Engel Nora, van Lente Harro
Department of Health, Ethics and Society/School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands.
Sociol Health Illn. 2014 Jul;36(6):917-31. doi: 10.1111/1467-9566.12125. Epub 2013 Dec 28.
Partnerships between public and private healthcare providers are often seen as an important way to improve health care in resource-constrained settings. Despite the reconfirmed policy support for including private providers into public tuberculosis control in India, the public-private mix (PPM) activities continue to face apprehension at local implementation sites. This article investigates the causes for those difficulties by examining PPM initiatives as cases of organisational innovation. It examines findings from semi-structured interviews, observations and document analyses in India around three different PPM models and the attempts of innovating and scaling up. The results reveal that in PPM initiatives underlying problem definitions and different control practices, including supervision, standardisation and culture, continue to clash and ultimately hinder the scaling up of PPM. Successful PPM initiatives require organisational control practices which are rooted in different professions to be bridged. This entails difficult balancing acts between innovation and control. The innovators handle those differently, based on their own ideas of the problem that PPM should address and their own control practices. We offer new perspectives on why collaboration is so difficult and show a possible way to mitigate the established apprehensions between professions in order to make organisational innovations, such as PPM, sustainable and scalable.
在资源有限的环境中，公共和私营医疗服务提供者之间的伙伴关系通常被视为改善医疗保健的重要途径。尽管印度再次确认了将私营提供者纳入公共结核病控制的政策支持，但公私合作（PPM）活动在当地实施地点仍面临担忧。本文通过将PPM倡议作为组织创新案例进行研究，探讨了这些困难的原因。它研究了围绕三种不同PPM模式以及创新和扩大规模的尝试，在印度进行的半结构化访谈、观察和文件分析的结果。结果表明，在PPM倡议中，潜在的问题定义和不同的控制措施，包括监督、标准化和文化，持续冲突，最终阻碍了PPM的扩大规模。成功的PPM倡议需要弥合植根于不同专业的组织控制措施之间的差距。这需要在创新和控制之间进行艰难的平衡。创新者根据他们自己对PPM应解决的问题的看法以及他们自己的控制措施，对此采取不同的处理方式。我们提供了关于合作为何如此困难的新观点，并展示了一种可能的方法来减轻各专业之间既有的担忧，以使诸如PPM这样的组织创新能够持续并扩大规模。
