Promoting collaborations that improve health

There is growing interest and investment in health-related collaboration in the United States. In an environment characterized by increasingly complex health problems, substantial resource constraints, and a fragmented health system, public and private organizations as well as communities are recognizing that most objectives related to health and health care cannot be achieved by any single person or organization working alone. Partnerships that bring together diverse people and organizations have the potential for developing new and creative ways of dealing with today's turbulent environment. Despite its potential advantages, collaboration also presents daunting challenges. Further, documenting the effectiveness of partnerships in improving health and well-being has been difficult. Given the significant difficulties of collaboration and the lack of evidence of its effectiveness, questioning whether the investment in health partnerships is justified seems reasonable. In this paper we address this question by illustrating the connective power of collaboration. We describe how collaboration, by connecting individual-level services, broadening community involvement in population-based health strategies, and linking individual-level services and population-based strategies, can improve the health of communities. We then discuss activities that could assist partnerships in reaching their collaborative potential and conclude by presenting the most compelling reasons for pursuing collaboration.     

Evaluation of cross-disciplinary training on the co-occurrence of domestic violence and child victimization: overcoming barriers to collaboration

The co-occurrence of child abuse and domestic violence has gained increasing attention over the last several years. As a result, there have been a number of efforts around the country to cross-train domestic violence and child welfare workers. Many of these initiatives are based on recommendations derived from prior research which emphasizes the importance of cross training child welfare workers, domestic violence advocates, and others in order to enhance interagency collaborations and ultimately improve the handling of co-occurrence cases. Using a survey design and two samples of child protective service (CPS) workers were drawn, this paper evaluates the effectiveness of a statewide initiative to improve inter-agency collaboration through a series of cross-disciplinary trainings. Special attention is also given to the identification of barriers and their potential role in shaping collaboration. While this study did not find significant changes in CPS workers' knowledge, attitudes, or self-reported levels of collaboration overall as a result of the training, collaboration was found to be related to increased knowledge and positive attitudes toward collaboration post training. The findings further demonstrate that efforts to cross-train staff can change the way CPS workers view the presence of some barriers to collaboration. Implications for future research and strategies for enhancing inter-agency collaboration in co-occurrence cases are discussed.     

Holding fast: the experience of collaboration in a competitive environment

Collaboration is one of the cornerstones of health promotion, with the literature indicating a range of circumstances under which it can either succeed or be undermined. In New Zealand in the 1990s, a market structure for health made collaboration of all kinds exceptionally difficult. This paper traces the efforts of a group of nutrition agencies (Agencies for Nutrition Action) to defy the popular wisdom and persist with collaborative efforts. The agencies were unsuccessful in their attempts to develop joint campaigns, but were very successful in advocacy and intersectoral action that did not threaten the position of individual agencies in the competitive environment. It is possible that the collaboration could have been more effective if agencies had been willing to surrender some autonomy and commit themselves to supporting a more independent new organization. However, this would have compromised not only their individual integrity but also their commitment to a relationship of equals. In 'holding fast' to a belief in health promotion, the ANA resisted being coopted by a now discredited market system, and emerged with its integrity and that of its participating agencies intact. ANA is now well positioned to work within an emerging policy environment that is more supportive of health promotion.     

Boundary at work: alternative medicine in biomedical settings

The study explores the process of boundary demarcation within hospital settings by examining a new phenomenon in modern medicine: collaboration between alternative and biomedical practitioners (primarily physicians) working together in biomedical settings. The study uses qualitative methods to examine the nature of this collaboration by calling attention to the ways in which the biomedical profession manages to secure its boundaries and to protect its hard-core professional knowledge. It identifies the processes of exclusion and marginalization as the main mechanisms by which symbolic boundaries are marked daily in the professional field. These processes enable the biomedical profession to contain its competitors and at the same time to avoid overt confrontations and mitigate potential tensions between the two medical systems.     

Teaching the public health core competency of policy development to baccalaureate student nurses

Teaching the public health core competency of policy development to baccalaureate student nurses was the purpose of this project. This project was implemented through interdisciplinary collaboration of one innovative state health district and the faculty of a large, urban university. Through education in the core competency of policy development, attention to one county's assessed health needs was introduced to its county board of health with the goal of influencing health policy regarding those needs. Data obtained have continued to be used by this county in health planning and grant writing activities and have been built upon by other student groups.     

