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You are here: Home Symposium From Rhetoric to Reality: Premises and Principles in Vertical/Horizontal Integration for Multiple Intervention Programs
From Rhetoric to Reality: Premises and Principles in Vertical/Horizontal Integration for Multiple Intervention Programs Print E-mail

Group Discussions

During the afternoon of Day 1, symposium participants were given the opportunity to discuss premises and develop principles related to vertical and horizontal integration. Participants selected one of four premises to work on in small discussion groups. Based on the group’s premise, each was asked to develop principles for a draft resolution that would be suitable for adoption at, for example, a Canadian Public Health Association Conference.

The following table summarizes key comments from these group discussions.

 

PREMISE

KEY COMMENTS and PRINCIPLES

PREMISE:
Distinct and potentially competing goals and accountabilities and structural "silos" and "tunnels" that inhibit communication and trust among sectors and levels inhibit integration and constrain the design and evaluation of multiple intervention programs.

NEW WORDING OF THE PREMISE was suggested:
“Distinct and potentially competing goals and separate accountabilities and funding structural silos and tunnels that inhibit communication, interaction, and joint planning among sectors and levels inhibit integration.”
DISCUSSION COMMENTS:

  • Re premise, ‘trust’ is a loaded word
  • Competing goals/different accountabilities
  • Structure of public health: funded by 3 ministries; accountability separate; diverse Interests; and lack of synergy
  • Funding structures
  • Leadership hubs (illustration from program of research funded by International Development Research Centre and led by Edwards, Kaseje and Kawa): structure that can be put in place to mitigate funding structure; formal process/structure; to break down silo issues and get people talking; engage public health practitioners at a local level
  • Example of multi-sectoral intervention: LHINs- Falls Prevention:
    • LHIN funding has led health units to collaborate with each other and other community partners (community funding lever)
    • LHINs have no jurisdiction over public health
    • Project meets needs of all partners
    • Common goals project established

PRINCIPLE should include:

  • Translation process
  • Levers for collaboration
  • Common goals
  • Set up formal structures (organic)
  • Establish same language
  • Common understanding
  • Develop strategies to better understand context and meaning around solution

PREMISE:
Input from the full range of affected parties is necessary and forms the basis for synergies in integrated program development.

PRINCIPLES:
Be it resolved that:

  • Priority will be given to community driven and governed approaches; these need to be used, applied, and investigated.
  • Affected parties, including service providers, community stakeholders, decision makers, researchers, policy makers, and politicians need to be identified and need to be invited/ encouraged/ supported/ accommodated/ engaged/ acknowledged.
  • Research needs to include the full range of affected parties in its activities and planning (audience-researchers).
  • Shared leadership and decision making with jointly-established parameters for decision making.

CLARIFICATION COMMENTS:

  • Representation must reflect population heterogeneity (as appropriate to the issue and size of planning group).
  • Adequate resources (time, money, space, and staff) need to be allocated for full implementation of these principles.

PREMISE:
Inequities in power and status, and lack of political will and/or executive buy-in lead naturally to unbalanced participation in integration efforts.

DISCUSSION COMMENTS:

  • Government perspective; strategies and frameworks; enable programs and legislation
  • How do voices move up?
  • Whose agenda is put forward?
  • What is the role of advocacy groups?
  • Executive buy-in: To a balanced perspective? Whose political will?
  • Strategies change

PRINCIPLES:

  • Unbalanced participation* and integration efforts are fostered/promoted by inequalities in power and status.

*Participants: those who are most effective by inequities

  • Balanced participation requires the following:

Be it resolved that:

  • Participatory processes to engage those most affected by inequities be adopted (equity impact, equity analysis homework, resource enablers? reimbursement?).
  • Participatory processes require new roles and appropriate (e.g., employment, and engagement) and respectful compensation.
  • Participatory processes must be incorporated in our program planning, delivery, policy development, and research.
  • Decision-making structure must be based on a power-sharing model.
  • Environment must be culturally sensitive, safe, and respectful.
  • Accessibility, timing, and location are important.
  • Meaningful engagement is required.

PREMISE:
Different research, evaluation and knowledge translation practices across sectors create challenges in the integration of existing research findings from different disciplines and the development of program monitoring and evaluation functions for intersectoral programs.

DISCUSSION COMMENTS:

  • There are differences in language across sectors, disciplines, and system levels.
  • There must be respect/understanding for different disciplines, methods, diversity, processes, and values.
    • Can’t assume understanding of your “language.”
    • Requires resources/infrastructure to understand our own and others’ interpretations.
    • Early engagement and an ongoing process – a true KT model is needed.
    • Knowledge translation requires cultivating multilingual capacity and critical thinking.
  • Social construction of knowledge is not a shared standpoint.
  • Engagement is necessary.
  • Teach differences/similarities across disciplines; develop elements of a common language.
  • Disengagement is a challenge.
  • Different players have different success indicators and priorities.
  • Synthesizing quantitative/qualitative research is critical.
  • How to integrate different types of indicators.

What PRINCIPLES should guide us?

  • Respect and honour diversity education/training about processes for working across disciplines.
  • Education institutions, professional associations.
  • Building consensus about language, meanings, approaches.
  • Infrastructure for engagement (especially time).
  • Each partner values the collaboration process.

Overall, the groups varied substantially in what they chose to work on and the extent of formulating principles for draft resolutions. This is perhaps somewhat reflective of the challenges facing policy development, research, and implementation of vertical and horizontal integration in multiple intervention programs.