Collaboration Structures

Types of Collaboration Structures

There are many forms of public health and primary care collaborations. The most common collaborations can be described in three ways.

Interdisciplinary teams
First are collaborations which involve interdisciplinary teams. This is likely to happen where primary care and public health are organized in a regional health authority such as in British Columbia or Alberta.

An example of this is a sexual health clinic that provides outreach services delivered by a multidisciplinary team of primary care and public health nurses, physicians, social workers, and outreach workers. A Quebec example is the social service center (CSSS), which is community-based, provides primary care services, and also has responsibility for population health. 

Public health programs/services in a primary care setting
For example, a community nutritionist is scheduled monthly to teach a group of persons with diabetes how to cook appetizing meals in healthier ways. This class occurs in the primary care clinic meeting room in conjunction with health monitoring conducted by the nurse practitioner.

Primary care programs or services in a public health setting
An example of this is the management and delivery of community flu clinics. Primary care nurses can be seconded from their clinics to help support public health nurses in these busy community clinics.

Example: Collaboration to Support Smoking Cessation
Often but not always, public health has been the initiator or facilitator of collaboration. It is not uncommon to find public health staff providing best practice information to primary care physicians, nurse practitioners, or primary care nurses to increase their capacity to implement best practices for smoking cessation. Public health nurses assisted primary care staff to identify and implement free medical resources to support tobacco cessation.

In this exemplary case, the following joint activities were agreed upon that expanded to include additional community partners and involved advocacy work, as well as supporting multiple smoking cessation interventions. They included:

• Implementing Best Practice Guidelines into all tobacco cessation strategies;
• Supporting workplaces to create comprehensive tobacco control policies to support cessation attempts by employees;
• Reorienting health and community services to include tobacco cessation activities in healthcare and community settings by providing training or support to healthcare professionals and lay health supports in accessing training as follows: Nicotine replacement therapy, intensive interventions, motivational interviewing, group facilitation, and other topics;
• Raising awareness among health professionals about tobacco use as a chronic disease risk factor and how cessation impacts chronic disease outcomes, and creating key messaging for this into current training;
• Participating in activities that support tobacco reduction and tobacco cessation;
• Developing and enhancing collaborative partnerships to increase cessation capacity within the community;
• Providing training to all staff to implement Fax Referral to the provincial smoker’s helpline;
• Promoting participation in the provincial quit smoking contest;
• Collaborating with Addictions Research Centre;
• Collaborating and advocating for a provincial cessation strategy with universal access to Nicotine Replacement Therapy.

This work quickly expanded to include other healthy living topics such as sun safety, physical activity, nutrition, and cancer prevention. Health unit staff also created a resource binder for each primary care office and provided a supply of resources including ordering information. This involved staff from a number of public health program areas and many staff in the primary care clinic.

Building a Common Understanding

For everyone who is involved in working together in a collaboration, it is helpful to have a common understanding of terms related to different ways of working together. A common language can help promote effective communication, which is a critical factor influencing collaboration.

Related: Effective Communication

Himmelman’s Collaborative Continuum
In 2002, Arthur Himmelman developed a collaborative continuum to help us understand various ways of working together between organizations. The concepts are applicable to primary care and public health collaboration.

The continuum includes: networking, coordination, cooperation, and collaboration. Each level builds on the next, along a developmental continuum. No one level is more important than the other and each strategy used will vary depending on the aim. There are greater levels of trust, time, and turf committed in the relationship as you move up through the continuum.

Networking simply involves the exchange of information for mutual benefit.

Networking
“I call the public health unit when I need something such as information on new vaccine schedules, or to notify them about a patient with a reportable communicable disease.”

 

Coordination builds upon aspects of networking by adding the dimension of altering activities for mutual benefit and to achieve a common purpose. Typically through better coordinating of programs and services, user-friendliness and access can be enhanced.

Coordination
“We’re looking at gathering information from the community and bringing them to the table, sharing information about what primary care, public health, and the other community agencies can provide and what is going on. Then, we are able to say that the community has identified this or that issue, such as obesity prevention. And this is something that we can each address in our own organizations. We can determine who feels best to take on different aspects of the problem.”

Cooperation builds on all the dimensions of cooperation and adds sharing of resources. Resources can be human, fiscal, or technical, such as knowledge resources.

Cooperation
“There is a community gathering on the weekend.  It is a full day event for homeless, or street-involved, or almost street-involved people.  Public health staff have been asked by our street outreach  program staff, which is run by our community centre, to provide flu shots at the event.”

Collaboration includes all of the above dimensions plus involves enhancing the capacity of another for mutual benefit and to achieve a common purpose.

Collaboration
“Our partners bring their organizations into a program-centred structure that involves a joint commitment to plan and act jointly on common goals and objectives related to our program. This is accomplished through a joint program committee. Partners work together to identify needs and resources, plan and achieve shared goals, and identify and eliminate gaps and duplication by shifting resources. This results in more comprehensive service delivery. 

Some jointly developed program-centred policies and communication mechanisms are developed to ensure a woman-centred approach which is consistent with a person-centred approach in primary health care. A formal Memorandum of Understanding outlines agreements of the partners and is overseen by a Management Committee that is made up of partners and that meets as required.”