A success-story in cross-border telemedicine in Europe: The use of intra-operative teleneuromonitoring during aorta surgery

Despite its potential benefits, telemedicine across borders in Europe is still in its early stages and little has been written about these collaborations. This paper aims to explore the factors, which have supported the implementation of a cross-border teleneuromonitoring collaboration between hospitals in the Netherlands, Germany and Switzerland. Semi-structured interviews with key actors were recorded and fully transcribed, and were analysed using framework analysis. Our results indicated that an array of factors facilitated collaboration in telemonitoring and assured its success and sustainability: (1) a real need to initiate the collaboration, (2) real benefits for all the parties involved, (3) agreed protocols and procedures from the start to overcome differences in healthcare systems, (4) two driving forces to sustain the collaboration; a quest for improved quality of care and for innovation, and (5) recognition that this is a bottom–up collaboration initiated by health care professionals who trusted each other.     

基于天气气候的健康气象预测研究展望

介绍影响人体健康的天气气候和大气环境因素、影响途径和方式,以及国内外基于天气气候的健康预测研究。气象与公共卫生部门密切的合作,开发基于天气气候的健康气象早期预警技术,增强预防干预措施,有利于降低相关疾病发生风险。     

Mandated collaboration: the case of the forensic MOU

The management and support of forensic clients is an area of interest to both clinicians and policy makers. Collaboration between hospital and community service providers is required and in some instances, mandated. This article reviews some of the literature about collaboration and examines selected experiences in the mental health field using a case study method. The case study examines the process of mandated collaboration in the development of the forensic MOU (memorandum of understanding), which involved CMHA Metro Toronto, and three general hospital ACT (assertive community treatment) teams and the Law and Mental Health Program at the Centre for Addiction Mental Health. The article offers observations on the extent to which collaboration is an emergent process that is responsive to its particular environment and explores power dynamics and how trust and flexibility affect outcomes in a positive or negative sense.     

Teaching Truth in Transitional Justice: A Collaborative Approach to Supporting Colombian Educators

The pursuit and acknowledgment of the truth of past atrocities and human rights abuses are critical processes in transitional societies. While truth commissions have become a central part of achieving these goals, there has historically been minimal attention to the role of teachers and students in this work. Critical and thoughtful teaching about the past conflict, however, may help prevent the reoccurrence of atrocities, promote acknowledgment and accountability of the past (which, in turn, fosters psychosocial healing), and support the construction of a peaceful society. In this paper, I detail a research collaboration with Colombia’s truth commission to aid its pedagogical efforts to develop effective resources and support Colombian educators’ instruction about the truth of past atrocities. I first draw on the literature to demonstrate the potential for education—and, specifically, teachers—to support the goals of truth commissions. Then, I describe the Colombian context and this specific collaboration. Finally, I end by presenting preliminary findings from surveys of teachers across Colombia and detailing future directions.     

Interorganizational collaboration for health care between nongovernmental organizations (NGOs) in Pakistan

The complexity and cost of health systems requires innovative forms of organization to provide accessible health services of an acceptable quality and at an acceptable cost. Interorganizational collaboration (IoC) is an innovation to increase the availability of organizational resources, improve service effectiveness, and improve access to health care. In Pakistan, a weak health system and little collaboration limit access, especially of women and children, to health services. Many nongovernmental organizations (NGOs) provide primary health care to the very poor, and some appear to collaborate to varying degrees; however, this has not been systematically analyzed. The purpose of this qualitative research, the first scientific study of collaboration between NGOs providing health services in Pakistan, was to describe collaboration between three pairs of NGOs providing community-based health services to women in Karachi. A long-term goal is to build a basis for future research linking IoC to access to health care and health outcomes. Findings indicated that collaboration was strongest when there was willingness to cooperate, a need for expertise and funds, and adaptive efficiency. In Pakistan's complex social environment, collaboration tended to be stronger when there was fairly high organizational formalization. Broader IoC appears to be positively associated with women's access to health care. Recommendations are made for future research, education, and management.     

