Collaboration between the public and private sectors in the realm of health and welfare is submitted to politically-driven, cognitive biases that give rise to prejudice and stereotypes.
Despite their good track record, public-private partnerships continue to cause ideological and political friction about the legitimacy of their providing public services.
"The discussion about public-private partnerships is still tethered to the classic dichotomy of public vs private which questions the legitimacy of public services being provided by public-private ventures," said Mónica Reig, associate director of EsadeGov.
According to this expert, the traditional approaches and misgivings between the two sectors are based on stereotypes.
"At times, the public authorities regard companies as rather unethical, corruptible and only interested in maximising profits, while private companies regard public authorities as bureaucratic, less effective and lacking in technical skills," said Reig. "These misgivings between the parties involved in public-private partnerships sometimes lead to poor coordination and management problems in joint projects."
Public-private alliances allow strategic cooperation between different sectors, acting as a complement to cultures, technical skills, resources and knowledge to create social value
In order to provide guidelines to help improve partnerships involving public and private agents, EsadeGov has published a report entitled The contribution to society made by public-private partnerships in health and social services. This publication produced by the EsadeGov PARTNERS Programme, the Institute for Healthcare Management and the association of health and social entities La Unió, is the combined effort of 27 academics, experts and professionals  in the public and private sectors.
"Public-private alliances allow strategic cooperation between different sectors, acting as a complement to cultures, technical skills, resources and knowledge to create social value," write the authors. The report analyses the specific case of public health in Catalonia, and outlines proposals on how public-private partnerships in the health and social sector could be improved.
Proposals to improve public-private partnerships
In response to current and future challenges, experts suggest that the following 10 proposals should be developed with a view to improving public governance and cooperation between the many agents in the public and private sectors.
1. Collaboration for dealing with social challenges
The UN Sustainable Development Goals are the new benchmark framework for dealing with the challenges posed by the transformation of public services. In modern societies, the public authorities, business world, civil society, scientific community and academia are working together to find solutions for common goals.
When proposing solutions for citizens' needs, it is essential to highlight the impact of these strategic public-private alliances to increase the social value that each agent contributes to achieving these solutions.
2. Involvement and empowerment of professionals
Healthcare management fosters a multidisciplinary form of collaboration aimed at providing health and social services based on professional responsibility.
The involvement of healthcare professionals in decision-taking and management by pooling values such as fairness, quality and sustainability has many advantages. It can:
- help improve patient care outcomes
- help reduce misgivings in this sector and among its professionals about projects run by public-private partnerships
- encourage innovation
- enable a medium- and long-term view of projects
3. Better governance
Public-private partnerships require transparent, neutral, strategic public procurement at the design stage and also during execution and evaluation.
It is essential to train the healthcare authorities for the governance of the system to implement effective public policies and ensure the provision of fair, quality services. The network that provides health and social services must be robust, inclusive and socially engaged, capable and managerially autonomous and firmly committed to assessment and accountability. It must not be discriminated against because of who is running it, and it must focus on achieving goals, contributing public value, social commitment and the public payback of economic development.
It is essential to train the healthcare authorities for the governance of the system to implement effective public policies
Inclusive governance enables a sustainable, hybrid system, avoids opportunism and has a multiplier effect on the knowledge and management culture of public and private entities and the network of professionals that comprise these entities.
4. Transformation of public-sector capabilities
A robust, modern public sector that champions good governance can drive a systemic culture shift and consolidate a result-oriented model.
It is essential to capacitate public institutions for the governance of public-private partnerships and drive a culture shift to rise to the challenges of this type of partnership.
Public-private partnerships require transformative, collaborative leadership in the public and private sectors to help create mutual trust and prioritise the general good.
Public-private partnerships require transformative, collaborative leadership
5. Common goals among the agents involved
Common goals are essential for the success of projects run by public-private partnerships. The public and private sectors have distinguishing traits so it is important for the agents involved to be able to put their specific goals forward in a clear, straightforward manner, and for them to be compatible with the common goal of the project.
