Collaborative population health planning between Australian primary health care organisations and local government: lost opportunity

Insights into a collective impact partnership to promote consumption of healthy drinks in North East Melbourne: A qualitative case study

ISSUE ADDRESSED

To explore insights and perspectives of a collective impact (CI) partnership taking on a new project that aimed to reduce sugary drink consumption and promote water as the drink of choice across North East Melbourne.

METHODS

A qualitative case study was undertaken. Semi-structured interviews were conducted with key stakeholders in the partnership. Data were analysed using thematic analysis.

RESULTS

Fourteen organisations participated in the North East Healthy Drinks Alliance. The data demonstrated that investing in developing a common agenda supported the establishment of a CI approach. The backbone organisation was found to have played a crucial role in coordinating the activities of the Alliance. This coordination was found to be particularly important in terms of ensuring that organisations were able to work on mutually reinforcing activities at their own pace. Program planning and reporting was managed through open continuous communication by the backbone organisation. The data collected pertains to the activities of the Alliance in its first 2 years, prior to the development of a shared measurement strategy, thus no data was collected on this aspect of the collective impact framework. Although some participants were found to have limited knowledge of CI, this did not seem to hinder their participation in the Alliance.

CONCLUSION

Selecting a relevant and accessible focus area and investing in developing a common agenda supported the establishment of a CI approach. SO WHAT?: The CI framework offers a valuable tool for undertaking cross-sectoral, local partnerships for health.

Local government's roles in community health and wellbeing in Australia: Insights from Tasmania

ISSUE ADDRESSED

Local governments are well-placed to respond to communities' health and wellbeing needs. However, in the Australian state of Tasmania, the sector's roles in that respect are unclear.

METHODS

We interviewed 10 municipal personnel in Tasmania to understand their views on local governments' community health and wellbeing functions.

RESULTS

Participants had an integrative understanding of community health and wellbeing and recognised that collective effort from all tiers of government, community members, and other place-based stakeholders would improve outcomes. They identified several roles local governments have to support and drive such improvements, including in relation to diverse place-specific determinants of health and wellbeing. Capacity and capability to fulfil what is needed varied, with rural and remote councils generally less able than urban counterparts to respond consistently or comprehensively to community members' complex needs. However, in the presence of clear expectations and parameters, and appropriate support from other tiers of government, participants were eager for their councils to do more to improve their communities' health and wellbeing, including via a mandate in legislation.

CONCLUSION

Local governments have the potential to do more to improve health and wellbeing outcomes in Tasmania, and the greatest gains could be made by addressing spatial inequalities faced by the sector. That insight is extensible to other comparable jurisdictions. SO WHAT?: We argue the need both for a shared societal goal of equitable wellbeing supported by all tiers of government and for actions proportionate to the needs of council areas.

Evaluating local primary health care actions to address health inequities: analysis of Australia's Primary Health Networks

BACKGROUND

Meso-level, regional primary health care organisations such as Australia's Primary Health Networks (PHNs) are well placed to address health inequities through comprehensive primary health care approaches. This study aimed to examine the equity actions of PHNs and identify factors that hinder or enable the equity-orientation of PHNs' activities.

METHODS

Analysis of all 31 PHNs' public planning documents. Case studies with a sample of five PHNs, drawing on 29 original interviews with key stakeholders, secondary analysis of 38 prior interviews, and analysis of 30 internal planning guidance documents. This study employed an existing framework to examine equity actions.

RESULTS

PHNs displayed clear intentions and goals for health equity and collected considerable evidence of health inequities. However, their planned activities were largely restricted to individualistic clinical and behavioural approaches, with little to facilitate access to other health and social services, or act on the broader social determinants of health. PHNs' equity-oriented planning was enabled by organisational values for equity, evidence of local health inequities, and engagement with local stakeholders. Equity-oriented planning was hindered by federal government constraints and lack of equity-oriented prompts in the planning process.

CONCLUSIONS

PHNs' equity actions were limited. To optimise regional planning for health equity, primary health care organisations need autonomy and scope to act on the 'upstream' factors that contribute to local health issues. They also need sufficient time and resources for robust, systematic planning processes that incorporate mechanisms such as procedure guides and tools/templates, to capitalise on their local evidence to address health inequities. Organisations should engage meaningfully with local communities and service providers, to ensure approaches are equity sensitive and appropriately targeted.

Factors that influence evidence-informed meso-level regional primary health care planning: a qualitative examination and conceptual framework

BACKGROUND

Evidence-informed primary health care (PHC) planning in decentralised, meso-level regional organisations has received little research attention. In this paper we examine the factors that influence planning within this environment, and present a conceptual framework.

METHODS

We employed mixed methods: case studies of five Australian Primary Health Networks (PHNs), involving 29 primary interviews and secondary analysis of 38 prior interviews; and analysis of planning documents from all 31 PHNs. The analysis was informed by a WHO framework of evidence-informed policy-making, and institutional theory.

