Voluntary Alliances Research Articles

Crafting intermediate care: one team’s journey towards integration and innovation

Aim This paper describes one multi-disciplinary, multi-agency team’s development of Person-Centred Intermediate Care (PCIC) for older people. This development involved integrating three separate enterprises – a not-for-profit charitable organisation, a local primary health care trust and referring hospitals and their local social care providers. Methods We used a mixed-methods case study, underpinned by the notion of an innovation journey, to explore how PCIC was developed by the team and how effective it was. Data were collected through semi-structured interviews, documentary analysis, closed-end questionnaires/scales and routinely collected activity data. Thematic and statistical analyses were used. Results were triangulated. Twelve staff, four key informants and 94 service users participated. Results The development followed the trajectory of innovation journeys. Our mixed-methods approach enabled us to expose staff’s negative experiences during this time whilst patients were largely satisfied with their care and made appropriate recovery. The triangulation of data in this mixed-methods study allowed us to seek explanations for this mismatch. We conjecture that the staff used emotional labour to lessen the effects of their negative experiences for the benefit of the patients. Conclusions This paper extends our knowledge of how, in a policy environment that encourages collaborative practice between public, private and voluntary alliances, and across sectors, such innovations work. In addition, the results suggest that emotional labour is used during change and care practices: preparing nurses better in order to use this ‘technique’ is a recommendation from this research.

Love Thy Neighbour: A Social Capital Approach to Local Government Partnerships

While controversy surrounds compulsory consolidation as a means of improving the operational efficiency of local government, the literature suggests that gains can accrue to groups of local councils which form voluntary alliances as platforms for shared service delivery. However, real‐world experience has demonstrated that voluntary alliances in local government are difficult to establish and do not always endure in the longer term. After reviewing the limited extant scholarly literature on shared services and local council voluntary alliances, as well as applications of the social capital approach to inter‐organisational endeavour, such as the Weber and Weber (2010) venture capital model, this article argues that the social capital approach can offer insights into local council cooperative alliance and shared service models.

Constrained choices in alliance formations: Cupids and organizational marriages

This article develops a constrained choice model of strategic decision-making for `cupid' alliances. Unlike voluntary alliances, cupid alliances are forged between `target' organizations at the behest of a third `cupid' organization that stands to benefit from creation of the alliance. Three key alliance decisions — whether to partner, with whom, and governance — are substantially curtailed by the cupid's requirements, producing a severely constrained set of strategic decisions. The conceptual model is supplemented with a case study which relies on qualitative interviews, observations and communication network data collected from principals negotiating a cupid alliance. A finding which may be unique to cupid alliances was the decline in trust over the course of the negotiation between those representatives whose organizations had no past alliance relationships. This finding is especially interesting given the fact that despite the decreased propensity for representatives to trust, an agreement was still reached.

Variations in hospitalizations for chronic obstructive pulmonary disease in rural and urban Victoria, Australia

Effective and timely management of COPD should reduce the risk of hospitalization. The purpose of this study was to describe variations in COPD hospital admission rates as an indicator of the adequacy of primary care services. Age- and gender-standardized hospital admission rates of COPD (2003-04) were computed using the Victorian Admitted Episodes Dataset. Potential predictors of COPD admission rates were identified from various sources of data. These included degree of remoteness, socio-economic status, number of general practitioners per population, percentage of Aboriginal or Torres Strait Islander people, percentage of smokers, and co-morbidities. These data were aggregated at the primary care partnership level, which are voluntary alliances of one or more local government areas in Victoria. Weighted least squares regression was used to identify the predictors of COPD admission rates. Hospital admission rates for COPD were higher in rural than in metropolitan areas of Victoria. Multiple logistic regression analysis showed significant associations between COPD admission rates and socio-economic status, smoking rates and remoteness of the area. Small-area analyses of COPD admission rates highlighted significant differences between urban and rural areas. The influence of socio-economic status and degree of remoteness on COPD admission rates highlights opportunities for policymakers to develop targeted public health and health service interventions.

Small Area Analysis of Diabetes Complications: Opportunities for Targeting Public Health and Health Services Interventions

The objective of this paper is to present small area analyses of diabetes complications in Victoria, Australia, and to illustrate their importance for targeting public health and health services interventions. Local government areas in Victoria were aggregated into 32 Primary Care Partnerships (PCP), which are voluntary alliances of primary care providers. The 32 PCP areas were used as the basic geographic units for small area analyses. Admission rates for diabetes complications were age and sex standardised using the direct method and the 1996 Victorian population as the reference. Admission rate ratios were calculated using the Victorian admission rates as the reference. The 95 per cent confidence intervals for the standardised admission rate ratios were based on the Poisson distribution. There was a wide variation (almost fivefold) in admission rates for diabetes complications across the PCP catchments, with the lowest standardised rate ratio of 0.37 and the highest of 1.75. There were 11 PCPs (seven metropolitan, four rural) with admission rate ratios significantly higher than the Victorian average. The seven metropolitan PCPs contributed more than 43% of all admissions and bed days for diabetes complications in Victoria. Small area analyses of diabetes complications are an exciting new development aimed at stimulating an evidence-based dialogue between local area health service providers, planners and policy-makers. The purpose is to provide opportunities to target public health and health services interventions at the local level to improve the management of diabetes complications in the community.

New Regional Transportation Organizations: Old Problem, New Wrinkle?

As attention turns to the operations and management of the nation’s highway infrastructure, regional operating organizations (ROOs) have increasingly become part of the transportation scene. Many ROOs are housed in new organizations, which are essentially voluntary alliances between state and local operating agencies in a region. The history of regional organizations and the so-called “new regional transportation organizations” that are being created around operations and management tasks is examined. Three questions are asked: ( a) Why are new organizations being created when regional organizations already exist? ( b) How do new organizations differ from those that currently exist? ( c) How will the new organizations operate within the existing metropolitan context as they develop and mature? The conclusion is that the success of these organizations depends on how they navigate the transition from being new organizations whose focus and jurisdiction do not adequately correspond to regionwide operations issues to being full-fledged regional organizations in an environment populated by existing metropolitan planning organizations (MPOs) and regional authorities. The particular challenge is how these organizations will be able to grow to meet region-specific needs and challenges while providing sufficient accountability and consistency to facilitate federal participation. The history of MPOs suggests that universal and far-reaching federal mandates may not be the best strategy to achieve these goals.

Trust in Relationships Between Primary Health Care Organisations

In Victoria the primary health care sector is in a period of change intended to strengthen the integration of a complex service system through a process of partnership development based on collaboration. The partnerships are voluntary alliances of the primary care service providers, usually within a locality of two to three local government areas. Their purpose is to improve the health and wellbeing of the local population by strengthening inter-agency coordination in the areas of needs identification, planning and service delivery. Trust is a key issue in this process. This paper is a report of the first stage of a study to explore trust in the context of relationships between organisations in the primary care sector.