Improving public health system performance through multiorganizational partnerships

Abstract

Public health activities in the United States are delivered through multiple public and private organizations that vary widely in their resources, missions, and operations. Without strong coordination mechanisms, these delivery arrangements may perpetuate large gaps, inequities, and inefficiencies in public health activities. We examined evidence and uncertainties concerning the use of partnerships to improve the performance of the public health system, with a special focus on partnerships between public health agencies and health care organizations. We found that the types of partnerships likely to have the largest and most direct effects on population health are among the most difficult, and therefore least prevalent, forms of collaboration. High opportunity costs and weak and diffuse participation incentives hinder partnerships that focus on expanding effective prevention programs and policies. Targeted policy actions and leadership strategies are required to illuminate and enhance partnership incentives.

Figure 1

Prevalence of 7 public health partnership configurations, 1998 and 2006. Error bars represent 95% confidence intervals. Data were obtained from a survey of the 351 agencies that responded in both years (29,30). Seven configurations were identified through multivariate cluster analysis, each one distinguished by network breadth, density, and centrality. Breadth represents the array of actors involved in the partnerships; density represents the amount of interconnectedness between organizations; and centrality represents the relative influence of a single organization within a partnership.