# Which Inter-Organisational Characteristics Supported More Effective Implementation of a New Zealand Falls and Fractures Prevention Programme? Applying and Adapting the Context and Capabilities for Integrated Care Framework

## TL;DR

This study explores why a falls and fractures prevention program worked better in some areas of New Zealand by examining organizational and collaborative factors.

## Contribution

The study adapts the CCIC framework by adding prior collaboration experience and a life-cycle approach to better explain program implementation.

## Key findings

- Five key factors influenced the success of the FFPP: governance, leadership, collaboration, prior experience, and population-based approaches.
- The CCIC framework was enhanced to include temporal and historical collaboration dimensions.
- Qualitative analysis revealed how organizational dynamics affect integrated care outcomes.

## Abstract

Why do integrated care programmes succeed in some settings but not others, even when national leadership and funding are aligned? This persistent question shaped our examination of the New Zealand Falls and Fracture Prevention Programme (FFPP), a complex, cross-sector initiative targeting older adults. We applied and extended the Context and Capabilities for Integrating Care (CCIC) framework to explore how organisational and inter-organisational factors contributed to variation in implementation and outcomes.

We conducted a qualitative comparative case study of four large districts with differences in FFPP implementation including 28 semi-structured interviews. Thematic analysis was primarily deductive, using the CCIC framework, but remained open to emergent, context-specific themes.

We identified 43 organisational and implementation factors, of which five had a particularly important effect on FFPP implementation and outcomes: a well-structured governance team, collaborative leadership, engagement with primary care and private organisations, positive prior collaboration experience, and applying a population-based approach. We modified the CCIC framework to more fully reflect our observations by adding prior collaboration experience and a life-cycle approach (from pre-engagement to establishment).

The CCIC framework captured most key organisational dynamics but was enhanced by incorporating temporal and historical dimensions of collaboration.