Challenges

Willingness to Share Roles
A major challenge to a collaborative organizational culture is turf protection or conflict. Tensions can arise when primary care and/or public health staff are unwilling to share roles and responsibilities for fear of losing their role and/or control. Staff may be protecting limited resources, such as funding, staff, time, products, or programs.

Flexibility                                                                                                                                                                                                                                                                                                                         Another challenge may be how large unionized public health organizations might be viewed by primary care. For example, public health may be viewed as being inflexible, not willing to work horizontally with community partners and not responding creatively or in a timely way.

“In my experience, public health is very structured. They say ‘we only do these things’. We asked for a public health nurse to come out four hours a week to do a breast feeding clinic. This request got turned down because public health thought if they did it for us, they might have to do it for other primary care practices too.

I think it was a really good idea, and actually I think it would have been a great pilot or a model that we could have developed. We needed to step outside of our normal roles and be a bit more creative and innovative.”

The reverse can also exist where public health does not understand primary care and is disappointed with an apparent lack of interest in working in partnerships.

“I want to have primary care and public health staff sit together and talk about what this could be and how it could be.

Public health loves to work with partners. They really do. It’s primary healthcare that doesn’t. They just don’t work with partners. And believe me, when I talk about collaboration, it’s really rough. They just don’t see why they need to work with others!”

It is not only the values, beliefs, and attitudes of individuals about collaboration that are important to consider. It is also those of organizations that need to be regarded; in other words, the organizational culture regarding collaboration needs to be understood and respected.

Related: Shared Values, Beliefs and Attitudes

Strong Leadership
It is also critical that the leadership in both primary care and public health promotes an organizational culture that values working together. Widespread support from primary care and public health staff is needed and not only reliance on an individual leader. Establishing a culture of collaboration can happen when each sector is valued by the other for their unique contributions and respectful negotiation occurs in relation to areas of duplication and/or overlap.