Linking Collaboration Dynamics and Outcomes in Collaborative Governance

Abstract

A person’s health is mostly attributable to social factors like public policies, education, access to affordable housing, and social norms. This means that health clinics, hospitals, public health departments, and managed care plans cannot by themselves create and maintain healthy communities. Instead, they must work across boundaries by partnering with community-based organizations, schools, businesses, government agencies, and tribal nations to create community health systems that address the whole person needs of the populations served. Yet cross-boundary collaboration is complex, challenging, and not well understood. Little is known about how to best structure collaborative processes—or collaboration dynamics—to increase the chances of achieving collective outcomes like improved health equity. This dissertation aims to illuminate the murky pathways of collaboration dynamics using concurrent mixed methods and the integrative framework for collaborative governance to investigate how and why collaboration dynamics influence the outcomes of positive systems change, improved equity, and collaborative sustainability. The study population includes 22 ACHs in California and Washington and uses data drawn from surveys (n = 596), interviews (n = 85), focus groups (n = 6), meeting observations (n = 12), documents (n = 1,796), websites, and secondary data sources. Quantitative data were analyzed using structural equation modeling. Qualitative data were analyzed using theory-testing process tracing. Results show that specific collaboration dynamics can be leveraged to improve different outcomes. Specifically, findings suggest that systems change is positively influenced by the vision definition element of principled engagement, the mutual understanding element of shared motivation, and the knowledge and procedural and institutional arrangements elements of capacity for joint action; improved equity is positively influenced by the diverse inclusion element of principled engagement and the trust element of shared motivation; and sustainability is positively influenced by the data and procedural and institutional arrangements elements of capacity for joint action. Furthermore, process tracing shows how collaboration dynamics interact to produce causal chains leading to collaborative outcomes. Research findings present implications for collaborative governance theory and practice, since they pinpoint specific dynamics that can be leveraged to influence the CGR outcomes of positive systems change, improved equity, and collaborative sustainability.