Elements for health-related cross-sector collaborations: a modified Delphi study in the Netherlands

Background

Cross-sector collaboration (CSC) is widely regarded as a key strategy in improving public health outcomes. Previous literature addressed various key collaboration conditions; however, a practitioner driven consensus on what is considered essential for achieving collective impact on public health by the staff working in the CSC is lacking. The aim of this study is to establish a set of practitioner-driven elements for achieving collective impact in health-related CSCs.

Methods

A four-round modified Delphi study was conducted with 29 participants from 17 health‑related CSCs in the Netherlands. The elements identified in the semi‑structured interviews in round 1 were rated in rounds 2–3, and ranked in round 4. The overall ranking indicated relative importance of the elements and Kendall’s W coefficient of concordance was used to quantify agreement. A Wilcoxon signed-rank test with Benjamini-Hochberg (BH) correction was used to estimate response stability across rounds 2 and 3.

Results

This study identified 99 elements (round 1) of which 33 were found of most importance (round 3). Examples of elements are ‘align implementation with the needs of the target group, ‘build trust between partners’ or ‘evaluate the overall achievement of the CSC’. The test for agreement resulted in p-values from 0.397 to 1, meaning that ratings were stable across rounds 2 and 3. This study did not find a clear overall ranking of the 33 elements (Kendall’s W of 0.11, round 4).

Conclusions

This study identified 33 elements that are important for achieving collective impact in health-related CSCs. As there is no clear overall ranking, all these elements are deemed important. Given the complexity of CSCs, it is advisable to incorporate all 33 items of the list when monitoring a CSC.

Key messages

• Cross-sector collaboration is a key strategy in improving public health outcomes. We identified 33 elements for achieving collective impact in cross-sector collaborations that can be monitored.

• There was no agreement by the participants on a further ranking of the identified elements, indicating all were considered essential.