Relational Coordination in Providing Holistic Care for People with Disabilities Living in for-Profit Residential Homes

Background: the global trend of market-oriented reforms in the welfare sector has made greater private-sector participation a popular policy agenda in organizing social services. In Hong Kong, for-profit residential care homes for disabled people have become a major component of the residential disability service sector in recent decades and were expected to maximize consumer choice and the cost-effectiveness of public spending. However, low quality of care has been a longstanding concern. These facilities were once named as “hell on earth” by commentators, even with many regulatory and monitoring measures in place. In 2019, after years of advocacy, a pilot project, Professional Outreaching Team for residential care homes for persons with disabilities (POT), was launched. It is subsidized by the government and operated by not-for-profit organizations, with the aim to collaborate with for-profit operators to accommodate the multi-faceted needs of their residents. Despite this new emphasis on collaboration, power dynamics between different sectors are often complex and intense. Would POT practitioners be seen as “spies” from the government? How does this public-private collaboration work? How is the effectiveness of this project? While the recent decades have witnessed an exponential increase of research in exploring the coordination work in health and social services, rare attention has been given to cross-sectoral collaboration involving for-profit providers.

Methods: this study employed mixed methods to explore the effectiveness of the pilot project and the dynamic coordinated work process involving different sectors and stakeholders. Periodic assessment records of 330 service users were examined, 23 service users (randomly selected from the more ‘successful’ and less ‘successful’ group) were interviewed and four focus groups (service users, family members, for-profit operators and POT staff) were conducted during 2021-2022.

Findings: examination of service records and service user interviews showed significant improvements in the quality of life, psychological and physical health of the residents. Data analyses of interviews and focus groups indicate the importance of relational coordination to the success of the pilot. We found that this coordination relied on the active, flexible interactions among different stakeholders rather than establishing communication mechanisms. Trust building was paramount to engaging for-profit providers, who were positioned not only as potential partners, referrers but also service targets. Knowledge sharing for for-profit operators contributed to aligning performance across public and private services. Further, facilitating multiparty communications (e.g., user-operator, family-operator, user-family, operator-government) bridged interests of different stakeholders, reduced conflicts and hostility, and promoted shared goals. This was a complex process involving persistent efforts and carefully planned strategies.

Implications: for professions including social work, care coordination is often a key part of our work. The study offers fresh insights and practical wisdoms for coordinating for-profit providers in delivering holistic care for disabled people, illustrating how a focus on collaboration and empowerment rather than regulation and supervision can be realized in a complex web of relationships. It contributes to a better understanding of our role in shaping greater and effective public-private collaboration.