public health partnerships: enthusiasm and evidence cpha conference 2014
TRANSCRIPT
Public Health Partnerships: Enthusiasm and Evidence
CPHA Conference 2014
Presenters
• Ross Graham– Manager of Strategic Projects, Middlesex-London Health Unit
• Shannon Sibbald – Assistant Professor, Faculty of Health Sciences & Schulich Interfaculty
Program in Public Health, Western University
• Anita Kothari– Associate Professor, Faculty of Health Sciences, Western University
Learning Objectives
• Describe the conflicting evidence and enthusiasm for public health partnerships
• Explore tools to support effective decision-making regarding partnerships
• Define strategies to optimize knowledge translation and service delivery via partnerships
Format
• Hands up Questions• Questions and discussion throughout• Questions at the end• Time for panel questions at the end
Public Health Partnerships: Enthusiasm & Evidence
Ross Graham MSc CHE
Manager, Strategic Projects
Middlesex-London Health Unit
“collaboration in public health… is not an option – it is necessary for success”(Wise, 2008)
PHPs in your Organization?
What areas of your organization commonly use PHPs?1. Not commonly used2. Commonly used, but mostly in health promotion areas3. Commonly used, but mostly in protection/prevention areas4. Commonly used across all areas
Roughly, how many PHPs is your organization involved with?5. 0 to 506. 51 to 1007. 100 to 2008. >200
Not Optional• A Core Competencies Canadian Public Health
Practitioners (#4)• A Foundation of the Ontario PH Standards
– And Mentioned ~10,000 times in the OPHS
• A Requirement for Ontario Health Organizations (#5.2)
And Internationally,• A core/essential/foundational PH practice (US,
UK, Australia)• A top PHSSR priority (in Canada too!)
However…
Partnerships are “perhaps the greatest challenge of the field” given public health’s “non-hierarchal structure involving seemingly limitless numbers of stakeholders”(Koh, 2009)
“the sheer variety of partnerships can be bewildering… possibly nowhere more so than in public health”(Hunter & Perkins, 2012)
What does the evidence say?
• “many studies, perhaps wrongly in some cases, equate the presence of collaboration with the success of a program without adequate empirical verification.”(McGuire, 2006)
• “despite a common belief that multisector collaboration can improve population health, researchers seldom study the effect of such collaboration on population health outcomes.”(Woulfe et al., 2010)
• partnerships still driven by ‘conventional wisdom’ rather than evidence. (Woulfe et al., 2010)
• only 30% of PHPs demonstrated “improved population-level outcomes that might be attributed to collaboration activities.”(Roussos & Fawcett, 2000).
Not Quite As Enthusiastic…
Not Quite As Enthusiastic…• “little evidence of the direct health effects of public health
partnerships”(Smith et al., 2009)
• “where successes relating to public health outcomes were observed, it was extremely difficult to assess the extent to which these were directly attributable to partnership working.”(Smith et al., 2009)
• From the incl. review (Smith et al.) “the impacts of intersectoral action on health equity are mixed and limited” (NCCMT, 2012)
• “Collaboration between local health and local government is commonly considered best practice. However, the review did not identify any reliable evidence that inter‑agency collaboration, compared to standard services, leads to health improvement” (Cochrane Review, 2011).
PHPs can be effective & necessary
PHPs Appear most effective at • fostering knowledge exchange (between
practitioners and organizations)• facilitating community-based research• achieving moderate behaviour-change in targeted
populations• supporting provision of PH services when PH
agencies have minimal resources
But Remember:Effective PHPs are the exception, not the rule
The Bottom Line• Mismatched enthusiasm &
evidence– Well-documented romance of
collaboration• Tough scenario for PH practitioners• Need to
– Discuss partnerships realistically– View partnerships as tool in PH
toolbox– Build the evidence base
Recommendations1. Use evidence-based criteria to assess probability of
success
2. Consider PHPs as one of many possible strategies to achieve a PH goal
3. Determine the optimal degree of involvement and investment
4. Insist on outcome measurements and publication of results
5. Devise an exit strategy that minimizes risks to stakeholder relations
Question
How does your agency decide whether or not to dedicate time/energy toward a PHP?
How do you monitor PHP effectiveness?
Tools for Partnering in Public Health
Shannon L SibbaldAssistant Professor, Faculty of Health Sciences & Schulich Interfaculty
Program in Public Health, Western University
Why Partner?
Public Health Agency of Canada
• To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health.
• Section Four: Partnerships, Collaboration and Advocacy
• Partnership and collaboration optimizes performance through shared resources and responsibilities
Why Partner?
• strong values of partnership, citizenship, and community
• Ethical obligation to do partnerships • public health/community partnership
– defining community health problems,– collecting and interpreting data, – designing appropriate interventions – jointly developing policies, regulations, and laws
Reflection
• What are some of the practical challenges you face in starting, maintaining, nurturing, sustaining partnerships?
