The use of Public-Private Partnerships in quality improvement in the primary care services. A description of two models
Report
|Updated
We have identified and described two partnership models in the primary care services: Community Care Network (CCN), and Primary Health Care Charter (the Charter).
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Key message
Public-Private Partnership (PPP) is a strategy from The Norwegian authorities to support quality improvement in the health services. We have identified and described two partnership models in the primary care services: Community Care Network (CCN), and Primary Health Care Charter (the Charter).
The models have several characteristics in common, including:
- The big potential of primary care services to improve the health of the population.
- That all relevant stakeholders must work together in order to realize this potential.
- System-wide improvements.
- User involvement.
- Anchoring within management and staff.
- Measurements-/evaluation.
Findings from research and evaluation from other PPPs than the two models, support the importance of anchoring within management and staff, and measurements-/evaluation to succeed. The findings also show some other factors connected to success. Examples:
- Clarification of roles and responsibilities, shared vision, common goals, trust, respect and good relations.
Findings from research and evaluation also show some challenges connected to PPPs. Examples:
- Complexity related to leadership, culture and legislation, vague descriptions and unclear roles.
- PPPs are not an easy way to success.
- There is no ideal model that can be used for any partnership at all times.
- Vision, goal and context are factors that should influence how a partnership is planned and implemented.
Summary
Background
Public-Private Partnership (PPP) is a strategy from The Norwegian authorities to support quality improvement in the health services. On this background the Centre for Quality work and Patient safety in General Practice (SAK) has commissioned The Norwegian Knowledge Center to identify and describe PPP models used in quality improvement in the primary care services.
Objective
A description of one or more PPP models used in quality improvement in the primary care services.
Method
Search on relevant Norwegian and international websites for descriptions of partnership models used in quality improvement in the primary care services.
Inclusion Criteria:
Population: Primary care services
Intervention: Public-Private Partnership
Comparison: None
Outcome: Quality improvement
Language: Literature published in english and scandinavian
Exclusion Criteria:
- PPPs that do not meet the requirements for what a model is in accordance with the chosen definition
- Partnership models which is not relevant for the primary care services in Norway.
Results
The search on Norwegian and international websites resulted in a large number of PPPs. By means of the inclusion- and exclusion criteria we were finally left with one article: Shortell et al., 2002. Evaluating Partnerships for Community Health Improvements: Tracking the Footprints . This article gives a description of the PPP model Community Care Network (CCN), one of the two models we have included. The second model - Primary Health Care Charter (the Charter), we already knew from attending international quality conferences. The description of this model builds on the Ministry of Health`s article: Primary Health Care Charter. A Collaborative Approach , 2007.
In addition to these two models we have included three studies and two evaluations of PPPs in this report. None of them meet the requirements for what a model is in accordance with the chosen definition. However, they are still included because they indicate criteria for success and challenges with PPPs.
Discussion
The models included - CCN and the Charter, have many features in common. One example is the potential of primary care services to improve the health of the population. It is underlined that all relevant stakeholders must work together, towards the same goals, to realize this potential. In both models PPPs are a conscious choice because of the equality of participants that lies in this concept.
The emphasis on system-wide improvements is also a common feature, together with user involvement: The citizens, users and their families needs are identified, and they take an active part as equal participants in the partnerships.
The importance of anchoring within management and staff, and the commitment of the management to achieve the goals of the partnership are highlighted in both partnerships. The same goes for the importance of measurement-/evaluation to find out if the PPPs reach their goals.
Conclusion
We have described two PPPs used to improve quality in the primary care services: Community Care Network and the Primary Health Care Charter. The models have some features in common:
- The potential the primary care services have to improve the health of the population.
- All the relevant stakeholders must work together to realize the potential.
- System-wide improvements.
- The need for an overall strategy.
- User involvement.
- Anchoring within management and staff, engagement and enthusiasm.
- Measurements-/evaluation.
Findings from research and evaluation from other PPPs than the two models support the importance of anchoring within management and staff, and measurements-/evaluation. These factors seem to be of importance to succeed with PPPs, in addition to the following: Clarification of roles and responsibilities, shared vision and goals, trust, respect and good relations.
There are several challenges connected with PPPs. Examples: Complexity in terms of leadership, culture and legislation, lack of anchoring in the target group / population, vague descriptions of how the partnerships are to be conducted, and unclear roles, description, and agreement of responsibility and authority. A partnership is no easy way to success, and there is no ideal model that can be used for all partnerships at all times.
PPPs are a strategy from The Norwegian authorities to support quality improvement in the health services. Vision, goals, context, target group and the partners' needs, etc. are all factors that should influence how a partnership is planned and implemented.
Needs for further research
Partnership, as other tools and methods used in quality improvement, are complex interventions to be implemented in complex organizations. A challenge to research then becomes: What activities implemented in the partnership affects what factors in the participating organizations? And what is the over all effect of the partnership?
Several studies show the need for further research regarding the efficiency of PPPs. A good example on such research is the mid-term evaluation process that Shortell et al., 2002, conducted of the partnershipmodel CCN in the United States. Both qualitative and quantitative methods were used. Such a thorough evaluation both require that the partnership is described, and that the vision is operationalized so that the effect can be assessed against clearly stated objectives and goals.