Table 3

Distinguishing statements for factor 3
No. Statement Factor 1 Factor 2 Factor 3
13 We need to spend time making sure that both parties clearly understand the difference between the roles of primary care organization and the roles of the Public Health organization. Interactional 0 1 5
40 Physicians, nurses and social workers are not sharing courses when they’re being educated; so they are not going to see the value of working collaboratively. Systemic −1 0 4
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. Organizational −4 −2 3
6 Collaboration won’t work if people haven’t got the stable and sustainable funding to get it established, evaluated and carry it on. Organizational 0 1 3
7 I think it is important in a collaboration that people use the skill set that they have. They do not always have to learn new skill sets, but utilize the skill sets that other people have. Interactional −1 −1 2
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 4 −1 1
3 It’s a lot about relationships and trust. People need to trust one another and know that everybody is working towards the same end. That will have the biggest impact on collaboration. Interactional 5 5 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 5 −4 0
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 −3 −2 0
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 3 −2 0
2 I think physical co-location of primary care and public health results in increased exposure to one another and therefore a stronger understanding of each other’s skills and roles. Organizational 3 1 −1
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 3 −1
30 A facilitator for collaboration would be having a public health staff presence in a primary care setting—so there’s a face to public health. I can get information without having to go through a complicated process. Organizational 1 1 −2
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 4 0 −2
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 −1 2 −3
17 We have evidence on the benefits of collaboration that are linked to long term health benefits for individuals in the population. Systemic −2 0 −4

Akhtar-Danesh et al.

Akhtar-Danesh et al. BMC Health Services Research 2013 13:311   doi:10.1186/1472-6963-13-311

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