Factors and Processes that Facilitate Collaboration In a Complex Organisation: A Hospital Case Study
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Purpose: The purpose of this study was to increase the knowledge on the processes and factors that facilitate and/or hinder collaborative functioning, by testing the utility of a newly developed model: The Bergen Model of Collaborative Functioning (BMCF) (Corbin, 2006) in the hospital setting. Health promotion strongly advocates for the use of effective collaborations. The aim is to achieve synergy, in which the output of the collaboration is greater than what partners could have produced individually. However, successful collaborative functioning in health care services is hard to achieve, because stakeholders have different aims, commitments, traditions, and mandates, and so on. Overcoming such differences to forge productive collaborations is a great challenge. Nevertheless, little attention has been paid in the health promotion- and hospital literatures to the actual factors and processes of collaborative functioning that lead to negative and/or synergistic outputs. Corbin (2006) developed a systems model for collaboration; the BMCF (figure 1) based on inputs (elements entering into the collaboration), throughputs (processes within the collaboration) and outputs (collaborative products), and the complex interactions between these. This model is the first to recognise the complex interaction between inputs, throughputs, outputs and processes in collaborations. Based on this model, the present study aimed to increase the knowledge on collaborative functioning by examining the utility of the Model through studying the factors and processes that facilitated and/or hindered the implementation of a complex hospital programme. This thesis also aimed to examine contextual factors that affect collaborative functioning. Method: This qualitative research applied the case study methodology to study a comprehensive hospital programme to handle patient malnourishment. Data from seventeen interviews (twelve respondents) were utilised. Two waves of data collection were applied; twelve respondents were interviewed once, two months after the programme was launched. Then, five interviewees were selected for a second interview ten months after implementation. The interviews were conducted face-to-face, and lasted from 30 minutes to 1 and ¾ hours. The interviews followed semi-structured interview guides, which were continuously modified to improve their utility. Documents such as mission statement, minutes of meetings and surveys were also utilised. The data were analysed to address the aims and research questions of this thesis, and the BMCF (Corbin, 2006), along with allowing new emerging findings. Results: The results told a story about the planning and early implementation of a hospital’s mission to handle patient malnourishment. The programme required substantial collaboration across a number of departments and professionals. The results show that committed partners overcame hierarchical challenges in the hospital, utilised the surrounding context, and lobbied for- and successfully collaborated to place the mission on the hospital’s agenda. That process was a collaboration in itself that produced synergy-- the mission gained urgency and increased some partners’ commitment; financial resources were allocated; much recognition was gained; and several extended effects followed. From that, a programme was established which aimed to screen all patients for malnourishment and act accordingly, educate all health professionals, and to create a pilot project to make meals more tempting, flexible and nourishing. The mission and its context, partners- and financial resources were inputs into the collaboration. The planning, production of tasks, and maintenance (fuel) of the collaboration was affected by; how inputs interacted, communication, structure, rules and roles, and leadership factors. Outputs were a result of the interactions above. Interestingly, the collaborative functioning of the general programme and the pilot project were like poles apart. The pilot project recruited several committed partners that interacted well. The project’s structure allowed adjustment per context and partners, and thus produced successful interactions and outputs. On the other hand, the implementation of the general programme mostly applied a hierarchical approach to the collaboration. Several stakeholders were mandated to perform tasks, yet were not included as actual partners to influence- or participate in the collaboration. Furthermore, lack of assessment of applicability and feasibility in all the multicultural contexts involved in the programme, hindered the collaboration. The above resulted in partner resistance to the mission and even boycotting-- despite policy-production and the leadership’s strong commitment to the programme. Committed partners interacted well, however an over-reliance on committed partners resulted in burnout and thereby loss of vital partner resources. Noticeably, the general programme applied a hierarchical approach that predominantly produced negative outputs, yet the pilot project produced much synergy using a collaborative approach. Conclusion: The BMCF proved to be a useful research framework to study the collaboration at hand; however, the findings also suggest modifications of the Model. The findings indicated that the mission’s context should be an input into the Model, because the context acted as a unique factor affecting the entire collaborative functioning. Secondly, the findings indicated a need to depict planning in the Model, as planning is essential prior to- and during collaborations. The conclusion from the case was that a hierarchical approach to collaboration could hinder synergistic outputs. Recruitment of committed partners is essential to facilitate collaborative functioning. However, failing to include all partners to participate in- and influence a collaboration, and failing to assess a programme’s applicability and feasibility in each area of implementation, can hinder partner commitment and create negative collaborative functioning and outputs. Therefore, this study concludes that a complex collaboration amongst multiple diverse partners can benefit from applying a model for collaboration. Knowledge on collaborative functioning can lead to successful planning that reduce the factors and processes that often produce negative outputs-- and thus increase the potential for synergy. These findings can aid current and future health care collaborations.
PublisherThe University of Bergen
- HEMIL Centre 32
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