Partnership Working in Public Health: The Implications for Governance of a Systems Approach

Abstract

Most of the research on partnerships has centred on health and social care, and while many of the findings remain relevant, public health partnerships concerned with 'wicked issues' give rise to a different and more complex set of issues which merit exploration. The study aimed to identify those factors promoting effective partnership working for health improvement; to assess the extent to which partnership governance and incentive arrangements were commensurate with the complexities of the problem; and to explore how far local partnerships contributed to better outcomes for individuals and populations. A three-year study of public health partnerships (2007-10) in nine localities across England involving semi-structured interviews at strategic and operational levels. Successful partnerships shared a number of characteristics: they were clear about goals and purpose; they were aware of partners' roles and responsibilities; and they had a clear strategic overview of performance through robust monitoring and evaluation. In many cases, partnerships were facades with a 'silo mentality' prevailing - there was an unwillingness to share information or resources, or to accord partnership working sufficient priority or support. Despite enthusiasm for partnerships and an insistence that they were essential, it was impossible to establish evidence of their impact on health outcomes. While the focus on partnerships tends to be on structures, relational factors, including high levels of trust and goodwill, were important ingredients of a well-functioning partnership. Less formal and more organic, operational partnerships were more effective than more formal, strategic level ones which were driven by targets. Finally, partnerships were, in part, shaped by the national policy context, with constant policy and organizational churn making it difficult to sustain long-term relationships. Future partnerships might be undertaken differently, adopting a complex adaptive systems perspective. This advocates an approach to partnership working that is less focused on rigid structures and much more on relational factors like trust and goodwill.