Addressing the non-medical determinants of health: a survey of Canada's health regions

BACKGROUND: The Canadian health system is undergoing reform. Over the past decade a prominent trend has been creation of health regions. This structural shift is concurrent with a greater emphasis on population health and the broad determinants of health. In parallel, there is a movement toward more intersectoral collaboration (i.e., collaboration between diverse segments of the health system, and between the health system and other sectors of society). The purpose of this exploratory study is to determine the self-reported level of internal action (within regional health authorities) and intersectoral collaboration around 10 determinants of health by regional health authorities across Canada. METHODS: From September 2003 to February 2004, we undertook a survey of regional health authorities in Canadian provinces (N = 69). Using SPSS 12.0, we generated frequencies for the self-reported level of internal and intersectoral action for each determinant. Other analyses were done to compare rural/suburban and urban regions, and to compare Western, Central and Eastern Canada. RESULTS: Of the 10 determinants of health surveyed, child development and personal health practices were self-reported by the majority of health regions to receive greatest attention, both internally and through intersectoral activities. Culture, gender and employment/working conditions received least attention in most regions. CONCLUSION: The exploratory survey results give us the first Canadian snapshot of health regions' activities in relation to the broad range of non-medical determinants of health. They provide a starting data set for baselining future progress, and for beginning deeper analyses of specific areas of action and intersectoral collaboration.     

Intervention strategies directed at exposure to organic solvents at worksites: A case study

Exposure to organic solvents is a serious occupational health problem. Research has mainly been focused on the harmful medical effects of the substances. Models for practical safety work are lacking. The purpose of this review is to summarize and scrutinize experience gained by implementing methods for early detection of symptoms caused by exposure to solvents in the health services and practical safety work in the wood processing industry. Five interdependent phases have been developed during a 10-year period within the framework of a multidisciplinary collaboration: i) community diagnosis, ii) a treatment program, iii) an occupational environment program, iv) education and v) a demonstration plant. The results illustrate the need for regional epidemiological surveillance and increased collaboration between the health services and other sectors of the community.     

开放信息环境下传统学术出版商的内容运营策略——以英国物理学会出版社为例

【目的】梳理开放信息环境下传统学术出版商的内容运营趋势,为我国学术出版发展提供借鉴。【方法】选取学协会出版的代表性机构——英国物理学会出版社为研究对象,从内容运营视角分析其近年来在合作出版、学术增值、开放获取方面的建设策略。【结果】英国物理学会出版社着重与世界范围内物理学组织和个人的良好交流和沟通,积极采用知识集成和知识发现方法,并大力支持开放获取运动。【结论】传统学术出版商应在内容开发层注重与研究人员、领域机构和图书馆等学术共同体的互动协作,在内容组织层强调学术资源加工处理和关联整合强度,在内容传播层充分利用开放获取环节。     

Dissonant role perception and paradoxical adjustments: an exploratory study on Medical Residents’ collaboration with Senior Doctors and Head Nurses

A good collaboration between health professionals is considered to have benefits for patients, healthcare staff, and organizations. Nevertheless, effective interprofessional collaboration is difficult to achieve. This is particularly true for collaboration between Medical Residents (MRs) and the immediate colleagues they interact with, as Senior Doctors (SDs) and Head Nurses (HNs). Role understanding is one of the factors that may explain difficulties in interprofessional collaboration. Based on this hypothesis, this paper focuses on MRs’ role, devoting particular attention to differences in role perception between MRs, SDs, and HNs, and to their consequences for interprofessional collaboration. An exploratory qualitative study inspired by Grounded Theory was conducted in April 2009 in a small peripheral and non-university hospital in Switzerland. Data came from two focus groups with MRs (13), one with SDs (8), and one with HNs (7), and were analyzed using the constant comparative method. Findings show that the expected and the enacted role of MR are perceived differently by SDs, HNs and MRs themselves. To face the inconsistencies within MR’s role, the three professional groups develop some adjustments that eventually prove to be paradoxical: on one side, they make collaboration possible and preserve the functioning of the ward, while on the other side they lead to mutual misunderstanding and discontent. These findings suggest that there is an urgent need of defining the role of MRs, of delimiting its boundaries and thereby distinguishing it from other health workers, and eventually of promoting a shared representation of it.     

