Exploring Mechanisms that Facilitate the Development of Collaborative Governance Structures Article Swipe

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Michelle Nelson , Alyssa Indar , Lauren MacEachern , Paula Blackstien-Hirsch , Ross Baker ·

YOU? · · 2025 · Open Access · · DOI: https://doi.org/10.5334/ijic.icic24191

Introduction: Globally, many health systems are moving toward integrated care. A Canadian example is the restructuring of care delivery in Ontario, to align with the Quadruple Aim. The vision for the Ontario Health Teams (OHTs), announced by the government in 2019, has prompted convergence across sectors with an initial focus on priority patient populations, and collaborative governance to achieve desired outcomes. The early implementation of OHTs was “low rules:” each OHT assembled its own leadership and governance infrastructure to meet local needs. This was (and remains) a significant task, requiring strategic thinking and inter-organizational collaboration. The ADVANCE program was created to support shared leadership, decision-making and accountability for leaders of OHT partner organizations. The purpose of this research was to analyze which partnerships within integrated health systems developed over time and to identify the interventions that support effective collaborative governance – specifically focused on leadership, decision making, and accountability. Methods: A qualitative study, framed by the model of Collective Impact, was undertaken to explore the mechanisms that supported the development of collaborative governance structures and processes within OHTs. We completed a document review to understand collaborative governance structures (e.g., collaborative decision-making frameworks, organizational charts, communication strategies etc.). We used these documents to create vignettes, which summarized information about each OHT. Concurrently, we conducted 15 interviews and two focus groups with members of OHTs’ senior leadership teams. We used a realist approach to frame data analysis, allowing us to summarize contextual factors and mechanisms that framed successful collaborative outcomes, as described by the study participants. Results: Participants were diverse in terms of their educational backgrounds, years of experience, position on the leadership council (e.g., CEO, Patient and Family Advisory Council member, community sector representative etc.) and their motivation for joining the leadership teams. There were a variety of contextual factors that were addressed by participants when describing their OHT’s journey toward collaborative governance; for example: the size of the OHT (e.g., the number and size of partners coming together), the level of partner engagement and the presence of historical relationships. Participants highlighted several mechanisms that facilitated collaborative governance including: (1) strong, effective intersectoral leadership (formal and informal), (2) the importance of backbone support, (3) development of trusting partnerships often based on past collaborations, (4) effective and widely distributed communication approaches, and (5) a continuing, articulated commitment to collaborative processes, guided by a clear, shared vision. These mechanisms facilitated outcomes that maximized performance on OHT-specific outcomes and supported synergy between partners. Conclusion and Next Steps: Study results provide insights into the contextual factors and mechanisms that contribute to successful collaborative outcomes. These insights may support others who are engaged in health care system transformation to consider varied cultural and operational approaches for building collaborative governance models.

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Process management Knowledge management Corporate governance Collaborative governance Business Computer science Finance

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Type: article
Language: en
Landing Page: https://doi.org/10.5334/ijic.icic24191
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DOI: https://doi.org/10.5334/ijic.icic24191

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Title: Exploring Mechanisms that Facilitate the Development of Collaborative Governance Structures

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Language: en

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Publication year: 2025

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Publication date: 2025-04-09

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Authors: Michelle Nelson, Alyssa Indar, Lauren MacEachern, Paula Blackstien-Hirsch, Ross Baker

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Landing page: https://doi.org/10.5334/ijic.icic24191

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Concepts: Process management, Knowledge management, Corporate governance, Collaborative governance, Business, Computer science, Finance

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abstract_inverted_index.convergence	43
abstract_inverted_index.development	169, 363
abstract_inverted_index.distributed	376
abstract_inverted_index.educational	262
abstract_inverted_index.experience,	266
abstract_inverted_index.facilitated	344, 396
abstract_inverted_index.frameworks,	191
abstract_inverted_index.governance;	311
abstract_inverted_index.highlighted	340
abstract_inverted_index.information	206
abstract_inverted_index.leadership,	103, 144
abstract_inverted_index.operational	447
abstract_inverted_index.performance	400
abstract_inverted_index.qualitative	151
abstract_inverted_index.significant	87
abstract_inverted_index.OHT-specific	402
abstract_inverted_index.Participants	255, 339
abstract_inverted_index.backgrounds,	263
abstract_inverted_index.participants	303
abstract_inverted_index.partnerships	122, 366
abstract_inverted_index.populations,	53
abstract_inverted_index.specifically	141
abstract_inverted_index.Concurrently,	210
abstract_inverted_index.Introduction:	0
abstract_inverted_index.collaborative	55, 138, 171, 185, 189, 246, 310, 345, 386, 427, 451
abstract_inverted_index.communication	194, 377
abstract_inverted_index.intersectoral	351
abstract_inverted_index.interventions	134
abstract_inverted_index.participants.	253
abstract_inverted_index.restructuring	15
abstract_inverted_index.accountability	106
abstract_inverted_index.collaboration.	94
abstract_inverted_index.implementation	63
abstract_inverted_index.infrastructure	77
abstract_inverted_index.organizational	192
abstract_inverted_index.organizations.	112
abstract_inverted_index.relationships.	338
abstract_inverted_index.representative	282
abstract_inverted_index.transformation	441
abstract_inverted_index.accountability.	148
abstract_inverted_index.collaborations,	371
abstract_inverted_index.decision-making	104, 190
abstract_inverted_index.inter-organizational	93
cited_by_percentile_year
countries_distinct_count	0
institutions_distinct_count	5
citation_normalized_percentile.value	0.16201595
citation_normalized_percentile.is_in_top_1_percent	False
citation_normalized_percentile.is_in_top_10_percent	True