Challenges

Conflicting organizational mandates, vision, and goals can be a significant challenge to primary care and public health collaboration. An unwillingness to take risks, as well as having different visions and conflicting views of collaboration are among the biggest stumbling blocks.

Differing Mandates and Policies
Sometimes limitations are experienced because of differing mandates of employers or differing organizational policies that allow staff to do certain things but not others. When you are working in a collaboration, people should be able to bring their diverse skills within their scope of practice to the table.

Incongruent Focus
An incongruent focus is another major challenge that can be a barrier to an existing collaboration and also makes it difficult to forge new ones. The divergent focus of the sectors can be seen through the differing work processes. For example, public health’s focus relates to population health and long term outcomes; however, the focus of primary care is essentially the individual client and shorter term outcomes.

Listen to hear two different viewpoints from a physician in public health and a physician in primary care who speak to this challenge:

Click to hear the viewpoint of a physician in public health.
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Click to hear the viewpoint of a physician in primary care.
Click for transcription >>

 

One public health physician offered an alternate strategy for considering the differences:

“How do we work together to address the continuum of care, bringing our respective strengths, knowledge, skills, and opportunities to bear? I wonder if there has been too much emphasis on differences and not enough on finding common ground and goals to leverage each other’s strengths to share in the continuum of care.”

Lack of formalized agreements between primary care and public health can be another challenge. In most cases, the lack of formal agreements fosters uncertainty and lack of buy-in for collaboration. A significant outcome is practitioner role confusion and ineffectiveness. However, in some cases, such as smaller collaborations, formal agreements may not be welcomed as informal arrangements seem to work better.

Large bureaucratic organizational structures can also hinder collaborations, particularly when they involve large bureaucracies where decision making can be very slow and there is limited flexibility in making changes on work processes.

Further, in large organizations, having different directors/managers for public health and primary care can add an additional challenge to any collaboration. In the event that these individuals do not have a positive interpersonal working relationship, this is emphasized. In collaborations, these leaders are interconnected in their overall goals and, consequently, need to be able to work well together.

Related: Trusting and Inclusive Relationships
Related: Shared Values, Beliefs, and Attitudes

Unions
Unions can also become a barrier in collaborations. For example, when activities or roles of unionized staff need to change to meet the needs of a collaboration to address newly developed goals, it can mean having to get approvals from unions for the necessary role changes. This can slow the processes down and the delay may be a challenge to accommodate.