Study on pathways to improve the capacity for vertical collaboration of medical personnel in county-level medical alliances: an empirical exploration based on the CLFI collaboration model

Abstract

To explore the key factors affecting the vertical collaboration of county and township medical personnel within county-level medical alliances and the paths for improvement, in order to provide suggestions for enhancing the intrinsic motivation for collaboration among county and township medical personnel. Based on D’Amour’s organizational collaboration theory, the CLFI vertical collaboration theoretical framework was constructed. Following this framework, a questionnaire was designed and administered using random sampling within one county-level medical alliance in Fujian Province, achieving a valid response rate of 96.95%. Ten dimensions, including shared goals and patient-centered orientation, were regarded as antecedent conditions. Fuzzy-set qualitative comparative analysis was employed to extract the pathways for enhancing the vertical collaboration capacity of county and township medical personnel. There are eight different configuration combinations, which can be summarized into five capability enhancement paths, namely the policy-driven path, the functional synergy path, the service-oriented path, the innovation-driven path, and the relationship-building path. The consistency of the solutions for these five combinations of causal conditions reached 82.2%. Strategically, policy coordination should be strengthened; cognitive linkages should be enhanced; patient outcomes should be embedded throughout the processes of collaborative goal setting, process design, and performance evaluation; a tolerance and assessment mechanism should be established to provide pilot support and dynamic monitoring for collaborative innovation; mutual trust among county and township medical personnel should be solidified, along with the consolidation of professional division of labor and capacity support, to promote the medical community’s transition from spontaneous cooperation to conscious coordination, ultimately achieving improved quality and efficiency in primary healthcare service capabilities. Not applicable.

The authors' abstract, as published at the source. BMC Health Services Research, 2026 · DOI ↗