, partnerships and field dynamics, how to deal with conflicts among partners, negotiating across power differences, partnerships for sustainability, collaborative governance, working across scale differences, and how partnerships transform fields.

Holmes B.J., Best A., Davies H., Hunter D., Kelly M.P., Marshall M., Rycroft-Malone J.

Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper moves the discussion to a practical level, proposing actions that can be taken to implement evidence successfully in complex systems. Key to success is working with, rather than trying to simplify or control, complexity. The integrated actions relate to co-producing knowledge, establishing shared goals and measures, enabling leadership, ensuring adequate resourcing, contributing to the science of knowledge-to-action, and communicating strategically.

Crosby B.C., ‘t Hart P., Torfing J.

Bryson J.M., Crosby B.C., Stone M.M.

Theoretical and empirical work on collaboration has proliferated in the last decade. The authors’ 2006 article on designing and implementing cross-sector collaborations was a part of, and helped stimulate, this growth. This article reviews the authors’ and others’ important theoretical frameworks from the last decade, along with key empirical results. Research indicates how complicated and challenging collaboration can be, even though it may be needed now more than ever. The article concludes with a summary of areas in which scholarship offers reasonably settled conclusions and an extensive list of recommendations for future research. The authors favor research that takes a dynamic, multilevel systems view and makes use of both quantitative and qualitative methods, especially using longitudinal comparative case studies.

Brugnach M., Craps M., Dewulf A.

Involving indigenous peoples in the development of mitigation measures for climate change presents procedural, conceptual and structural challenges. Here, we reflect on some of these challenges and ways of overcoming them, as suggested by collaborative approaches to policy and decision making. We specifically focus on issues of scale, knowledge and power, and how they interrelate to act as a barrier or opportunity for the involvement of indigenous groups. We argue that multi-scalar negotiations, blended knowledge and power-sharing structures are all necessary to include indigenous communities as valuable partners in climate change mitigation, and we suggest strategies and recommendations for actively accomplishing this inclusion. Examples from recent literature about the inclusion of indigenous communities in different sectors, are used to illustrate and provide evidence of the current problematic and the need for collaborative solutions. Overall, the ideas expressed here, serve as a conceptual framework to better understand and support the inclusion of indigenous communities in policy and decision making processes.

Huxham C., Vangen S.

Head B.W., Alford J.

The concept of “wicked problems” has attracted increasing focus in policy research, but the implications for public organizations have received less attention. This article examines the main organizational and cognitive dimensions emerging from the research literature on wicked problems. We identify several recent approaches to addressing problem complexity and stakeholder divergence based on the literatures on systems thinking, collaboration and coordination, and the adaptive leadership roles of public leaders and managers. We raise some challenges for public management in some key functional areas of government—strategy making, organizational design, people management, and performance measurement. We argue that provisional solutions can be developed, despite the difficulties of reforming governance processes to address wicked problems more effectively.

Morse R.S.

Integrative public leadership is a process of developing partnerships across organizational, sectoral and/or jurisdictional boundaries that create public value. This paper explores the concept in the context of the literature and illustrates some salient features of integrative public leadership through three cases involving extensive multi-sector collaboration in the western (Smoky Mountain) region of North Carolina. The cases are different in subject matter—sewer lines to a rural community, broadband infrastructure across a network of rural schools and colleges, and a major environmental preservation effort—but they all share some key elements. Leadership in each case is enacted through structure, process, and people. Boundary organizations provide a structural context for partnership development; boundary experiences and boundary objects serve to bridge differences and create a common purpose; and boundary spanners exhibit entrepreneurial qualities and leverage relationship capital in order to facilitate integration.