Forming a successful public health collaborative: A qualitative study

Abstract

Coordinated approaches are needed to optimally control the spread of resistant organisms across facilities that share patients. Our goal was to understand social tensions that may inhibit public health-led community partnerships and to identify factors for success. A collaborative to control transmission of multidrug-resistant organisms (MDROs) was formed in Utah following a regional outbreak, with members from public health, hospitals, laboratories, and transport services. We conducted and qualitatively analyzed 3 focus groups among collaborative stakeholders to discuss their experiences. Via 3 focus groups and additional interviews, we found the collaborative made institutional tensions between stakeholders explicit. We identified 4 factors that facilitated the ability to overcome institutional tensions: public health leadership to establish a safe space, creation of cross-institutional group identity with mutual respect and support, standardized communication, and group cohesiveness through shared mental models of interdependencies. Stakeholders' concerns regarding being blamed for MDRO transmission versus contributing to shared health care community MDRO control efforts resembled a "prisoner's dilemma." Four social components mitigated tensions and facilitated cooperation in this public health-led collaborative. This study identified strategies that public health-led coordinated approaches can use to facilitate cooperation.