title: Collaboration: developing integration in multi-purpose  services in rural New South Wales, Australia.
abstract: BACKGROUND
  The Multi-purpose Service (MPS) Program was introduced to rural Australia in 1991 as a solution to poor health outcomes in rural compared with metropolitan populations, difficulty in attracting healthcare staff and a lack of viability and range of health services in rural areas. The aim of this study was to describe the main concerns of participants involved in the development of multi-purpose services in rural New South Wales (NSW). This article is abstracted from a larger study and discusses the extent to which collaboration occurred within the new multi-purpose service.
  
  
  METHODS
  A constructivist grounded theory methodology was used. Participants were from 13 multi-purpose services in rural NSW and 30 in-depth interviews were conducted with 6 community members, 11 managers and 13 staff members who had been involved in the process of developing a multi-purpose service.
  
  
  RESULTS
  The main concern of all participants was their anticipation of risk. This anticipation of risk manifested itself in either trust or suspicion and explained their progression through a phase of collaborating. Participants who had trust in other stakeholders were more likely to embrace an integrated health service identity. Those participants, who were suspicious that they would lose status or power, maintained that the previous hospital services provided a better health service and described a coexistence of services within the multi-purpose service.
  
  
  CONCLUSIONS
  This study provided an insight into the perceptions of community members, staff members and managers involved in the process of developing a multi-purpose service. It revealed that the anticipation of risk was intrinsic to a process of changing from a traditional hospital service to collaborating in a new model of health care provided at a multi-purpose service.
authors.affiliation: School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Bathurst, New South Wales, Australia. juanderson@csu.edu.au
authors.forename: Judith K
authors.initials: JK
authors.lastname: Anderson
authors.forename: Ann
authors.initials: A
authors.lastname: Bonner
authors.forename: John
authors.initials: J
authors.lastname: Grootjans
mesh_terms: D001291:Attitude of Health Personnel; D003256:Community Participation; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration*; D009517:New South Wales; D019035:Rural Health Services / Q000458:organization & administration*