School of Health Sciences, Surrey Research Park, Surrey, United Kingdom.
Health Services Management Centre, Park House, University of Birmingham, Birmingham, United Kingdom.
PLoS One. 2022 Apr 11;17(4):e0266899. doi: 10.1371/journal.pone.0266899. eCollection 2022.
Inter-organisational collaborations (IOCs) in healthcare have been viewed as an effective approach to performance improvement. However, there remain gaps in our understanding of what helps IOCs function, as well as how and why contextual elements affect their implementation. A realist review of evidence drawing on 86 sources has sought to elicit and refine context-mechanism-outcome configurations (CMOCs) to understand and refine these phenomena, yet further understanding can be gained from interviewing those involved in developing IOCs.
We used a realist evaluation methodology, adopting prior realist synthesis findings as a theoretical framework that we sought to refine. We drew on 32 interviews taking place between January 2020 and May 2021 with 29 stakeholders comprising IOC case studies, service users, as well as regulatory perspectives in England. Using a retroductive analysis approach, we aimed to test CMOCs against these data to explore whether previously identified mechanisms, CMOCs, and causal links between them were affirmed, refuted, or revised, and refine our explanations of how and why interorganisational collaborations are successful.
Most of our prior CMOCs and their underlying mechanisms were supported in the interview findings with a diverse range of evidence. Leadership behaviours, including showing vulnerability and persuasiveness, acted to shape the core mechanisms of collaborative functioning. These included our prior mechanisms of trust, faith, and confidence, which were largely ratified with minor refinements. Action statements were formulated, translating theoretical findings into practical guidance.
As the fifth stage in a larger project, our refined theory provides a comprehensive understanding of the causal chain leading to effective collaborative inter-organisational relationships. These findings and recommendations can support implementation of IOCs in the UK and elsewhere. Future research should translate these findings into further practical guidance for implementers, researchers, and policymakers.
医疗机构间合作（IOC）被视为提高绩效的有效方法。然而，我们对于促进 IOC 运作的因素，以及情境因素如何和为何影响其实施的理解仍存在差距。一项对 86 个来源的证据进行的现实主义综述，旨在引出和精炼情境-机制-结果配置（CMOC），以理解和精炼这些现象，但通过采访参与 IOC 开发的人员可以进一步加深理解。
我们使用了现实主义评估方法，采用了先前的现实主义综合研究结果作为理论框架，我们试图对其进行精炼。我们利用 2020 年 1 月至 2021 年 5 月期间进行的 32 次访谈，访谈对象包括 29 名利益相关者，包括 IOC 案例研究、服务用户以及英格兰的监管视角。我们采用回溯性分析方法，旨在根据这些数据检验 CMOC，以探讨先前确定的机制、CMOC 和它们之间的因果关系是否得到证实、反驳或修正，并精炼我们对 IOC 成功的原因和方式的解释。
我们之前的大多数 CMOC 及其潜在机制在访谈结果中得到了支持，证据来源广泛。领导行为，包括表现出脆弱性和说服力，有助于塑造合作运作的核心机制。这些机制包括我们之前的信任、信念和信心机制，这些机制得到了大部分证实，只有一些细微的修正。行动陈述被制定出来，将理论发现转化为实际指导。
作为一个更大项目的第五个阶段，我们精炼的理论提供了对导致有效协作式机构间关系的因果链的全面理解。这些发现和建议可以支持英国和其他地方的 IOC 实施。未来的研究应将这些发现转化为实施者、研究人员和政策制定者的进一步实用指南。
