Primary Care and Public Health Collaboration: Interactional Factors Influencing Capacity Building 1 Linda O Mara, 1 Ruta Valaitis, 1 Nancy Murray, 2 Donna Meagher-Stewart, 3 Sabrina Wong, 2 Ruth Martin-Misener, 1 Patricia Austin 1 McMaster University, 2 Dalhousie University, 3 University of British Columbia CANADIAN PUBLIC HEALTH ASSOCIATION CONFERENCE TORONTO, ONTARIO JUNE 20, 2011 omara@mcmaster.ca
Project Team Overall 4 year Program Lead: Ruta Valaitis. Researchers: Noori Akhtar-Danesh, Andrea Baumann, Paula Brauer, Fred Burge, Maureen Dobbins, Michael Green, Janusz Kaczorowski, Marjorie MacDonald (co-site lead British Columbia), Ruth Martin-Misener (co-site lead Nova Scotia), Donna Meagher-Stewart (co-site lead Nova Scotia), Linda O Mara (co-site lead Ontario), Rachel Savage, Sabrina Wong (co-site lead British Columbia). Decision-makers: John Blatherwick, Paula English, Lisa Grandy, Mary Fleming, Doris Grinspun, Jane MacDonald, Valerie MacDonald, Garey Mazowita, Jack McCarthy, Penny Nelligan, Vena Persaud, Joan Reiter, Mary Woodman. Advisory Committee: Allan Best, Donna Ciliska, Raisa Deber, Nancy Edwards, Jane Underwood. Research Coordinator: Patricia Austin Research Assistants: Laura Housden, Megan Kirk, Nancy Murray, Kristin MacLellan, Karen McNeil, Leena Wu. Students: Judy Burgess (post-doctoral Fellow), Sandy Isaacs (Doctoral Student)
Study Sponsors We would like to thank the following sponsors for financial and inkind support for this program of research: Canadian Health Services Research Foundation Health Services and Policy Research Support Network (HSPRSN) Partnership Program, the Michael Smith Foundation for Health Research School of Nursing and Faculty of Health Sciences, McMaster University Public Health Agency of Canada Huron County Health Unit Victorian Order of Nurses Canada Registered Nurses Association of Ontario Capital District Health Authority, Nova Scotia Canadian Alliance of Community Health Centres Association Somerset West Community Health Centre Canadian Public Health Association Hamilton Niagara Brant Local Health Integration Network
Presentation Outline Background of study Need for research Theoretical framework Methods Results Conclusions Next steps
Study Background Worldwide, health systems are struggling to determine the best ways for primary care (PC) and public health (PH) to collaborate. Health Canada s report Canadian Public Health and Primary Health Care Workshop stated that, since examples of successful collaborations between PC and PH exist, and future research needs to document what has worked and lessons learned.
Framework An evolving framework by San Martin-Rodrigues, Beaulieu, D Amour & Ferrada Videl is used to guide the research. This framework identifies three determinants for collaboration including: systemic determinants (outside the organization) in the environment where the collaboration takes place, organizational determinants (conditions within the organization) and interactional determinants (interpersonal interactions between team members).
Overall Research Question What do key informants perceive influences collaboration between public health and primary care at the interactional level?
Research Methods Study Design: Qualitative Descriptive Data Sources: 74 primary care and public health key informants interviews in British Columbia, Ontario and Nova Scotia Identified by team members and advisory committee and snowball sampling Data Analysis: Content analysis Coded with multiple research team members with primary care and public health expertise using constant comparison (NVivo 8 and 9) Multiple meetings using in-person, web conferences, and teleconferences to agree on coding definitions and structures to enhance rigour
Male n = 16; Female n = 58
Results Diagram Focus on interactional Intrapersonal Interpersonal
Inter and Intra Personal Factors
Intrapersonal Knowledge and Skills Lack of understanding of processes Individual's authoritarian style Leadership Skills Patience Personal Initiative Positive personal characteristics of practitioners Skills in facilitating change Values and Beliefs Individual versus a population focus Liability concerns Responsiveness of professionals The ability to manage nonhierarchical networking Unwilling to work in a team model Willingness, openness to collaborate
Interpersonal Decision Processes Trusting Inclusive Relationships Role Clarity Shared Values and Beliefs
Interpersonal Decision Processes Effective problem solving Effective decision making Ineffective problem solving Ineffective decision making Trusting Inclusive Relationships Effective /Ineffective Communication Previous existing relationships Social connection and dialogue Facilitation Lack of Trust, Respect Lack of willingness to work together Lack of common language Dialogue and Education MD communication challenges Strategies for building relationships Collaborative working style Inclusion and Involvement
Interpersonal Role Clarity Experience with other role Knowledge of who does what Understanding and agreement of roles and mandate Flexibility, Role Adaptation Lack of agreement and understanding of roles and mandate Feeling unappreciated and misunderstood by the other sector Perception and misconception about the other
Interpersonal Shared Values and Beliefs Belief in Collaboration Common Goals and Philosophy Entrenched negative interdisciplinary beliefs attitudes and or behaviours Lack of valuing of the role or work of the other sector No belief in benefits from collaboration Openness Shared Interests Valuing roles Task orientation of PC MDs Values Attitudes Philosophical Differences and Resistance to Change
Conclusions Numerous factors at the interactional level impact on collaboration between primary care and public health Relationships between factors exists within each level Results are consistent with our scoping literature review (http://strengthenphc.mcmaster.ca) Results provide direction for recommendations for policy makers/shapers, managers and practitioners
Next Steps Study 4 Case studies across 3 provinces (N = 10) 4 Ontario 3 Nova Scotia 3 British Columbia ON Pilot study data collection completed
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