Commentary: human service delivery and interorganizational relationships.
Subject: Interorganizational relations (Management)
Human services (Management)
Health care industry (Management)
Health care industry (Services)
Author: Leslie, Reuben
Pub Date: 06/22/2012
Publication: Name: Journal of Health and Human Services Administration Publisher: Southern Public Administration Education Foundation, Inc. Audience: Academic Format: Magazine/Journal Subject: Government; Health Copyright: COPYRIGHT 2012 Southern Public Administration Education Foundation, Inc. ISSN: 1079-3739
Issue: Date: Summer, 2012 Source Volume: 35 Source Issue: 1
Topic: Event Code: 200 Management dynamics; 360 Services information Computer Subject: Health care industry; Company business management
Product: SIC Code: 8000 HEALTH SERVICES
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 304051550
Full Text: The article on interorganizational relationships in a multi-tier human service delivery system focuses on differences in relationships at the service and administrative levels, and the author concludes: "organizations involved in direct service delivery form more collaborative relationships." From my experience, this finding is not surprising and provides a useful starting point for more complex discussion of the many issues related to interorganizational collaboration, including differing roles, capacities, communication channels and levels of control. Although the author discusses funding levels, it also would be interesting to know whether results differ significantly by amount or percentage of grant funding. Of interest for future research, addressing questions such as "What about individuals' and organizations' staff tenure and prior experiences or the size, sophistication, level of support, and the level and types of competition the organizations faced?" would also improve our ability to manage and lead interorganizational arrangements.

As mentioned by the author, future research about efficiencies, multiple relationships, networks, management, and intermediary organizations would further our understanding of the rich complexities and dynamics of interorganizational relationships. Regarding the main finding of more collaboration at the service delivery than the administrative level, practitioners likely would be interested in understanding whether different levels' different roles require a different character and intensity of relationships. An additional question of practitioner interest might include whether state or federal governmental agencies can work in all regions without intermediaries, that is, why would local or regional governmental entities not be equally suitable in capability and scale? Clearly, as the author discusses, how one sees a problem depends on where one sits within the system.

The conclusion states well why multi-sector collaboration is needed in health and human services and the challenges that collaborators face at all levels in such complex systems, noting that "public accountability and effective service delivery can be at odds." But in practice, both are necessary at all levels at all times with or without devolution. The service delivery system, whether designed or not and whether its problems are chosen or not, already exists and operates. The article offers a " ... framework for dealing with the issues of public accountability and effective locally driven service provision." Practitioners engaged in interorganizational relationship building must emphasize their attention to furthering peer-to-peer interorganizational and intra-organizational relationships. Teams of individuals and organizations involve shared and common patterns that can be managed with effective planning and communication. Teambuilding and team management are at least as important as team members' relationships with the leader and both types take time and effort to build trust and good performance. Building such relationships in interorganizational networks adds additional complexity. In addition to the works cited in the article, readers may want to consult two resources for practical guidance in improving multi-sector collaboration:

* The New Community Collaboration Manual by the National Assembly of National Voluntary Health and Social Welfare Organizations, 1997, which focuses on and provides guidance on shared vision, skilled-leadership, process orientation, cultural diversity, member driven agenda, multiple sectors, and accountability, and

* The Three Pillars of Public Management: Secrets of Sustained Success, Ole Ingstrup and Paul Crookall, 1998, which outlines teamwork and communications essential to effectiveness.


Texas Health and Human Services Commission

Reuben Leslie is a Senior Rate Analyst for Medicaid Acute Care in the Texas Health and Human Services Commission. He has managed and coordinated interorganizational collaboration projects and programs for local and statewide health and human services, serving as contract manager, evaluator, program manager, program specialist, management analyst, management trainer, and director of resource management.
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