Capital District Health Authority (NS)

  • Carolyn Edwards, Director, Primary Healthcare, Capital District Health Authority, Halifax, Nova Scotia
  • Richard Gibson, Chief, District Department of Family Practice, Capital District Health Authority, Halifax, Nova Scotia
  • Shannon Ryan Carson, Manager, Primary Healthcare, Capital District Health Authority, Halifax, Nova Scotia

Inter-organizational Relationships: A Continuum of Working Together

Primary Health Care (PHC) is a key component of Capital Health’s evidence-informed approach to enhanced community based healthcare. Such system level change crosses boundaries of organizations, service areas, and policy and therefore depends to a great extent on the relationships between and within organizations (which in this context can be subunits within the parent organization, or a department and an outside agency).

In forming Inter-Organizational Relationships (IORs), two or more organizations commit to working together on an issue of mutual interest in pursuit of a common goal, often with the expectation that by working together they will achieve more than they would by working separately. Unfortunately, IORs do not always function optimally, resulting in failure to achieve the intended outcomes and misuse of time and resources. Contributing factors include failure to prioritize the importance of forming and maintaining relationships, a mismatch between the type of working relationship and the purpose, failure to specify the intended purpose/outcome, inattention to the barriers and facilitators, and a gap in skills and competencies of those involved.

The objective of this intervention was to address these gaps by developing, applying and evaluating an evidence-based framework and associated tools to guide organizations in “working together”, either when they have a history of working together or when the partnership is newly forming. The tools are applicable across varying settings and sectors.

Based on a literature search, between the extremes of “fragmentation” and “integration”, various forms of working together exist on a continuum; these forms can be labelled as communication, cooperation, coordination, and collaboration. They differ according to characteristics which include their vision, goals and outcomes, trust, power, decision making, information exchange, resources, membership and leadership, and accountability.

This information was compiled into a Working Together Framework. To support the practical application of the Framework, an evidence-based Practical Tool and associated User Guide were then developed and field tested. The Tool first asks groups to specify the intended purpose/outcome. They then consider key relationship characteristics, paying particular attention to the barriers and facilitators that impact working together. Next, the partners explore their current working relationship as well as the targeted end point, to avoid any mismatch between the type of working relationship and the purpose.  Finally, partners reflect on several other key questions, including whether working together is a better way to achieve the desired outcomes than working separately.

To date, PHC team members have been trained in the use of the Framework and Practical Tool through ongoing operational activities (e.g., department meetings, orientation of new team members) and through pilot testing in the context of various operational initiatives. The second stage of dissemination involves key leaders within Capital Health whose roles could foster, or are dependent on, successful working relationships. The third stage of dissemination is anticipated to involve development of training for all Capital Health employees, physicians and community partners. Publication of the framework will be explored to support dissemination at a broader level.