RESULTS

Influential actors included federal and state/territory governments, Local Health Networks, Aboriginal Community Controlled Health Organisations, local councils, public hospitals, community health services, and providers of allied health, mental health and aged care services. The federal government was most influential, constraining PHNs' planning scope, time and funding. Other external factors included: the health service landscape; local socio-demographic and geographic characteristics; (neoliberal) ideology; interests and politics; national policy settings and reforms; and system reorganisation. Internal factors included: organisational structure; culture, values and ideology; various capacity factors; planning processes; transition history; and experience. The additional regional layer of context adds to the complexity of planning.

CONCLUSIONS

Like national health policy-making, meso-level PHC planning occurs in a complex environment, but with additional regional factors and influences. We have developed a conceptual framework of the meso-level PHC planning environment, which can be employed by similar regional organisations to elucidate influential factors, and develop strategies and tools to promote transparent, evidence-informed PHC planning for better health outcomes.

Multisectoral actions in primary health care: A realist synthesis of scoping review

BACKGROUND

Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems.

METHODS

We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley's realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level).

RESULTS

A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals' social determinants of health.

CONCLUSION

Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.

Continuity and care coordination of primary health care: a scoping review

BACKGROUND

Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time. However, systematic evidence synthesis is lacking in the care coordination of health services. This scoping review synthesizes evidence on different levels of care coordination of primary health care (PHC) and primary care.

METHODS

We conducted a scoping review of published evidence on healthcare coordination. PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science and Google Scholar were searched until 30 November 2022 for studies that describe care coordination/continuity of care in PHC and primary care. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies. We analysed data using a thematic analysis approach and explained themes adopting a multilevel (individual, organizational, and system) analytical framework.

RESULTS

A total of 56 studies were included in the review. Most studies were from upper-middle-income or high-income countries, primarily focusing on continuity/care coordination in primary care. Ten themes were identified in care coordination in PHC/primary care. Four themes under care coordination at the individual level were the continuity of services, linkage at different stages of health conditions (from health promotion to rehabilitation), health care from a life-course (conception to elderly), and care coordination of health services at places (family to hospitals). Five themes under organizational level care coordination included interprofessional, multidisciplinary services, community collaboration, integrated care, and information in care coordination. Finally, a theme under system-level care coordination was related to service management involving multisectoral coordination within and beyond health systems.

CONCLUSIONS

Continuity and coordination of care involve healthcare provisions from family to health facility throughout the life-course to provide a range of services. Several issues could influence multilevel care coordination, including at the individual (services or users), organizational (providers), and system (departments and sectors) levels. Health systems should focus on care coordination, ensuring types of care per the healthcare needs at different stages of health conditions by a multidisciplinary team. Coordinating multiple technical and supporting stakeholders and sectors within and beyond health sector is also vital for the continuity of care especially in resource-limited health systems and settings.

The place of digital triage in a complex healthcare system: An interview study with key stakeholders in Australia's national provider

Background

Digital triage tools such as telephone advice and online symptom checkers are now commonplace in health systems internationally. Research has focused on consumers' adherence to advice, health outcomes, satisfaction, and the degree to which these services manage demand for general practice or emergency departments. Such studies have had mixed findings, leaving equivocal the role of these services in healthcare.

Objective

We examined stakeholders' perspectives on Healthdirect, Australia's national digital triage provider, focusing on its role in the health system, and barriers to operation, in the context of the COVID-19 pandemic.

Methods

Key stakeholders took part in semi-structured interviews conducted online in the third quarter of 2021. Transcripts were coded and thematically analysed.

Results

Participants (n  =  41) were Healthdirect staff (n  =  13), employees of Primary Health Networks (PHNs; n  =  12), clinicians (n  =  9), shareholder representatives (n  =  4), consumer representatives (n  =  2) and other policymakers (n  =  1). Eight themes emerged from the analysis: (1) information and guidance in navigating the system, (2) efficiency through appropriate care, (3) value for consumers? (4) the difficulties in triage at a distance, (5) competition and the unfulfilled promise of integration, (6) challenges in promoting Healthdirect, (7) monitoring and evaluating digital triage services and (8) rapid change, challenge and opportunity from COVID-19.

Conclusion

Stakeholders varied in their views of the purpose of Healthdirect's digital triage services. They identified challenges in lack of integration, competition, and the limited public profile of the services, issues largely reflective of the complexity of the policy and health system landscape. There was acknowledgement of the value of the services during the COVID-19 pandemic, and an expectation of them realising greater potential in the wake of the rapid uptake of telehealth.

Towards an effective collaboration between the South Western Sydney Local Health District and local councils: insights from a qualitative study

BACKGROUND

Partnership between local government and local health districts is imperative, given their overlapping goals. However, the need for further evidence-informed actions to address health inequities remains. The effectiveness of such partnerships requires better insight into how local governments perceive partnerships with local health districts, and how well equipped and prepared they are to deal with the health equity opportunities and challenges. It was precisely for these reasons that a qualitative study was conducted by South Western Sydney Local Health District (SWSLHD) in 2016.

OBJECTIVE

This study aims to better understand how to improve the effectiveness of collaboration between local governments and the public health sector.

