Complexity in partnerships: A qualitative examination of collaborative depression care in primary care clinics and community‐based organisations in California, United States

Abstract

This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractPartnering across health clinics and community organisations, while worthwhile for improving health and well-being, is challenging and time consuming. Even partnerships that have essential elements for success in place face inevitable challenges. To better understand how cross-organisational partnerships work in practice, this paper examines collaborations between six primary care clinics and community-based organisations in the United States that were part of an initiative to address late-life depression using an enhanced collaborative care model (Archstone Foundation Care Partners Project). As part of an evaluation of the Care Partners Project, 54 key informant interviews and 10 focus groups were conducted from 2015 to 2017.Additionally, more than 80 project-related documents were reviewed. Qualitative thematic analysis was used to code the transcripts and identify prominent themes in the data. Examining clinic and community organisation partnerships in practice highlighted their inherent complexity. The partnerships were fluid and constantly evolving, shaped by a multiplicity of perspectives and values, and vulnerable to unpredictability. Care Partners sites negotiated the complexity of their partnerships drawing upon three main strategies: adaptation (allowing for flexibility and rapid change); integration (providing opportunities for multi-level partnerships within and across organisations) and cultivation (fostering a commitment to the partnership and its value). These strategies provided opportunities for Care Partners collaborators to work with the inherent complexity of partnering. Intentionally acknowledging and embracing such complexity rather than trying to reduce or avoid it, may allow clinic and community collaborators to strengthen and sustain their partnerships. K E Y W O R D S collaborative care, depression, evaluating complex interventions, multi-sector collaborations, older adults, qualitative research

Meaningful Engagement of Patient Advisors in Research: Towards Mutually Beneficial Relationships

“…These recommendations include creating an environment conducive to members making a genuine and unique contribution, building a sense of community between researchers and advisors, using best practices to engage, and providing tools and training (Harrison et al, 2018). When developing the partnership relationship, several strategies can enhance the experience, including providing flexibility to adapt to changing circumstances, fostering integration among the team, and cultivating a shared identity as members of the PAB (Henderson et al, 2020). In our experience, these approaches were key to developing a productive and mutually satisfying working relationship among the team.…”

When trust, confidence, and faith collide: refining a realist theory of how and why inter-organisational collaborations in healthcare work

“…Geographical proximity is one element that is difficult to mitigate, as a greater geographical distance between collaborators increases time spent building relationships significantly, by presenting a barrier to ease of arranging meetings and enabling informal interaction [ 44 ]. Greater geographical proximity was most often cited as improving communication, but can also be unhelpful if conflict is already occurring [ 47 , 81 ]. Additionally, having a larger size and/or quantity of organisations involved can make communicating more difficult, due to the increased number of involved actors and moving parts [ 39 ].…”

“…One could also criticise the review for being UK-centric, however, we did include several studies from outside the UK, such as Austria [ 51 ] and the United States [ 47 ] and did not purposely remove any based on country-specific metrics. Indeed, additional information from other regulatory contexts would have only been more informative.…”

When trust, confidence, and faith collide: refining a realist theory of how and why inter-organisational collaborations in healthcare work

“…With respect to ensuring appropriate communication between collaborators, a number of contextual elements are key. Geographical proximity is one element that is di cult to mitigate as it increases time spent building relationships signi cantly (48) and was most often cited as improving communication, but can also be unhelpful if con ict is already occurring (55,76). Additionally, having a larger size and/or number of organisations involved can make communicating more di cult due to the increased number of involved actors and moving parts (50).…”