Inetersectoral Collaboration Toward Building Healthy Cities

1
Inetersectoral Collaboration Toward Building
Healthy Cities

• - Theory and Practice -

Tomoyuki Matsuno Okinawa Pref. Miyako Welfare and
Health Center
2
Importance of Intersectoral Collaboration for
Healthy Cities

• Improvement of health and well-being requires
  more than services delivered by the health sector
  alone. All problems related to health and
  well-being are complex and interconnected.
• Intersectoral collaboration has been emphasized
  since a new and broader definition of health and
  its health promotion strategies was issued by the
  WHO.

3
Practices and theory (ONeil, 1997)

• The discrepancy between practices and research of
  intersectoral collaboration comes from the
  vagueness of the concept and trial-and-error
  based recommendations rather than building theory
  to explain the process of intersectoral
  collaboration.
• With analysis of three intersectoral actions in
  Canada, he concluded that, "by using coalition
  theory, we can go beyond ideological enthusiasm
  to understand exactly how intersectoral
  collaborations succeed or fail."

4
Development of Community Coalition (Butterfoss,
1996)
Lead Agency
Ad Hoc Committee of Community Leaders
Formation
Bussiness
Education
Media
Youth
Religion
NPO
Neighborhood
Conduct Needs Assessment
Implementation Maintenance
Chairpersons Consolidate Work of Individual
Committees
Comrehensive Community Plan
Plan Implementation
Outcome
Impact on Community Health Indicators
5
Factors involved in Collaboration Formation

• Positive attitude towards collaboration (Becker
  1970, Whetten 1981, Akinbode 1976, Davidson 1973)
• Knowledge of potential partners and previous
  history of collaboration by potential member
  organizations (Whetten 1981)
• Capacity to maintain collaborative linkages
  (Whetten 1981)

6
Factors in Implementation and Maintenance
1Butterfoss (1993), Rogers (1993), and
Wandersman (1997)

• Leadership characteristics
• Formalized rules, roles, and procedures
• Operational understanding
• Sense of ownership
• Resources of staff organization for maintenance
• Member characteristics

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Factors in Implementation and Maintenance
2Butterfoss (1993), Rogers (1993), and
Wandersman (1997)

• Benefit and cost of participation
• Member satisfaction and commitment
• Member-staff relationships, member relationships,
  and staff relationships
• Communication patterns
• Community representation
• Decision-making processes

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Purpose of the study

• To expand knowledge of the factors promoting or
  reducing intersectoral collaboration and to
  understand the interrelationships among the
  identified promoting or inhibiting factors.
• To provided insights into intersectoral
  collaboration efforts in general and within the
  context of the Japanese society.

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DESIGN AND METHODOLOGY

• Subject of Research Healthy Families Planning
  in Okinawa Chubu District (1996 2005)
• Thirty-six interviewees of planning committees of
  Seven Municipalities in Okinawa
• MethodIn-depth Interview Method and Grounded
  Theory Method

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In-depth Interview Interview Guide

• 1) What did you feel about this committee when
  you were asked to be a committee member?
• 2) What benefits did you have by attending the
  HFPP committee?
• 3) What difficulties did you experience in this
  committee?
• 4) What do you think promotes collaboration in
  this committee?
• 5) What do you think inhibits collaboration in
  this committee?
• 6) What do you think about the methods used by
  the HFPP?
• 7) What new activities do you have in your job
  after attending the HFPP?
• 8) What collaborative activities do you have with
  other organizations?
• 9) What is needed to promote the collaboration
  among participating organizations?

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Previous communication and collaboration

• Representative of mothers clubAs I know most
  of the committee members, I could freely express
  my ideas in the committee meeting I felt
  comfortable in giving my honest opinions. In
  addition, I felt a responsibility to give my
  honest opinion as a representative of
  child-raising mothers. (Interview 26, p.2)
• A representative of a child care center At the
  beginning, it was difficult to participate in the
  subcommittee discussions, because I did not know
  the other members. In addition, there were few
  members who knew how to proceed with the planning
  process. Another subcommittee involved in
  prenatal health, I felt that there was a good
  atmosphere because the member had known each
  other well before this project, and also Ms F
  knew the planning process well. The other
  subcommittee involving adolescent health also had
  a good atmosphere because most of the members
  knew each other from PTA meetings. As a result,
  staff members should take it into consideration
  familiarity of members with each other when they
  organize members of each subcommittee.
  (Interview 30, p.6)

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Process toward collaborative actions for health
among multi-sectoral organizations
13
Predisposing Factors
Before Committee
Committee Discussion
After Committee
Feedback
Organizational
Atmosphere
Barriers
Collaborative
(Considering
Actions
feasibility)
Mutual Learning Process
Predisposing
Understand-
Exploring one's
factors
ing others
role
System
thinking
Failure of
collaborative
actions
Maintenance
of committee
Feedback
14
Predisposing Factors

