Challenges

Time Pressures
Finding adequate time for collaboration activities is a common challenge in building and maintaining collaborations. Time pressures can include:

  • Time for meeting, establishing, and maintaining relationships,
  • Time to participate in and maintain collaborations,
  • Time for strategic planning,
  • Time for developing creative solutions to problems and collaboration development,
  • Scheduling conflicts.

Time spent on such activities does divert time from other work.  As an illustration, when staff are permitted to leave regular work to attend a collaboration activity and are not replaced, there is an additional strain on the work team, as well as, it may also challenge relationships in the collaboration.

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 Related: Optimal Use of Human Resources

 

Alternate Funding Model
One potential way to overcome some of the time challenges is to move to alternative funding models in primary care to replace fee for service payment models. In a fee for service payment plan, practitioners have little financial incentive to take the time needed to work on collaborations and can suffer a financial loss for time spent on activities which are not billable. Although not all physicians in a fee for service payment model have this problem, it can be a barrier for many.

Money

Challenges also include the lack of funding for primary care staff training, participation in collaboration meetings, and secretarial support to assist in coordination of meetings and other administrative activities.

Inequitable Resources
Another challenge which may be experienced is financial resources being drawn from one partner more than another or there has been an unequal contribution from one partner. Unequal contributions are not unusual and may not present a real problem. To prevent a conflict, an agreement by both partners on what they each bring to the table in terms of time, financial, and other resources is a viable solution.

The goal is not having equality in resources shared in the collaboration but rather having a shared goal for the collaboration itself.

Geography
The lack of geographic proximity between partners can also be a significant challenge. In particular, the distance between partners in rural communities can present a barrier to accommodate meeting one another on a regular basis. In these situations, virtual communication is the most effective means.

Priorities
Prioritizing where and how to use limited resources can in some cases present a strain on bi-sectoral collaborations. Given high demands in most organizations, it can be a challenge to think about adding new activities to already full schedules and to release staff to engage in the collaboration activities. The terms of reference of the collaboration often provide an avenue to resolve conflicts.

Time
Time for collaboration diverts time from other work. When there is pressure to spend time on service delivery activities in a collaboration rather than communication among partners, the results can be stressful. However, it is important to take this time to engage in strategic communication and coordination mechanisms, with collaboration partners.

Unequal Pay Differentials
Another factor which may potentially be a challenge is unequal pay differentials between and within sectors. For example, a public health nurse and a primary care nurse may earn very different hourly rates, although they are working at the same flu vaccination clinic.

Also, in some primary care settings, clinic staff may be paid from different pots of funding and/or have unequal access to resources such as paid continuing education days. This presents an inequity which can create conflict in collaborations. It is important to give consideration to these potential situations which might help to explain difficulties in buy-in by some staff. Identifying ways to address these variances can be immeasurably helpful for a collaboration’s success.