• What do you do about it?• What can be done to improve your
experiences, outcomes and sustainability of partnerships?
Partnership ‘Tools’
• Prescriptive > how ought a partnership form and function
• Descriptive > how a partnership is functioning• Prescriptive > how to improve partnerships
• six “R’s” of participation: recognition, respect, role, relationship, reward, and results
Steps to Successful Partnership
• Stage 1: Initial Development• 1. Vision; 2. Goals; 3. Understanding the Situation; 4.
Commitment; 5. Implications
• Stage 2: Making It Happen• 1. Action Plans; 2. Resources; 3. Roles and Responsibilities; 4.
Capacity Building
• Stage 3: Accountability and Future Directions1. Evaluation; 2. Future Directions; 3. Revision, Renewal and
Closure
Frank &Smith. 2000. The Partnership Handbook
The Partnership Analysis Tool• VicHealth, Australia (2011)
• Goals: Maximize effectiveness of partnership through continuous assessment and monitoring in order to identify that need improvement
• Use: to promote discussion between agencies that will clarify roles(takes time to do this); completed by both partners together; to reflect on partnership
The Partnership Analysis ToolTool is divided into 3 sections/Activities
1. Assess the purpose2. Map the partnership3. Provide feedback
Available at: www.vichealth.vic.gov.au/partnerships
Social Network Analysis
• Mapping • describe interactions
– Snapshot• Individual or org level• Intervention
– longitudinal
Partnership Self-Assessment Tool• Center For The Advancement Of Collaborative Strategies In Health
(2002)• Eleven sections that are measured using a Likert scale and/or yes or no
questions: – synergy– leadership– efficiency– administration and management– non-financial resources– financial and other capital resources– decision making – benefits of participation – drawbacks of participation – benefits and drawbacks of participating in the partnership– satisfaction with participation
Available through NCCMT: http://www.nccmt.ca/uploads/registry/PSA%20Tool%20Questionnaire.pdf
NIQ/PIQ
• Examine: i) quality and ii) initial impacts of the partnerships
• 9 Domains:– communication, collaborative research,
dissemination of research, research findings, negotiation, partnership enhancement, information needs, rapport, and commitment
• Common, early and mature indicators
Kothari A, MacLean L, Edwards N, Hobbs A: Indicators at the interface: managing policymaker-researcher collaboration. Knowledge Manage Res Pract 2011, 9:203–214.
Successful partnership
• Things commonly found in successfully partnerships: – Partnership is doing what it was set to do– Partnership is having impact beyond its immediate
stakeholder group – Partnership is sustainable and self managing – The partnership has had ‘added value’ leading to
significant benefits for both partners
Ross, T. 2011. The partnering toolbook
Recommendations for strengthening collaborative partnership for health:
• Establish monitoring systems to detect progress in achieving population health and health equity
• Develop and use action plans that assign responsibility for changing communities and systems
• Facilitate natural reinforcement for people working together across sectors
• Assure adequate base funding for collaborative efforts that is sufficient to improve population-level outcomes
• Provide training and technical support for those working in collaborative partnerships
Recommendations for strengthening collaborative partnership for health:
• Establish participatory evaluation systems for documenting and reviewing progress and making adjustments.
• Arrange group contingencies to ensure accountability for progress and improvement.
Integrated Knowledge Translation Partnerships (IKTP)
Anita Kothari
Since we are talking about cross-sector…what sector are you from?
/
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Public Health/Community Health
Education/ResearchFaculty/Staff/Student
Provincial/Territorial Government/Ministry
Long Term Care Community-based (non-health) organization
Private Industry
Have you been involved in conducting research with your community/regional/provincial/federal partner?
• No • Yes
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AGENDA
Characteristics of IKT partnerships
What is being discussed in this area that helps us think about all collaborations?
Implications for public health
Characteristics: Type 1 & 2 Knowledge Translation
•Type 2: Integrated Knowledge Translation
•“Researcher – knowledge-user partnerships in health research” (Dennis and Lomas, 2003).
•“Academic-practitioner partnership”
•Getting researchers and decision makers to come together in health and health-related research.
•Type 1: End of Grant Knowledge Translation
•Grant is done – get the word out:
•Tailored reports, presentations, webites.
Characteristics: IKT is about collaborative knowledge/research generation
• Two-Communities Thesis (Caplan, 1979)– Researchers and policy makers have different
languages– Have different reward systems– Have different values– Have different timelines (for decisions)
• Do you and your community/provincial/federal partners have different reward systems, values, timelines?
