Commentary: Trust Is Key to Collaboration in Managed Care Health Service Delivery Networks

Published date01 September 2014
Date01 September 2014
Ron Aldrich is a health care leader
with 48 years of experience in health care
governance, administration, and education
in all regions of the United States, including
25 years of chief executive off‌i cer experi-
ence. Ron has also served on the boards
of six health systems, three universities
or colleges, and multiple regional, state
and national health associations. Former
board chair of Christus St. Vincent Regional
Medical Center in Santa Fe, New Mexico,
he also chaired the Community Health &
Wellness Committee, which led the 2013
Community Health Prof‌i le.
Trust Is Key to Collaboration in Managed Care Health Service Delivery Networks 599
Public Administration Review,
Vol. 74, Iss. 5, pp. 599–600. © 2014 by
The American Society for Public Administration.
DOI: 10.1111/puar.12232.
Ron Aldrich
Limberpine Associates, Inc.
“Knowledge Sharing in a  ird-Party-Governed
Health and Human Services Network” by Kun Huang
draws much-needed attention to the crucial role of
formal and informal relationships between and among
networked service providers in the dissemination and
implementation of evidence-based service innovations.
In these times of intensive knowledge expansion and
mounting pressures to contain service costs through
managed care, the article also examines the inf‌l uence
of a network administrative organization (NAO) in
fostering the willingness of provider agencies to share
competitively sensitive information, best practices,
and strategic opportunities.
While Huang’s article empirically analyzes these fac-
tors in a statewide delivery network managed by a for-
prof‌i t NAO that does not provide health and human
services, my 48 years of health care experience as chief
executive of‌f‌i cer and board member of several national
and regional health care organizations correlates with
the article’s observations and conclusions. As Huang
correctly notes, “It is important to recognize that
interorganizational relationships are enacted by agency
leaders or key staf‌f members.  eir positive or nega-
tive interpersonal relationships could either facilitate
or hinder collaboration.  us, collaborations are both
interorganizational and interpersonal.”
Of course, the quality of interorganizational and
interpersonal relationships directly af‌f ects successful
outcomes in all kinds of networks and multifaceted
organizations, but it is particularly signif‌i cant for
community health care organizations seeking to serve
the widely varying health needs of diverse populations
within a context of shrinking f‌i nancial resources.  e
key success factors in strong network relationships are
frequent communication (both structural and social),
collaboration, and cooperation—all of which are
grounded in and facilitated by trust.
ere is only one way to engender, nurture, and
sustain trust: by being trustworthy. Paraphrasing other
researchers, Huang asserts, “Interorganizational trust
refers to a common expectation among the mem-
bers of an organization that another organization’s
members will act in accordance with any explicit or
implicit commitments between the two organiza-
tions.  us, the extent to which an organization can
be trusted, or trustworthiness, is determined by its
perceived fulf‌i llment of commitment by the leader or
key staf‌f members of a partner organization.”
Trust is the essential prerequisite for authentic collabo-
ration, which is distinct from compelled or coerced
collaboration. Moreover, to maximize information
exchange, creative thinking, and innovative solutions,
authentic collaboration also requires the participation
and input of diverse interests, viewpoints, experiences,
motivations, and agendas. With a rich diversity of
backgrounds and perspectives, trust-based collabora-
tion is typically synergistic, often producing astute
insights and unexpected opportunities that otherwise
may have remained undiscovered.
A case in point is the 2013 Community Health
Prof‌i le for Santa Fe County, New Mexico, which
was jointly sponsored by the Christus St. Vincent
Regional Medical Center’s Community Health and
Wellness Committee, Santa Fe County Community
Services Division, and Santa Fe County Health Policy
and Planning Commission (see http://www.santafe-‌i les/HealthStatusProf‌i le6-2-2013.
pdf).  is comprehensive health needs assessment was
derived in part from public documents and in part
from the input of health care providers, policy and
resource allocation decision makers, and the general
public. With the benef‌i t of extensive community
relationship building, trust-based collaboration was
initiated at the inception of the study and continues
into the decision making and implementation stages.
As the authors of that prof‌i le observed, “Santa Fe
County faces serious health and health care challenges.
… Some health problems may not be ‘solvable’ at the
community level, but progress can be made in reduc-
ing the prevalence and detrimental impact of virtually
Trust Is Key to Collaboration in Managed Care Health
Service Delivery Networks

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