Partnerships based on transparent, open communications enable goals to be shared between the agents and upheld while projects are being carried out.
6. Greater trust
The increasing need to inspire trust in the public sector as a promoter of public values, and in private companies as an agent that creates social value, is a core factor in the effective implementation of public-private partnerships.
A willingness to engage in a culture of collaboration based on trust and accept distinguishing traits can also help strengthen mutual understanding to improve services and overcome conflicts that may arise in the course of these partnerships.
7. Appreciation of citizens as taxpayers
Collaboration with civil society is an essential part of the public health system and is necessary for the success of public-private partnerships in the health and welfare sector.
These partnerships entail the definition of rights and responsibilities of the parties involved in the projects and, therefore, mean a greater degree of transparency and accountability to citizens.
Understanding citizens' attitudes to public-private partnerships and the factors that affect their viewpoints is essential to bring these projects into line with taxpayers' interests. Citizens do not only require public services to meet certain levels of efficiency and quality, they also want to be involved in the decisions about public policies.
8. Strengthen the private sector as a source of social and public value
The business sector has expressed its commitment to cooperating with the public sector on drawing up public welfare and healthcare policies. Therefore it is important to emphasise the potential advantages of the private sector and its ability to produce public value, not just financial profit, when dealing with social challenges.
It is imperative to shake off stereotypes about the public and private sectors
9. Break away from ideological dichotomy
The public and private sectors have different organisational environments, goals, values and approaches. It is precisely these differences that make these two agents complement each other in terms of knowledge, resources and skills.
The political debate about public-private partnerships is still hampered by the traditional stereotypes of public-sector red tape and inefficiency and private-sector profit maximisation. It is imperative to shake off these stereotypes about the public and private sectors, roll out the social and financial potential of these partnerships, commit to public-private partnerships that generate public value, and keep away from opportunists.
10. Advance the public-private partnership narrative
Communication has a huge impact on the public arena and is a basic tool for engaging all the agents involved and setting goals and expectations. It is necessary to highlight the value of the public sector's participation in the governance of these projects and the private sector's ability to contribute value to the community in order to enhance the current debate.
Against this backdrop, the UN sustainable development goals may offer an opportunity to move beyond the futile debate about the dichotomy between the public and private sectors and contemplate the need for inter-organisational partnerships able to make a contribution to society.
 The following persons took part in the discussion and helped write the report by pooling their knowledge:
- Artur Arqués, director general, Càtering Arcasa, SL
- Manel Balcells, president of the Department of Health advisory board, Generalitat de Catalunya
- Carles Campuzano, director, Dincat
- Àngels Cobo, director general, SUARA
- Manuel del Castillo, director, Hospital Sant Joan de Déu
- Alex Fabra, partner at Everis
- Roser Fernández, director general, La Unió
- Josep Ganduxé, board member, Cercle de Salut
- Francisco Longo, director, EsadeGov
- Enric Mangas, president, board of directors, La Unió
- Ramon Massaguer, 2nd vice president, board of directors, La Unió
- Josep Martí, director, Forwards
- Xavier Mate, regional director, Quirónsalud
- Jordi Mercader, vice president and director general, Miquel y Costas & Miquel
- Carles Mundó, lawyer and partner at Bufet Vallbé
- Olga Pané, director, Mar Parc de Salut de Barcelona consortium
- Manel Peiró, director, Institute for Healthcare Management, EsadeGov
- Àngel Pes, deputy director general, Fundación Bancaria “La Caixa”
- Esteve Picola, board member, La Unió
- Mònica Reig, director, Partners Programme, EsadeGov
- José Luis Roselló, operations director general, DOMUSVI
- Albert Salazar, managing director, Hospital de la Santa Creu i Sant Pau
- Jaume Sellarès, vice president, Col.legi Oficial de Metges de Barcelona
- Josep Tabernero, director, Instituto de Oncología de la Vall d’Hebrón
- Núria Terribas, director, Fundación Víctor Grífols y Lucas
- Manel Valls, director general, Fundació Sant Andreu Salut
- Xavier Viñolas, head of the Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau
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