Struggling with the governance of interprofessional elderly care in mandated collaboratives: a qualitative study

Abstract

Background Governing interprofessional elderly care requires the commitment of many different organisations connected in mandated collaboratives. Research over a decade ago showed that the governance relied on clan-based mechanisms, while lacking formal rules and incentives for collaborations. Awareness and reflection were seen as first steps towards progression. We aim to identify critical governance features of contemporary mandated collaboratives by discussing cases introduced by the healthcare professionals and managers themselves. Methods Semi-structured interviews (n = 24) with two regional mandated collaboratives took place from November 2019 to November 2020 in the Netherlands to learn more about critical governance features. The interviews were thematically analysed by the project team (authors) to synthesise the results and were subsequently validated during a focus group. Results Critical governance features of interorganisational activities in mandated collaboratives include the gradual formulation of shared vision and clear client-centred goals, building trust and acquaintanceship for the advancement of an open collaborative culture, establishing a non-extreme formalised governance structure through leadership, mutual trust and innovation support and facilitating information exchange and formalisation tools for optimal elderly care. Conclusion Trust and leadership form the backbone of interorganisational functioning. Interorganisational functioning should be seen in light of their national embedment and resources that are (being made) available, which makes them susceptible to constant change as they struggle with balancing between critical features in a fluid and intermingled governance context. The identified critical features of (contemporary) mandated collaboratives may aid in assessing and improving interprofessional functioning within integrated elderly care. International debate on governance expectations of mandated collaboratives may further contribute to sharpening the roles of both managers and healthcare professionals.

Co-producing and co-assessing a new service solution for enhancing health and social care integration: a participatory research protocol

“…From this painful experience, governments have started to establish or reinforce existing networks composed of health, social and third sector organizations that collaborate with each other in caring for citizens, especially the elderly ones. Indeed, elderly people usually share complex and multi-dimensional needs that require the support of several service providers belonging to the health and social sectors [7]. Although the relevance and effectiveness of health and social care integration is not a new practice in developed countries[8], its adoption is limited and discontinuous [9,10] and remains so even after COVID-19 [11].…”