Why do some inter-organisational collaborations in healthcare work when others do not? A realist review

Justin Avery Aunger,Russell Mannion,Anne-Marie Rafferty,Hugh Mcleod,Joanne Greenhalgh,Ross Millar

doi:10.1186/s13643-021-01630-8

Abstract

BackgroundInter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, enabling resource sharing, and promoting innovations. However, in practice, due to the complexity of the process, such efforts are often rife with difficulty. Notable contributions have sought to make sense of this area; however, further understanding is needed in order to gain a better understanding of why some inter-organisational collaborations work when others do not, to be able to more effectively implement collaborations in the future.MethodsRealist review methodology was used with the intention of formulating context-mechanism-outcome configurations (CMOCs) to explain how inter-organisational collaborations work and why, combining systematic and purposive literature search techniques. The systematic review encompassed searches for reviews, commentaries, opinion pieces, and case studies on HMIC, MEDLINE, PsycINFO, and Social Policy and Practice databases, and further searches were conducted using Google Scholar. Data were extracted from included studies according to relevance to the realist review.ResultsFifty-three papers were included, informing the development of programme theories of how, why, and when inter-organisational collaborations in healthcare work. Formulation of our programme theories incorporated the concepts of partnership synergy and collaborative inertia and found that it was essential to consider mechanisms underlying partnership functioning, such as building trust and faith in the collaboration to maximise synergy and thus collaborative performance. More integrative or mandated collaboration may lean more heavily on contract to drive collaborative behaviour.ConclusionAs the first realist review of inter-organisational collaborations in healthcare as an intervention for improvement, this review provides actionable evidence for policymakers and implementers, enhancing understanding of mechanisms underlying the functioning and performing of inter-organisational collaborations, as well as how to configure the context to aid success. Next steps in this research will test the results against further case studies and primary data to produce a further refined theory.Systematic review registrationPROSPERO CRD42019149009

Highlights

Inter-organisational collaboration is increasingly prominent within contemporary healthcare systems
These were screened for relevancy, i.e. whether these papers included sufficient descriptive depth regarding contextual factors, mechanisms, and outcomes underlying inter-organisational collaboration, which resulted in 35 included papers
Our research supports the findings of other realist reviews in the literature on related topics, e.g. those by Jagosh et al, through its similar inclusion of the trust-building loop, and we build upon existing realist-based studies of healthcare collaboration [18, 19, 96]. While these contributions draw attention to particular intervention types and contexts, our contribution provides much needed insight into the inter-organisational entities currently being promoted across healthcare settings. These findings demonstrate that many inter-organisational collaborations may struggle to achieve the collaborative synergy required for better performance due ‘collaborative inertia’ brought about by unfavourable configuration of contexts

Summary

Introduction

Inter-organisational collaboration is increasingly prominent within contemporary healthcare systems. Defined as ‘a mutually beneficial process by which stakeholders or organizations work together towards a common goal’, inter-organisational collaboration is synonymous with the ‘joint development of structures in which decisions are made, resources shared, and mutual authority and accountability exercised’ [2]. Such arrangements have a long and complex history in the National Health Service (NHS) in England since the 1960s [3]. The response to COVID-19 has emerged as a timely example of unprecedented collaboration across organisations and sectors as the NHS responds to the pandemic [9, 10]

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