Case Example
Case 1
A small urban community was suffering from a lack of coordination for well-baby and child health services. Problems included a concern about well-baby and child/youth health and access to care for families who were unattached to primary care services.
The Goal
The goal of the collaboration was to increase comprehensiveness of and access to well-baby and child/youth health care and reduce duplication.
The Mandates
The Rourke infant/child well-baby assessment was among the many activities that occurred in the public health nurses’ training by primary care practitioners. For further information regarding the Rourke Baby Record, Clinical Tools, and Resources, see www.cps.ca/tools-outils/rourke-baby-record.
It was believed that infants and children without a family doctor could be assessed by the public health nurse. This seemingly simple intervention raised many questions and concerns regarding the public health organization’s mandate.
One member of the collaboration, a public health promoter, explained the following: “It seems to me that conducting the Rourke assessments was actually considered a downstream approach regarding screening for individual client problems. This does not support a public health focus of upstream population health promotion.”
Related: Governmental and Regulatory Policies and Mandates for Collaboration
Public health staff were expected to work on population-level interventions, such as the development of policies around breastfeeding in public places. The plan to change the public health nurses’ role to incorporate Rourke assessments and screening was considered a move to downstream work and thus, was not easily accepted by the public health staff.
Some public health practitioners were now more confused about their mandate. One staff member shared her perspective: “One reason I don’t have a lot to do with primary care is because their role is care and my role is not care. So it’s hard to mesh our approaches.”
Addressing the Conflict
This conflict was partly addressed at the organizational level by the creation of strategic plans, operational plans, and formal agreements that outlined goals, mandates, vision, and roles and responsibilities of all partners. This helped clarify everyone’s roles, as well as communicated the main goals for the collaboration.
However, despite the fact that a clear goal for this collaboration was established up front at the organizational level, this situation demonstrated the challenges that can still occur when there are conflicting understandings of organizational mandates and the roles and expectations of staff working on the front lines.
It also demonstrated the challenges that can be created when mandates at the provincial (systems) level are not aligned with those at the organizational level. It also shows that overcoming such philosophical differences can be challenging and require significant time and effort to resolve.
Case 2
- Responsibilities and assignment of services,
- Commitment related to evaluation,
- Conflict management/ conflict resolution,
- Record sharing,
- Space and resource sharing commitments.
Another case example of a smoking cessation program illustrates how a clear mandate, vision, and goals between partners, as well as having a congruent focus and good understanding of the roles of each partner facilitates successful collaboration.
Smoking Cessation Program
The goal for this collaboration was to establish an effective smoking cessation program. The setting is in an urban/rural community with a population of 100,000, in a primary care office with an interdisciplinary team. The region had one of the highest smoking rates in the province and had a lack of programming aimed at tobacco reduction/smoking cessation in the area. Additionally, a number of health agencies/organizations had formed a tobacco network/coalition demonstrating a readiness in the community for more tobacco reduction action.
Roles, Responsibilities, and Mandates
Both the primary care physician and nurse practitioner in the primary care office saw the need for and value in setting-up a smoking cessation program for their patients. The nurse practitioner contacted the nurse manager at the public health unit to help them set-up a program.
The primary care nurse practitioner received a positive response from the nurse manager. For these nurses, their roles, responsibilities, and mandates needed to be identified, understood, and agreed upon from the start by the organizations. As time went on, they also agreed that there needed to be room for flexibility and adaptability in their roles.
The primary care nurse practitioner and the public health manager organized an orientation for new staff about the tobacco cessation program that included details related to their roles. Therefore, all the members involved in the smoking cessation program had a common understanding and agreement of roles and mandates.