Governance for health system collaboration: The case of the South-West Queensland Primary Care Alliance, Queensland, Australia.
Authors: Nicholson Caroline , Jackson Claire , Brown Anthony , Gillies Sandy , Gauld Robin 
Published: January 2024

Background: Internationally, as countries orientate health systems to embrace an integrated, person-centered approach it demands a fundamental shift in the way health services are funded, managed and delivered. Requisite to meeting these challenges given the involvement of multiple organisations, and therefore varying governance arrangements, is strengthening of shared governance with clear and transparent accountability mechanisms, across the health system where initiatives to better integrate care are being implemented.  Governance models to achieve this have been attempted in several countries. The best fit for the Australian system is likely to be the Alliance contracting approach.

The Alliancing concept was derived from the construction industry, where different organisations work collaboratively to ensure achievement of common goal, to complete a project successfully, on time and within budget. They help one another and, where relevant, share resources. Alliance governance is the set of rules which govern an Alliance. At their core, they are centered around governance that ensures the building of collaboration and a ‘whole of system’ approach to service planning and delivery. This is different and challenging and calls on members to focus primarily on their community rather their individual circumstances / organisations.

Target audience: Policy makers, health system executives, funders, researchers.

Alliance Partners: Western Queensland Primary Health Network, South West Hospital & Health Services, Health Workforce Queensland, Charleville & Western Areas Aboriginal & Torres Strait Islander Community Health, Royal Flying Doctor Service, private general practices, and CheckUP.

What we did: Thematic analysis of a previous SW partnership project, against evidence-based health governance elements for integrated care, to distil learning for the SW Primary Care 5-year plan and conducted a rapid review to identify further evidence base for the alliance governance model in health. This evidence was incorporated into a stakeholder workshop to advise implementation.

Results/impact: Using an evidence-based governance framework for integrated care, the South-West Primary Care Alliance was developed. An Alliance Charter, outlining the rules of engagement and commitments, has been passed.  A governance framework agreed and an implementation plan adopted.

Learning for international audience: More recent Australian reform documents identify the importance of a regional approach in bringing together all sources of health funding into one coordinated local service delivery approach. In particular, the ongoing difficulty in aligning Australia’s fragmented Commonwealth and State health systems, mean that for our health system this is the most critical reform step. This is more ambitious than co-commissioning or bilateral project-focused funding. It includes all relevant service delivery organisations making formal governance commitments to work together over time in addressing key areas of service gap or duplication.

Next steps: Three work programs have been identified by the Alliance Leadership Team for implementation 2023-2025. The first of these, workforce, has an implementation plan set for 2023. As part of the implementation the barriers and critical success factors to implementing and sustaining this model of care will be investigated.