From KT to Engaged Scholarship: Promoting Research Relevance and Utilization. Bowen and Graham. 2013
Characteristics: IKT is similar to the partnerships we are talking about today in terms of process
- Sharing- Frequent meetings- Working together- Finding common ground- Finding resources- Collaborating to achieve something
that couldn’t be done independently
IKT Concepts to think about for PH partnerships
1)Open System of Knowledge ProductionCollective narratives of expertise
2)Application-OrientedThe Agora
3) Trans-disciplinarity
Science’s new social contract with society. Gibbons. 1999
IKT Concepts to think about for PH partnerships
Transformation among the team New identity Joint sensemaking Common language
“partnerships move within and across different professional worlds, and they can have a multifaceted grasp of the programs [or research] and work to help others make sense of them”
IKT Concepts to think about for PH partnerships
Understanding is not just about knowing but encompasses ways of being and relating
Common way to see the world
Common understandings of problems and solutions
IKT Concepts to think about for PH partnerships
• Low impact/Expect actionable outcomes from research (positivity bias)
• Researcher dominance• Policymaker dominance, integrity of the research
process and content
• What is knowledge? Worldviews, Theories, Methodologies
• A Critical Second Look at IKT. Kothari and Wathen. 2013.• Mode 2 Revisited: the New Production of Knowledge. Nowotny et al.
2003
Implications for PH partnerships
• Expect positive outcomes
• Dominance by one side
• Common understanding of problems and solutions
• Resource intensive – determine if it is worth it (evaluate!)
• Why is PH the steward of these partnerships?
• How can we use this common understanding?
IKT for research PH partnerships (let’s discuss)
Implications for PH partnershipsIKT for research PH partnerships (let’s discuss)
• ??
• ??
• ??
• The team is transformed – relational capital is created
• Collective expertise Multiple accountabilities
• Open system for knowledge contribution: private sector?
Final Thoughts
Denis & Lomas (2003, p. S2:4 ): “collaborative research clearly has multiple objectives and meaning in the eyes of those engaged in such partnership” but the overriding aim of IKT is the use of research findings in practice or policy decisions.
Collaborative program planning & implementation has multiple objectives and meaning in the eyes of those engaged in such partnerships but the overriding aim is improving population health and decreasing health inequities.
Questions for the PANEL?
Complexity of Partnerships
Public Health Partnerships: Enthusiasm and Evidence
Key References1. Frankish CJ, Moulton GE, Quantz D, Carson AJ, Casebeer AL, Eyles JD, et al. Addressing the non-medical determinants of health. Can J Pub Health
2007;98(1):41-7. 2. Sibbald S, Kothari A, Rudman D, Dobbins M, Rouse M, Edwards N & Gore D. Partnerships in public health: lessons from knowledge translation and program
planning. Can J Nurs Res 2012;44(1):95–119.3. Smith KE, Bambra C, Joyce KE, Perkins N, Hunter DJ & Blenkinsopp EA. Partners in health? A systematic review of the impact of organizational partnerships on
public health outcomes in England between 1997 and 2008. J Public Health 2009;31(2):210–221. 4. Mitchell SM & Shortell SM. The governance and management of effective community health partnerships: a typology for research, policy, and practice.
Milbank Q 2000;78(2):241–289.5. Hunter D & Perkins N. Partnership working in public health: the implications for governance of a systems approach. J Health Serv Res Policy 2012;17(suppl
2):45–52. 6. McGuire M. Collaborative Public Management: Assessing What We Know and How We Know It. Publ Admin Rev 2006;66:33–43. 7. Andrews R & Entwistle T. Does Cross-Sectoral Partnership Deliver? An Empirical Exploration of Public Service Effectiveness, Efficiency, and Equity. J Public
Admin Res Theory 2010;20(3):679–701. 8. Woulfe J, Oliver TR, Siemering KQ & Zahner SJ. Multisector Partnerships in Population Health Improvement. Prev Chronic Dis 2010;7(6).9. Assessing the impact and effectiveness of intersectoral action on the social determinants of health and health equity: An expedited systematic review
[Internet]. National Collaborating Centre for Determinants of Health; 2012 [cited 2013 Aug 13]. Available from: http://nccdh.ca/images/uploads/ISA_Report_EN1.pdf.
10. Crossing Sectors: Experiences in Intersectoral Action, Public Policy and Health [Internet]. Public Health Agency of Canada; 2007 [cited 2013 Aug 13]. Available from: www.phac-aspc.gc.ca/publicat/2007/cro-sec/.
11. Roussos ST & Fawcett SB. A review of collaborative partnerships as a strategy for improving community health. Annu Rev Public Health 2000;21:369–402.12. Zakocs RC & Edwards EM. What explains community coalition effectiveness?: a review of the literature. Am J Prev Med 2006;30(4):351–361. 13. Hunter DJ, Perkins NS, Bambra C, Marks L, Blackman T, Hopkins T, et al. Partnership Working and the Implications for Governance: issues affecting public
health partnerships. Final report [Internet]. NIHR Service Delivery and Organisation programme; 2010 [cited 2013 Aug 11]. Available from: www.dur.ac.uk/resources/wolfson.institute/SDO_FR_08-1716-204_V011.pdf.
14. Israel BA, Schulz AJ, Parker EA & Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Ann Rev Public Health 1998;19:173–202.
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