Initial program theory 2
| Strategy | Context | Mechanism | Outcome | |
|---|---|---|---|---|
| GMI | The overarching GM governance level organized single leadership – management structures on the locality level underpinned by MoU | Power was delegated along layered governance structure which set out organizations' roles and responsibilities | Leaders understood their roles and due to the delegation of power, felt joint ownership for setting budgets | Supposed to ensure money shifted more easily across the system to address regional needs |
| VHCSII | The City organized a layered governance structure underpinned by MoU | The City and Health Authority set VHCS goals-targets, with Leadership Table's buy-in, but no alignment across City departments | Differences in departments' views triggered differences in ownership and interests | Departments' budgets and work-planning were not integrated, which negatively influenced sense of shared responsibility |
| Table unclear about roles and functions | Uncertainty prevented shared sense of ownership | Need for accountability framework | ||
| GEN-HIII | Implemented convener | Convener used delegated power and role to organize regional responsibility by examining, together with 80 leaders, what evidence-based strategies achieve long-term TA* outcomes | To counter each organization having its own set of goals and priorities, they felt shared ownership was necessary | Consensus regarding regional responsibility for GEN-H strategy |
| GKIIII | Organized an integrator role | Convener kept insurance companies outside the network and took intermediary role between providers and payers | Enabled convener to get physicians to think at a more strategic level about population health needs | Physicians took regional accountability for population health needs not just costs |
| Convener brought operational, management, financial expertise |
| Strategy | Context | Mechanism | Outcome | |
|---|---|---|---|---|
| GMI | The overarching GM governance level organized single leadership – management structures on the locality level underpinned by MoU | Power was delegated along layered governance structure which set out organizations' roles and responsibilities | Leaders understood their roles and due to the delegation of power, felt joint ownership for setting budgets | Supposed to ensure money shifted more easily across the system to address regional needs |
| VHCSII | The City organized a layered governance structure underpinned by MoU | The City and Health Authority set VHCS goals-targets, with Leadership Table's buy-in, but no alignment across City departments | Differences in departments' views triggered differences in ownership and interests | Departments' budgets and work-planning were not integrated, which negatively influenced sense of shared responsibility |
| Table unclear about roles and functions | Uncertainty prevented shared sense of ownership | Need for accountability framework | ||
| GEN-HIII | Implemented convener | Convener used delegated power and role to organize regional responsibility by examining, together with 80 leaders, what evidence-based strategies achieve long-term TA* outcomes | To counter each organization having its own set of goals and priorities, they felt shared ownership was necessary | Consensus regarding regional responsibility for GEN-H strategy |
| GKIIII | Organized an integrator role | Convener kept insurance companies outside the network and took intermediary role between providers and payers | Enabled convener to get physicians to think at a more strategic level about population health needs | Physicians took regional accountability for population health needs not just costs |
| Convener brought operational, management, financial expertise |
Note(s): Create shared ownership for achieving the initiative's goals. IGM: Greater Manchester; IIVHCS: Vancouver Healthy City Strategy; IIIGEN-H: Generation Health; IIIIGK: Gesundes Kinzigtal; *TA: Triple Aim