A multilevel transition perspective on embedding intersectoral action in local health policies.

Intersectoral action is advocated as a social practice that can effectively address health inequalities and related social issues. Existing knowledge provides insight into factors that may facilitate or hinder successful intersectoral action, but not much is known about how intersectoral action evolves and becomes embedded in local health policies. This is where this study aims to make its contribution, by adopting the multilevel perspective on transitions, which is increasingly used to study social innovation in sustainability transitions but has not yet been applied to public health and health promotion. Through this perspective, it was unravelled how intersectoral action between youth-care organizations and community sports clubs became embedded in local health policies of Rotterdam, a large city in the Netherlands. A single explorative case study was conducted based on content analysis of policy documents and 15 in-depth interviews with policy officers, managers and field workers operating in the fields of youth and sports in Rotterdam. The findings showed that intersectoral action between community organizations and policymakers evolves through congruent processes at different levels that changed institutional logics. Moreover, it emerged that policymakers and other actors that advocate novel social practices and act as boundary spanners can adopt multiple strategies to embed these practices in local health policy. The multi-level perspective adds value to earlier approaches to research intersectoral collaboration for health promotion as it allows to better capture the politics involved in the social innovation processes. However, further sharpening and more comprehensive application of transition concepts to study transitions in public health and health promotion is needed.

Public-private partnerships, boundary spanners and the boundary wall in the English National Health Service.

PURPOSE: The paper investigates English National Health Service (NHS) organisations partnering with private companies, a form commonly known as a Public-Private Partnership (PPP). Successive governments have promoted PPPs as a way of improving the delivery of health care, making the best of the different skills/experience which both sectors bring. However, the task of making these relationships work on the ground often falls to individual leaders/practitioners ("boundary spanners") whose role has been under-researched in this type of partnership. DESIGN/METHODOLOGY/APPROACH: The paper opted for a comparative three case study approach, including 13 semi-structured interviews and questionnaires with employees representing middle and senior management involved in managing the partnerships. The data were complemented by documentary analysis, including minutes, descriptions of internal processes and press releases. FINDINGS: The paper provides conceptual and empirical insights by creating a framework called the "boundary wall" that indicates the ways in which different elements of the boundaries between organisations influence the role and activities of boundary spanners (managers of the partnership). RESEARCH LIMITATIONS/IMPLICATIONS: This is an initial framework in an under-researched area, so will need further testing and application to other case study sites in future research. PRACTICAL IMPLICATIONS: The paper includes implications for both practice and policy. ORIGINALITY/VALUE: While we know an increasing amount about the role of boundary spanners in public partnerships, the paper makes a unique contribution by exploring these concepts in the context of relationships between the public and private sectors.

Strengthening collaboration within Dutch municipalities for a healthier living environment: experiences and possible improvements according to civil servants.

Background: Health is partly determined by the physical environment in which people live. It is therefore crucial to consider health when designing the physical living space. This requires collaboration between the social and physical domains within municipalities. Collaboration is not self-evident, however, and it is difficult to achieve due to barriers relating to culture, language and work processes. Additionally, improvements in collaboration are desperately needed to address complex health issues, and working according to the new Environment and Planning Act in the Netherlands requires more collaboration. One relevant question concerns how civil servants describe the current collaboration between the social and physical domain and the concrete improvements they propose to improve such collaboration to build a healthier living environment. Methods: In this qualitative study, the Collaborative Governance framework was used to present data from semi-structured interviews with 21 civil servants in five Dutch municipalities. Respondents were asked to reflect on their current experiences with collaboration and suggest concrete opportunities for improving collaboration. Results: The results indicate that enhancing collaboration between the social and physical domains can be achieved by proceeding from the inhabitants' perspective, as well as by encouraging aldermen and managerial personnel to take a more active and committed role in collaboration. This involves formulating and communicating a joint vision, in addition to guiding and facilitating collaboration through integrated assignments, forming multidisciplinary teams and appointing boundary-spanners. Civil servants see a clear role for themselves in the collaborative process. They recognize their own contributions to and obligations in enhancing collaboration by actively seeking contact, absorbing each other's perspectives and pursuing common ground, starting today. Conclusion: There are many concrete opportunities to improve collaboration between the social and physical domains. This could be initiated immediately if civil servants, managers and aldermen approach collaboration as an essential part of their jobs and acknowledge the interdependency that exits.

The Influence of Guanxi Between Boundary Spanners on Opportunistic Behaviors Based on the Theory of Reasoned Action Model.

This study constructs a mechanism of the influence of Guanxi between boundary spanners on opportunistic behaviors in collaborative innovation projects based on the theory of reasoned action model. The study conducts a survey in the automobile industry in Changchun, Jilin Province, China, and analyzes the research data using the structural equation model. The findings show that Guanxi has a negative an significant influence on opportunistic behavior attitudes and subjective norms., Guanxi has the greater influence on subjective norms than attitudes. Then, opportunistic behavior attitudes and subjective norms positively influence intentions. The influence of subjective norms is stronger. The attitudes and subjective norms of opportunistic behaviors also play mediation roles. Furthermore, opportunistic behavior intentions have a positive and significant influence on behaviors. In short, the study's findings reveal a mechanism of Guanxi between boundary spanners influencing opportunistic behaviors of boundary spanners. It also provides a reference for corporate managers to govern opportunistic behaviors of collaborator while inhabiting opportunistic behaviors of their own boundary spanners.

Implementing health and social care integration in Scotland: Renegotiating new partnerships in changing cultures of care.

Health and social care integration has been a long-term goal for successive governments in Scotland, culminating in the implementation of the recent Public Bodies (Joint Working) Scotland Act 2014. This laid down the foundations for the delegation of health and social care functions and resources to newly formed Integrated Joint Boards. It put in place demands for new ways of working and partnership planning. In this article, we explore the early implementation of this Act and how health and social care professionals and the third sector have begun to renegotiate their roles. The paper draws on new empirical data collated through focus groups and interviews with over 70 professionals from across Scotland. The data are explored through the following key themes: changing cultures, structural imbalance, governance and partnership and the role of individuals or "boundary spanners" in implementing change. We also draw on evidence from other international systems of care, which have implemented integration policies, documenting what works and what does not. We argue that under the current framework much of the potential for integration is not being fulfilled and that the evidence suggests that at this early stage of roll-out, the structural and cultural policy changes that are required to enable this policy shift have not yet emerged. Rather, integration has been left to individual innovators or "boundary spanners" and these are acting as key drivers of change. Where change is occurring, this is happening despite the system. As it is currently structured, we argue that too much power is in the hands of health and despite the rhetoric of partnership working, there are real structural imbalances that need to be reconciled.