• Previous Communication and Collaboration
• Pattern of previous communication and
  collaboration
• Formal Organizational Communication and
  Collaboration
• Informal Organizational Communication and
  Collaboration
• Individual Communication and Collaboration
• Community Level Communication and Collaboration
• Willingness to Collaborate with Other
  Organizations
• Passion to Contribute to Community
• Recognition of Mutual Need
• Initial Involvement of Committee Members
• Awareness As a Shareholder

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Mutual Learning Process
Committee Discussion
Before Committee
After Committee
Feedback
Organizational
Atmosphere
Barriers
Collaborative
(Considering
Actions
feasibility)
Mutual Learning Process
Predisposing
factors
Failure of
collaborative
actions
Maintenance
of committee
Feedback
16
Mutual Learning Process

• Mutual Understanding
• Levels of Understanding
• System Thinking Toward Exploring Ones Role
• Sharing Desired Outcomes
• Discussion of Cause-Effect Relationship and
  Possible Activities toward Exploring Ones Role
• Understanding of Interconnectedness
• Developing Clear, Organized, and Detailed Ideas
• Understanding Role of Each Organization and
  Exploring Ones Own Role in an Interwoven World
• Clarification of Goals of Each Members
  Activities by Indexes and Targets
• Dynamics of Three Components

17
Workshop
MiyakoIsland
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Hirara City
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5km
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Healthy Miyako Healthy Hirara City
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Atmosphere in Mutual Learning Process
Committee Discussion
Before Committee
After Committee
Feedback
Organizational
Atmosphere
Barriers
Collaborative
(Considering
Actions
feasibility)
Mutual Learning Process
Predisposing
Understand-
Exploring one's
factors
ing others
role
System
thinking
Failure of
collaborative
actions
Maintenance
of committee
Feedback
19
Atmosphere in Mutual Learning Process

• Enjoyable Discussion
• Ownership of Proposed Plan
• Trust between Participants

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Maintenance of Committee
Committee Discussion
Before Committee
After Committee
Feedback
Organizational
Atmosphere
Barriers
Collaborative
(Considering
Actions
feasibility)
Mutual Learning Process
Predisposing
Understand-
Exploring one's
factors
ing others
role
System
thinking
Failure of
collaborative
actions
Maintenance
of committee
Feedback
21
Maintenance Structure to Sustaining Mutual
Learning Process

• Good Facilitator
• Helping Participants to Relax
• Guidance of Procedure of Planning
• Facilitating Participants to Freely Express as
  Many Ideas as They Have, and Avoiding Discussion
  Overcome by Negative Comments
• Avoiding Dead-end Discussions and Keeping the
  Discussions Moving Forward
• Maintenance Structure for Committee Meetings
• Enough Resources of Staff Organization
• Teamwork among Staff Members
• Time Schedule of Committee Meetings
• Off-committee Coordination with Committee Members
• Choice of Planning Methods

22
Process toward collaborative actions for health
among multi-sectoral organizations
After Committee
Committee Discussion
Before Committee
Feedback
Organizational
Atmosphere
Barriers
Collaborative
(Considering
Actions
feasibility)
Mutual Learning Process
Predisposing
Understand-
Exploring one's
factors
ing others
role
System
thinking
Failure of
collaborative
actions
Maintenance
of committee
Feedback
23
Converting Discussed Activities into Practical
Applications

• Evaluation of Possible Activities by Committee
  Organization related factors
• cost and benefit of possible activities,
• feasibility of possible activities themselves,
• type of organization, and
• position of representatives in its organization.
• Coordination with Other Participating
  Organizations

24
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What healthy diet promoting group can do?
25
Who?
When?
?2 ???????
To promote healthy diet, what each organization
will do?
26
Process toward collaborative actions for health
among multi-sectoral organizations
After Committee
Committee Discussion
Before Committee
Feedback
Organizational
Atmosphere
Barriers
Collaborative
(Considering
Actions
feasibility)
Mutual Learning Process
Predisposing
Understand-
Exploring one's
factors
ing others
role
System
thinking
Failure of
collaborative
actions
Maintenance
of committee
Feedback
27
Summary

• Six core categories that are related to
  intersectoral collaboration has been identified
  in this study.
• Six core categories are
• Predisposing Factors,
• Mutual Learning Process,
• Atmosphere,
• Maintenance of Committee,
• Considering Feasibility, and
• Collaborative Actions.
• Coordinators can manage intersectoral
  collaboration by using this model.