Aligning healthcare, public health and social services: A scoping review of the role of purpose, governance, finance and data

Abstract

Organisations spanning social services, public health and healthcare have increasingly experimented with collaboration as a tool for improving population health and reducing health disparities. While there has been progress, the results have fallen short of expectations. Reflecting on these shortcomings, the Robert Wood Johnson Foundation (RWJF) recently proposed a new framework for cross‐sector alignment intended to move the field towards improved outcomes. A central idea in this framework is that collaboratives will be more effective and sustainable if they develop collaborative systems in four core areas: shared purpose, governance, finance and shared data. The goal of this paper is to provide a foundation for research on the four core areas of the cross‐sector alignment framework. Accordingly, this study is based on two guiding questions: (1) how are collaboratives currently implementing systems in the four core areas identified in the framework, and (2) what strategies does the literature offer for creating sustainable systems in these four areas? Given the emergent nature of research on health‐oriented cross‐sector collaboration and the broad research questions, we conducted a systematic scoping review including 179 relevant research papers and reports published internationally from the years 2010–2020. We identified the main contributions and coded each based on its relevance to the cross‐sector alignment framework. We found that most papers focused on programme evaluations rather than theory testing, and while many strategies were offered, they tended to reflect a focus on short‐term collaboration. The results also demonstrate that starting points and resource levels vary widely across individuals and organisations involved in collaborations. Accordingly, identifying and comparing distinct pathways by which different parties might pursue cross‐sector alignment is an imperative for future work. More broadly, the literature is ripe with observations that could be assessed systematically to produce a firm foundation for research and practice.

Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study

“…Our analyses uncovered three key mechanisms through which case management impacted patients: [ 1 ] Psychosocial work, defined as interpersonal and emotional support provided through the case manager-patient relationship, [ 2 ] System mediation work to navigate systems, coordinate resources, and communicate information and [ 3 ] Addressing social needs, or working to directly mitigate the impact of social conditions on patient health. While these themes represent qualitatively distinct mechanisms, we found that they were closely intertwined and mutually reinforcing (Fig.…”

“…Although health care systems are increasingly exploring interventions to assist patients with social needs [1,2], a lack of evidence about the mechanisms by which these complex interventions benefit patients challenges translation across settings and populations. In social needs case management [3][4][5], a professional works collaboratively with a patient to identify, coordinate, and advocate for services, which may span the medical, behavioral health, and social care systems [6].…”

How Aligning Sectors Builds Resilient, Equitable Communities

“…A Framework for Aligning Sectors (Figure ) offers an innovative approach to successfully align health care, public health, social services, and other sectors to jointly tackle complex challenges that matter to community members. The framework emphasizes 4 critical components 5 sectors can implement:…”

“…A Framework for Aligning Sectors (Figure) offers an innovative approach to successfully align health care, public health, social services, and other sectors to jointly tackle complex challenges that matter to community members. The framework emphasizes 4 critical components5 sectors can implement: Shared purpose : The organizations involved establish shared areas of focus and outcomes in partnership with people who experience the worst effects of inequitable systems. Shared data : The organizations involved share data that are meaningful to all partners and that enable sectors to effectively coordinate activities and measure shared progress 6 Shared financing : The organizations involved create or access long-term financing supports, including appropriate incentives and shared accountability structures, that coordinate and partner with community members. Shared governance : The organizations involved maintain robust governance and leadership structures that include and elevate local representation and voices. …”

Development and Validation of a Measure to Assess Readiness to Advance Health and Equity: The Assessment for Advancing Community Transformation (AACT)

“…Accordingly, policy makers and program funders have increasingly called on collaboratives and gone so far as to require their creation to receive funding for programs designed to address various social determinants of health (Alley et al, 2016; Daniel et al, 2018). Over the past several decades, the number of multi-sectoral collaboratives working to address public health issues has grown, and they will likely remain key players as larger health systems reform continues and the evidence base related to broader cross-sector alignment between healthcare, public health, and social services grows (Erickson et al, 2017; Fichtenberg et al, 2020; Lanford et al, 2022).…”