Barriers and opportunities for developing sustainable relationships for health improvement: The case of public health and primary care in the UK

Abstract

The British National Health Service has enjoined public health and primary care via a series of policy initiatives. Inter-organizational relationships provide the foundation for managing the system changes required to deliver policy, but are often taken for granted. This article reports on a study that sought to answer three key questions. First, which relationships are important for improving health? Second, what are the key areas in these relationships that might impact on delivery of improved public health? Third, what issues should be addressed in developing emerging relationships? Following a questionnaire to a sample of primary care organizations and a series of intensive workshops with key informants, findings indicate that there is an extensive network of relationships in which public health staff may participate. However, active participation is problematic in terms of identifying the most relevant relationships and ensuring protected time to develop these. Key relationship dimensions impacting on improved public health included different organizational perceptions of relationships and limited mutual understanding. However, despite a lack of a shared view of public health, the diversity of skills and backgrounds was viewed as an asset to joint working. Emerging relationships were generally perceived to be quite effective and expected to significantly improve though capacity issues and the frequency of organizational change appeared to make relationships more difficult to sustain. These issues needed to be recognized in developing and implementing policy, with further clarity needed as to which relationships are key for public health development and the costs and dividends of supporting these.

Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market

“…Relational aspects include trust, common values, and networks, whether established or new [32-35]. The emphasis on relational contracting in our data may have been exaggerated by the fact that any use of the more transactional mechanisms to engender change seemed to take place elsewhere in the PCTs, outside the commissioning meetings associated with particular service areas (most likely in contract negotiations led by senior finance personnel and commissioning directors which the study was not able to observe).…”

A scoping literature review of collaboration between primary care and public health

“…Interestingly, not all successful collaborations required additional investments (Lasker and The Committee on Medicine and Public Health, 1997); some pooled and shared resources (CIHR, 2003) and capitalized on volunteer and in-kind contributions PHRED, 2006;Shaw et al, 2006).…”

Transformational leadership, relationship quality, and employee performance during continuous incremental organizational change

“…Rafferty and Griffin () provided evidence that employees experienced higher uncertainty as the number of internal changes (e.g., ranks of top management, consolidation of human resource functions) increased. Higher change frequency can also make relationships difficult to maintain, raising doubts about the interpersonal support employees might have previously experienced (Shaw, Ashcroft, & Petchey, ). Such doubts are likely greater in work teams consisting of members with interdependent work relations.…”