Aligning health care and social services for patients with complex needs: The multiple roles of interorganizational relationships

Leading health care institutions have recommended greater alignment among health care and social services organizations as a strategy to improve population health. Deepening our understanding of how interorganizational relationships among health care and social service organizations influence care for people with complex needs could improve the design of interventions aimed at aligning these organizations to achieve health goals. Accordingly, we used qualitative methods to (1) elucidate the functions performed by health care and social service organizations caring for older adults and (2) investigate corresponding relationship forms. In-depth interviews with 175 representatives of health care and social service organizations in 10 communities were analyzed. Three distinct interorganizational relationships functions emerged: First, interorganizational relationships gave organizations a deeper and more accurate understanding of how their work was interdependent with the work of other organizations in the community. This function was achieved through coalitions that loosely tied large numbers of organizations and allowed information to flow among them. Second, interorganizational relationships allowed organizations to take joint action toward a shared goal, a function achieved in the form of pairs or small groups of organizations working closely together. Third, interorganizational relationships fostered accountability, with one organization advocating for the needs of clients or patients with another organization. Our results suggest that initiatives to promote regional alignment among health care and social services organizations may benefit from flexible models that anticipate a narrowing of partners to achieve tangible outcomes. Initiatives also need to accommodate low-level conflict that routinely exists among organizations in these sectors.