Influences of the social environment on engagement in occupations: the experience of persons with rheumatoid arthritis

The aim of this explorative study was to describe and enhance the understanding of how persons with rheumatoid arthritis (RA) experience the influence of the social environment on their engagement in occupations. Nine persons were interviewed and the data obtained were analysed using a comparative method. The findings revealed that other persons in the social environment influenced informants' experiences of engaging in occupations in two ways, which formed the categories: "Constructive collaboration" and "Insufficient collaboration". These categories had certain properties related to the actions the others undertook to assist the informants during their collaboration. These assisting actions influenced the informants' possibilities to engage in occupations, and also their experience of engagement. The findings also showed that the "Conditions for collaboration" varied and influenced their collaboration, which thereby constituted a third category. The findings may contribute to a deeper understanding of how other persons can facilitate and restrict meaningful occupational experiences. This provides knowledge that can be used by occupational therapists when empowering their clients and those close to them to reflect on their actions and the consequences of these actions to enhance occupational engagement.     

Haemodialysis in Turkey

In Izmir, Turkey's third largest town, remarkably good treatment results have been achieved in haemodialysis patients. This success has been achieved by the formation of a close-knit and durable team of physicians and nurses at Ege University. This has enabled patients to be treated using a strict volume-control method and to be given individual attention and psychosocial support. This has been made possible by close collaboration with a producer of dialysis machines. Possible conflicts of interest were avoided as there were no personal connections between physicians and the production sector.     

#CienciaenelParlamento: la necesidad de una oficina parlamentaria de asesoramiento científico y tecnológico

One of the aims of the citizen's initiative #CienciaenelParlamento is helping to establishing a parliamentary office of scientific and technological advice in the Spanish parliament. Said office would be in charge of fostering networking spaces between scientific knowledge and public policies and of triggering public debate between policy-makers, experts and the general public. In this article, we first review the main parliamentary mechanisms of scientific advice, with special attention to one in particular: parliamentary offices of scientific and technological advice. These offices exist in 22 parliaments worldwide, but there are none in Spain. Second, we describe the activity undertaken by #CienciaenelParlamento in its collaboration with the Congress of Deputies during the 12th Spanish Legislature. This collaboration reached its peak with a two-day networking event in November 2018 with over 200 scientists and almost 100 deputies, who all debated twelve topics of social interest and the most up-to-date scientific knowledge. Thanks to this collaboration, the Congress has taken the first steps towards officially establishing a parliamentary science advice office. Lastly, we enumerate some examples about how these parliamentary offices in other countries have contributed with other stakeholders to better public debate and processing of public policies in public health and other areas. To conclude, we at #CienciaenelParlamento believe that a parliamentary science advice office would help to enhance the science-policy ecosystem in Spain.     

Strategic market analysis: an effective tool for collaboration

If collaboration, not unrestrained competition, is part of the answer to containing health care costs, providers must choose their partners carefully. Competition won't disappear. It's here to stay. But many in our industry have come to the conclusion that increased collaboration is necessary to preserve community health care resources and prevent wasteful duplication of services and technology. Managed competition--a combination of government regulation and free markets--means simply that collaboration and competition will coexist in a new health care environment evolving toward integrated delivery systems of varying kinds.     

Examining variables related to successful collaboration on the hospice team

Although social work participation on interdisciplinary teams is long-standing, little research has been done to examine its effectiveness. This study used the Index of Interdisciplinary Collaboration to explore relationships between selected variables and teamwork in the hospice setting.The findings indicate that hospice social workers report a high level of interdisciplinary collaboration with colleagues. Whereas education, hospice census, the presence of other social workers, and quality of care were found to be unrelated to overall levels of collaboration, individual items measuring collaboration proved to be linked with hospice census, the presence of other social workers on the team, and quality of care. Further research is required to investigate other possible related variables and their impact on successful interdisciplinary collaboration and service delivery.