METHODS

Qualitative data were collected from 14 in-depth interviews with staff representing five of the local councils comprising SWSLHD. These data were then thematically analysed using inductive and deductive reasoning through the application of NVivo software.

RESULTS

While councils recognize the potential value of consulting SWSLHD, limited communication and the absence of a clearly defined process for collaboration needs to be addressed. Moreover, councils perceive knowledge gaps in relation to basic issues, such as who provides what services to whom, and how to access local-government-level data from health experts.

CONCLUSIONS

The study confirms the importance of providing locally relevant public health data to help address issues of mutual concern that arise during the consultation process. Moreover, it suggests that proactive and ongoing consultation between SWSLHD and councils is critical if there is to be effective engagement, and coordinated and sustained action. The concerns raised in this study echo findings from studies from other local government settings of Victoria, South Australia and New South Wales. Thus, the study findings may be applied to other councils beyond the SWSLHD.

Challenges facing primary health care in federated government systems: Implementation of Primary Health Networks in Australian states and territories

In many federated countries, there is divided health system responsibility that can affect primary health care (PHC) policy and implementation, and complicate collaboration between PHC actors. We examined an Australian policy initiative, Primary Health Networks (PHNs), which are regional PHC organisations, to examine how they collaborated with state and territory PHC actors, and what factors enhanced or constrained collaboration. For PHNs we surveyed 66 staff, interviewed 82 staff, examined board membership, and analysed documents from all 31 PHNs. We also interviewed 11 state and 5 federal health bureaucrats. We mapped the PHC system in each state, and conducted team thematic analysis of the qualitative data collected. We found variation in how well PHNs collaborated with state and territory actors, ranging from poor relationships through to strong cooperation and co-commissioning. This was affected by factors to do with the state health department, geography, PHN funding and regulations, ambiguities in the federal/state divided responsibilities for PHC, and the extent of use of collaboration mechanisms and strategies. Resourcing and supporting such collaboration mechanisms, and increasing regional funding flexibility of funding would increase the potential for regional organisations to successfully navigate ambiguities in responsibility and foster a more integrated, cohesive PHC system.

Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research

Introduction

In many countries, elderly patients with chronic conditions require a web of services delivered by several providers collaborating in inter-organisational networks. In view of their global importance, it is surprising how little we know how these networks are led. Like traditional organisations, networks require leadership to function effectively. This paper reviews central characteristics of leadership in integrated care networks and proposes opportunities for future research.

Theory and methods

Analysing 73 studies published in leading academic journals, this paper consolidates research on leadership media, practices, activities and outcomes, covering the network, policy and organisation levels of analysis.

Results

Findings indicate that the field has focused on leadership media and outcomes at the network level. They also suggest that leadership in integrated care networks faces multiple tensions. Future research could usefully provide a fuller picture by examining leadership practices, activities and outcomes at the policy and organisation level, integrating advances in the wider leadership literature.

Discussion and conclusion

These findings contribute to the debate on leadership in integrated care networks. They also inform practice, drawing attention to persistent tensions as a core leadership challenge and offering latest scholarly evidence practitioners can use to reflect on and advance their own leadership practice.

Developing and Maintaining Public Trust During and Post-COVID-19: Can We Apply a Model Developed for Responding to Food Scares?

Trust in public health officials and the information they provide is essential for the public uptake of preventative strategies to reduce the transmission of COVID-19. This paper discusses how a model for developing and maintaining trust in public health officials during food safety incidents and scandals might be applied to pandemic management. The model identifies ten strategies to be considered, including: transparency; development of protocols and procedures; credibility; proactivity; putting the public first; collaborating with stakeholders; consistency; education of stakeholders and the public; building your reputation; and keeping your promises. While pandemic management differs insofar as the responsibility lies with the public rather than identifiable regulatory bodies, and governments must weigh competing risks in creating policy, we conclude that many of the strategies identified in our trust model can be successfully applied to the maintenance of trust in public health officials prior to, during, and after pandemics.

Strife of Interests: Constraints on integrated and co-ordinated comprehensive PHC in Australia

The 1978 World Health Organisation Alma Ata Declaration on Primary Health Care (PHC) emphasised a comprehensive view which stressed the importance of cure, prevention, promotion and rehabilitation delivered in a way that involved local communities and considered a social, economic and political perspective on health. Despite this, selective approaches have dominated. This paper asks why this has been the case in Australia through a multi-method study of regional PHC organisations. Interviews with senior policy players, focus groups with non-government organisations and document analysis inform an institutional and power analysis of PHC. The findings indicate that there are different interests competing for attention in PHC but that medical perspectives prove the most powerful and are reinforced by the actors, ideas and institutions that shape PHC. Community perspectives which stress lived experience and social perspectives on health are marginal concerns in the implementation of PHC. The other important interest is that of a neo-liberal perspective on health policy which stresses cost-containment, close measurement of activity and fragmented contracting out of services. This perspective is not compatible with a social determinants of health perspective and can also conflict with a medical view. The result of the interplay between competing interests and the distribution of power is a selective PHC system that is not likely to change without radical shifts in power and perspectives.