Table 5.

List of statements in the Q-sample

Statement number	Statement
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.
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.
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.
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.
5	I think different work processes are a barrier to collaboration. For example, staff who work in clinical services work at the very usually stressful sort of primary care pace. Colleagues who work in other areas of Public Health aren’t in the same mindset, stress level, pace level.
6	Collaboration won’t work if people haven’t got the stable and sustainable funding to get it established, evaluated and carry it on.
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.
8	I think that 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.
9	For better collaboration we need to define roles, where everyone fits in the big picture. It is not about turf and it’s not about ‘I can do this better than you’. It’s about how can we deliver cost effective care to the patient the best way.
10	A lack of vision in collaborations is a barrier. For example, people are not being clear on what the end result is going to be.
11	I think politicians have research evidence to say that collaboration will save money so will put money behind it.
12	I don’t see any formal linkage between the public health nurses and the primary care physicians and there is no support at the higher systems level for that to happen.
13	We need to spend time making sure that both parties clearly understand the difference between the role of primary care organization and the role of the Public Health organization.
14	Everybody feels that they are at capacity and there’s no room for anything more such as working on a collaboration.
15	For better communication there has to be availability of electronic communication mechanisms (i.e. email listserv) between public health and primary care. (i.e., for information sharing about free mental health sessions in the community).
16	There’s a strong lack of collaboration for prevention interventions. Primary care and public health work in silos. I think we need to break those silos.
17	We have evidence on the benefits of collaboration that are linked to long term health benefits for individuals in the population.
18	If primary care and public health professionals are so married to how they interpret their role and mandate, that a person can’t step outside of that role if the situation calls for it, it can be a barrier to collaboration. People need to be comfortable with a blurring of the lines.
18	In collaborations there is a threat that public health staff who don’t have a primary care background are moving into situations where they’re going to have to deal with primary care issues.
19	I think you need to have someone in the Ministry that believes a collaborative structure is important and would make it happen.
20	There is limited evidence of effectiveness of collaboration. I think evaluations should occur regularly and collaborators should keep talking all the way along.
21	I think it is easy to get people in all branches/departments of the Ministry/Ministries to recognize the importance of public health and prevention.
22	I think the fee-for-service model doesn’t work. We need to have money attached in a way that fosters collaboration. To really get doctors to pay attention beyond their practice and their individual patients, we have to pay them differently if we want them to do different work.
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.
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.
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.
26	I think collaboration needs contributions in-kind from each party of their own staff and resources as well as additional resources.
27	Public Health is organized by programs and not geography necessarily. We need to align more geographically so we can start working a little more closely with our primary care and community partners.
29	In a provincial healthcare system, you have to have the primary care and public health players in the collaboration working for the same entity-- for the same overall administrative structure.
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.
31	I think the fee-for-service physician model is a disincentive to collaboration. For example, it is a disincentive to meet with collaborators during billable office hours.
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.
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.
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.
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.
36	We need to have a better consciousness-raising about what collaborations might be possible and would be beneficial, and also reflect on the collaborations that we already have.
37	I think the issue of patient confidentiality and privacy is a huge area of concern when working in a collaboration.
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.
39	Mutual respect between primary care and public health sectors is not necessarily required for effective collaboration.
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.
41	There are turf protection issues. Public health wants to make sure that they don’t get swallowed up by primary care issues. They want to deal with issues at a population level as opposed to an individual health level.
42	The lack of communication between the various government agencies is obvious just from the large number of faxes that come through. So integration of high tech communication is in its infancy and needs to be improved.
43	What fosters collaboration at the organizational level is if we can keep it small to start.
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 o any kind of collaboration.