Table 1 Distinguishing statements for factor 1

34

We need to have a clear mandate from the top to enable public health, primary care and the rest of the health system to work together more effectively.

Systemic

8

I think that people in different branches in the Ministry/ Ministries have to really believe in collaboration and support it enough so that they write policies that say these organizations are going to work together.

Systemic

38

I think we need models like community health centres which are globally funded (salaried physicians who work in a team setting with a range of health professionals – nurses, nutritionists, social workers). So the more we move into this kind of model, primary care and public health collaborations might become richer.

Systemic

33

I think the base unit of the health care system, just as WHO and everybody else around the world suggests, should be some sort of community health centre model which provides a primary care range of services practicing in the context of community.

Systemic

35

I think without knowing what one another does and how we can actually utilize one another, we are really actually providing a disservice to communities that we serve.

Interactional

19

I think you need to have someone in the Ministry who believes a collaborative structure is important and would make it happen.

Systemic

32

It’s a problem when there is a lack of involvement of all parties in the planning stages. For example, when middle management is not involved in the decision making process or we need the people who are going to be delivering the programming when it hits the ground at the table.

Organizational

4

Partners need to consistently engage in dialogue to resolve issues. For example, they are working together identifying specific patients that both are involved with.

Interactional

1

I think we need to move more toward use of the electronic health record where all collaboration partners have full access to every chart. Then everyday communication around patient care would be much better.

Organizational

23

I think an important facilitator of collaboration is having a memorandum of understanding (MOU) of how we work together. For example, MOU says that each partner agrees to put X hours of service in on a weekly basis and we will have a planning day every year.

Organizational

44

I think a problem in collaborations is that there are funding differences between primary care and public health systems, namely, primary care has a lot more money and people than public health. That’s a built-in challenge to any kind of collaboration.

Systemic

24

Public health is largely in a unionized environment and is a bigger, institutional culture. They’ve got much more prescribed practices around how they can deploy staff which is a big barrier to collaboration.

Organizational

25

I think differing mandates are a barrier to collaboration. Public health can’t provide individual care because they are population health-based and group-based. For example public health is working on healthy food policies and trying to work with schools.

Systemic