Cross-sector collaboration in transitional care of people experiencing homelessness: insights from an exploratory network analysis

Interprofessional care coordinators informally collaborate across sectors to facilitate care of patients with multimorbidity and social complexity, such as in the case of ill-housed persons at hospital discharge. The complexity of homeless patients demands research on cross-sector collaborative interventions like medical respite, a cross-sector transitional care model. Relational Coordination (RC) and exploratory social network analysis were used to assess the cross-sector collaboration of a medical respite network (N = 15 organizations), by comparing administrative (n = 20) and frontline care coordinator (n = 41) behavior. Five elements of cross-sector collaboration were measured: collaboration frequency, communication, relationships, coordinating mechanisms, and role attributes. Data were collected by semi-structured interviews and surveys; analyzed with UCINet and RC indexing. Collaboration across sectors was evident in all network organizations. Administrative representatives were more connected than frontline (cohesion 0.95; 0.77). Both showed weak RC scores (<3.5 out of 5.0), value on accurate communication, problem-solving communication, and shared goals. Organizations with coordinating mechanisms (shared meetings, contracts, etc.) showed higher centrality and RC scores. Our study suggests ties between administrative and frontline workers and coordinating mechanisms optimize cross-sector collaboration in interprofessional teams. Intraorganizational behavioral differences between administrators and frontline care coordination professionals denote the need for further research individual provider attribute (sector, role, education, licensure) impact.