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

• Published date: 01 September 2014
• Author: Ron Aldrich
• Date: 01 September 2014
• DOI: http://doi.org/10.1111/puar.12232

Commentary

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.

E-mail: limberpine@aol.com

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-

countynm.gov/userf‌i 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