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Managed Care, Medicaid, and Public Health: Building Collaborations That Work
Barriers to Collaboration
Anne M. Barry, J.D., M.P.H., Deputy Commissioner, Minnesota Department of
Finance, St. Paul, MN.
A number of barriers exist to creating and sustaining effective collaborations, including:
- Financial: Funding streams are often categorical, with little or nothing allotted to administration. Organizations have to rearrange priorities in order to create resources for collaborative efforts.
- Understanding/trust: Often "where you sit is where you stand."
- Common mission(s)/language: Definitions—even of terms such as "collaboration"—will differ. Also, it is important that all partners first know each others' missions, to avoid possible collisions.
- Incentives: A show of hands among workshop participants illustrated that "ability to collaborate" is increasingly included in job descriptions. How this is evaluated depends on the organization, include monthly activity reports, process measures (including having to respond to the question, "How has working with this particular collaborative changed your understanding of the problem or made this organization more effective?"), measurable timetables, and outcome measures.
- Systemic issues: Staff turnover can sideline collaborative efforts unless these efforts are part of an organization's way of doing business, rather than depending on individuals. In addition, we all work in environments that allocate and legislate on 1- and 2-year cycles. It is difficult to pursue long-term change in this kind of environment.
- Personal risks and rewards: Ms. Barry posited, "How uncomfortable can you be with being uncomfortable?" She added that effective partners are willing to risk failure.
- Legal: The statutory structure of the State can influence delegation of duties, data practices, organizational structure, and personnel for public entities involved in collaborations. She added that there are ways to share data among partners.
- Technology: Not everyone has the same access to technologies, especially in very rural areas.
- Measuring success: Ms. Barry pointed out that examples—such as a University of Michigan prenatal care study—can be used very effectively in gaining support and resources. Better measures are needed to show how outcomes are related to a collaboration's efforts.
- Looking to the future: Ms. Barry stated that not every problem should be solved through collaborations; sometimes individual organizations do a better job.
Ms. Barry provided examples of effective collaborations following one of two approaches: the legal approach or the common-purpose approach (which involves no contract or legally binding agreements). The legal approach is illustrated by Minnesota's legislation requiring collaboration plans between local public health agencies and managed care organizations (MCOs) and by children's grants that require agreements between at least three units of local government. The common-purpose approach is illustrated by the "Fitness Fever" program, in which healthy activities were promoted through a variety of entities, including schools and an MCO, and through "Home Safety Checks" in which a collaboration that included a waste-collection agency established an accident prevention program.
Finally, Ms. Barry noted that the most important question that staff will ask of their leadership is, "Why collaborate?" Unless leaders are prepared with examples of the benefits and successful models (and perseverance), staff will "wait out" leadership's desire to collaborate.
The children's cabinet: history in Minnesota. Minneapolis (MN): Collaborative Coordinating Group (CCG);1998 Sep.
Collaboratives in Minnesota. Minneapolis (MN): Family Services Collaborative;2000 Jan.
Family services and community based collaboratives. Minneapolis (MN): Minnesota State Office of Revisor of Statutes;1999.
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