Collaborative Governance for Integrated Care: Insights from a Policy Stakeholder Dialogue

Dara Gordon; Sandra McKay; Gregory Marchildon; R. Sacha Bhatia; James Shaw

doi:10.5334/ijic.4684

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Ansell and Gash (2008) Model of Collaborative Governance (Reproduced with permission).

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Collaborative Governance: Enhancing the Symposium Recommendations.

Symposium Recommendations	Alterations from Collaboration Governance
Recommendation #1: Enhance approaches to governance and accountability at the LHIN and sub-region levels to promote a more integrated patient experience of the health care system
1.1 Encourage shared accountability arrangements between health care delivery organizations wherever possible, in order to enable more integrated patient experiences of the health care system. 1.2 Establish clinician-level accountability mechanisms for more integrated care. 1.3 Develop incentives to build collaborative relationships with non-health system stakeholders, in order to connect patients with all the services they need.	Starting Conditions: Collaborative governance involves an explicit recognition of power or resource imbalances and historical dimensions that influence whether and how current collaboration unfolds. These dimensions are important considerations for any novel approaches to sharing accountability agreements and incentives acting on stakeholders. Institutional Design: Collaborative governance suggests that clear ground rules for engaging in collaborative work that do not unduly privilege any party drive the success of collaborative governance approaches. Such ground rules would be an important part of an approach to shared accountability.
Recommendation #2: Establish metrics and measurement strategies that provide a clear picture of quality across the continuum of care, and reflect the perspective of patients, families and providers
2.1 Patients and caregivers should be systematically engaged to help co-design priority metrics that can be used to guide the implementation of Patients First. 2.2 Build health care providers perspectives and experiences into the evaluation of Patients First. 2.3 Enable provider and manager access to performance data relevant to their local level of care delivery.	Intermediate Outcomes: Collaborative governance suggests that “small wins” are an important component of the success of collaborative initiatives. Selecting metrics that can represent short-term successes would be an important addition to the development of metrics for integrated care in our recommendations.
Recommendation #3: Leverage the sub-regions to enable health care providers to develop, scale and spread innovative strategies of care delivery
3.1 Identify and share best practices for engaging health care providers in the local development of innovative initiatives, including care coordinators. 3.2 Build clinical leadership at the sub-region level. 3.3 Streamline administrative functions to make innovation easier. 3.4 Build on innovative funding models that promote innovation, and particularly those in the areas of digital and mobile health. 3.5 Develop a provincial communications plan that emphasizes provider opportunities for innovation.	The Collaborative Process: Collaborative governance outlines the centrality of trust building to successful collaboration for complex problems, suggesting that face-to-face meetings are essential to building trust. In order to accomplish the goals identified in these recommendations, stakeholders must meet face-to-face and commit to the process outlined in order to successfully share best practices. Doing so is the primary mechanism by which shared understanding is achieved. Facilitative Leadership: Strong leadership that encourages a balance of perspectives and participation is seen to promote successful collaborative governance. Identifying individuals to explicitly lead the collaborative process will support successful collaboration.
Recommendation #4: Continue to engage patients and caregivers as central partners in health system planning
4.1 Continue to enable patient and caregiver engagement at the level of the LHINs and sub-regions. 4.2 Support training and capacity development of patients and caregivers. 4.3 Develop a communications strategy specifically directed to patients and the public that tells the story of how the health care system is changing, why, and what will be different for them as users of the system.	Institutional Design: To the extent that patients’ views should be incorporated in the collaborative governance process, the involvement of patients must be a systematic element of the institutions in which collaborative governance takes place.

Collaborative Governance for Integrated Care: Insights from a Policy Stakeholder Dialogue

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