While there are often strong financial motivations behind organizations wishing to work closely together, these should not be the overriding motivation for PNA. Reactive, finance-driven activity often fails to take hold once the initial compulsion fades.
Partnerships, networks and alliances can be divided into two broad categories – proactive and reactive.
For example, in the US, a new wave of PNA activity is being driven by the Affordable Care Act (ACA). Larger systems are extending their reach into the growing insured population, and smaller hospitals perceive the benefit of partnering or ownership by the larger system in order to leverage resources towards sustainability. This could be described as activity rather than success. It is a response to current policy initiatives or the quest for financial sustainability. It follows rather than leads (reactive).
The Yale New Haven strategy, on the other hand, has a much broader foundation, seeking to achieve better value in terms of quality, cost and population health; embedding financial aims as a part of its wider mission — an important but not dominant consideration of the strategy.
In the Netherlands, success is planned rather than emergent, and no less dependent on thinking beyond simply size and money. An insurer, Menzis, has a goal for a high-performing triangle of access, quality and affordability. Working with the care system redesign methodology from KPMG, it has created a collaborative process between providers in the north east of the country to shift services and create more out-of-hospital alternatives.
This process is grouped into three themes:
Children’s Healthcare Networks in New South Wales, Australia provided a study of new networks driven overwhelmingly by the intention to improve health and health services, as opposed to ‘empire building’.
In response to high-profile hospital service failures and a state-wide inquiry, two levels of network for children were established in 2011. The last decade has witnessed serious quality failures in a number of health systems — Mid Staffs Hospitals NHS Foundation Trust in the UK and hospitals in New South Wales, Australia, for instance.
The formal reviews of these have prompted major changes in partnerships and networks. In NSW the Garling Report of 2008, recommended the integration of children’s services into networks. In addition the Healthcare Reform Act of 2011 required the creation of statewide children’s services to ensure access, linkage and continuity so that no group or geography is disadvantaged. This culminated in two levels of network for children: one between the major children’s hospitals (Sydney Children’s Hospital Network), and another to coordinate primary and community services across the state (NSW Kids and Families). The hospital network has a broad-based strategy focused on collaboration and integration across four domains — clinical care, research, education and advocacy. These clearly add up to a focus on sustainable quality.
So, while clearly regrettable, major service failure can generate the new partnerships, networks and alliances needed to drive quality. One downside of this can be a lower chance of success if PNAs are engineered by government rather than naturally occurring. Nevertheless, in the case of NSW Kids and Families, the quality focus means they are not perceived as evidence of creeping bureaucracy or political interventions. This is largely because of their transparency and capacity for self- reflection. NSW Kids and Families, for instance, goes regularly to the market for evaluation of its current programs and advice on the creation of new themes.