Holt Ditte Heering, Aveling Emma-Louise
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, USA.
Health Promot Int. 2023 Feb 1;38(1). doi: 10.1093/heapro/daac203.
Intersectoral partnerships have the potential to co-produce 'synergistic' solutions to complex public health problems, exceeding what any single organization acting alone might achieve. Synergy requires shared decision-making and equitable co-construction by partners. However, many partnerships struggle to realize such synergistic potential. Building on the Bergen Model of Collaborative Functioning, this study offers insights for optimizing partnership synergy by examining interactions between 'inputs' to the partnership-shared mission, and partner resources. Specifically, we introduce the concept of 'dependency structure' to draw attention to how these input interactions shape the balance of power and hence the potential for shared decision-making and co-construction. Findings are based on qualitative data from 10 intersectoral, health promotion partnerships in Denmark, including 27 interviews, 10 focus groups, partnership documents and meeting observations. We identified eight distinct types of 'input resources', which were important in shaping the potential balance of power between partners in more or less productive ways. However, the dependency structure that materialized-and its synergistic potential-was contingent on how these inputs interacted with the partnership mission. Our findings suggest a well-developed shared mission serves three functions-(i) foregrounding a common purpose, (ii) aligning individual partner's self-interests and (iii) enabling action. The extent to which partnerships developed a shared mission serving all three functions influenced realization of a balanced dependency structure in which collaborators recognized their interdependencies, in turn promoting shared decision-making. To ensure the greatest potential for synergy, early and ongoing discursive processes to co-develop the partnership mission were particularly important.
跨部门伙伴关系有潜力共同产生针对复杂公共卫生问题的“协同增效”解决方案，其效果超过任何单个组织单独行动所能达到的程度。协同增效需要伙伴之间共同决策和平等共建。然而，许多伙伴关系难以实现这种协同增效潜力。基于卑尔根协同运作模式，本研究通过考察伙伴关系的“投入”（共享使命和伙伴资源）之间的相互作用，为优化伙伴关系协同增效提供见解。具体而言，我们引入“依赖结构”概念，以关注这些投入互动如何塑造权力平衡，进而影响共同决策和共建的潜力。研究结果基于对丹麦10个跨部门健康促进伙伴关系的定性数据，包括27次访谈、10个焦点小组、伙伴关系文件和会议观察。我们识别出八种不同类型的“投入资源”，它们以或多或少富有成效的方式塑造伙伴之间潜在权力平衡方面具有重要意义。然而，实际形成的依赖结构及其协同增效潜力取决于这些投入如何与伙伴关系使命相互作用。我们的研究结果表明，一个完善的共享使命具有三项功能——（i）突出共同目标，（ii）协调各伙伴的自身利益，以及（iii）促成行动。伙伴关系制定的共享使命在多大程度上具备这三项功能，会影响到平衡依赖结构的实现，在这种结构中，合作者认识到彼此的相互依存关系，进而促进共同决策。为确保实现最大协同增效潜力，早期和持续的共同制定伙伴关系使命的话语过程尤为重要。
