Challenges

It is not uncommon to find that some members of a collaboration lack knowledge about it altogether. This is often related to a failure of formal communication processes and/or structures.

Problematic communication processes can be related to:

• Slow communication that occur in large public health bureaucracies;
• Different types of communication processes in each organization;
• Lack of a common language between sectors;
• Lack of involvement of some players in communications;
• Lack of orientation of new members to the collaboration;
• No staff history of the collaboration;
• Lack of ongoing communication;
• No formal processes for communication;
• The fast pace and scheduled nature of primary care that makes it difficult to find time to communicate;
• Fear for some to breach their professional code of ethics of sharing client information;
• Email is effective however it can present challenges when it displaces face to face, in-person, contacts which are one of the central means to building and maintaining relationships.

Structures that can be challenges to communication processes are related to:

• A lack of information and communication infrastructure or technical difficulties in communication, such as email being down or telephone problems;
• Physical barriers, such as dealing with multiple partner sites, a lack of space for meetings, lack of shared space, and simply large physical distances between partners;
• Lack of structured time for communication;
• Logistical issues involving partners at all levels in the planning from the front line staff to the director level;
• Special challenges exist in rural areas when in-person contacts can be particularly challenging to maneuver.

Related: Optimal Use of Resources

Strategic coordination challenges at the organizational level

Problems with strategic coordination mechanisms can also occur. For example, due to the fast pace of primary care, processes can be difficult to change.  There can be difficulties with cross-sectoral planning, coordination, and implementation.

“There hasn’t been sustained planning for the collaboration, so it builds up and then it kind of disappears…”

Strategic planning is important, takes time and energy, and needs to be actively sustained.

Disconnect
It is not uncommon to have a disconnect between planning and implementation, a lack of an organized approach for addressing goals, no administrative supports to coordinate activities, and no policies and procedures in place. Overall it can be challenging to work across jurisdictions to involve all sectors.

Sharing of Information
Another challenge involves a lack of sharing of client information and or records. This can be related to a lack of use of electronic health records, lack of seamless information sharing, lack of comfort of one agency sharing information with another, an absence of cross jurisdictional information sharing agreements, and uncertainty about confidentiality related to sharing patient information.  Finally, organizations can be deterred by having inefficient or dissimilar documentation systems that present barriers to exchange of information.